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CC BY 4.0 · Ibnosina Journal of Medicine and Biomedical Sciences
DOI: 10.1055/s-0045-1812290
Case Report

Circadian Rhythm Disruption Presenting as Adrenal Insufficiency: Diagnostic Challenges and Clinical Implications

Authors

  • Shamma Alshamsi

    1   Division of Endocrinology, Department of Medicine, Tawam Hospital, Shaikh Tahnoon Medical City, SEHA, United Arab Emirates

  • Bachar Afandi

    1   Division of Endocrinology, Department of Medicine, Tawam Hospital, Shaikh Tahnoon Medical City, SEHA, United Arab Emirates
    2   Faculty of Medicine and Health Sciences (FMHS), United Arab Emirates (UAE) University, Al Ain, United Arab Emirates

Funding and Sponsorship None.
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Abstract

We describe the case of a 24-year-old woman with persistently low early morning cortisol levels and an initial adrenocorticotropic hormone stimulation test demonstrating a preserved cortisol response, raising concern for possible secondary adrenal insufficiency. Pituitary imaging and laboratory evaluation revealed a nonfunctioning pituitary microincidentaloma. Subsequent testing demonstrated higher serum cortisol levels later in the day. Further history revealed a longstanding delayed sleep phase, and serial cortisol testing suggested a shifted diurnal rhythm. This case highlights the importance of interpreting cortisol results in the context of clinical presentation, behavioral patterns, and circadian timing and raises awareness of the emerging concept of circadian misalignment impacting endocrine evaluation.

Keywords

low morning cortisol - ACTH stimulation test - secondary adrenal insufficiency - pituitary microadenoma - circadian misalignment - HPA axis - hypothalamus pituitary axis

Authors' Contributions

S.A.: Conceptualization, data collection, manuscript writing, and submission.

B.A.: Clinical supervision, manuscript review, and editing.


Patient's Consent

The authors confirm that they have due consent from the patient on the basis of totally anonymous publication and that all efforts will be made to hide the identity of the patient.


Compliance with Ethical Principles

No prior ethical approval is required for single case reports and small case series.




Publication History

Article published online:
10 October 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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