Cortisol PM · high result
What does a high Cortisol PM mean?
Short answer
Cortisol should be at its lowest late in the evening, so a PM value that fails to fall raises the question of Cushing's syndrome, where the daily rhythm is lost. Far more often it is high because of shift work, stress, illness, poor sleep, alcohol, oral estrogens, or a draw taken too early. Late-night salivary cortisol and a dexamethasone suppression test confirm or exclude it.
Medically reviewed by Youmna DiStefano, MD · Last reviewed September 2026
What is the normal range for Cortisol PM?
- age 18+, drawn 4–6 PM: 2.30 – 11.9 mcg/dL
Full reference table, citations and testing options: Cortisol PM biomarker page.
What are the common causes of high Cortisol PM?
- Acute stress, illness, pain, poor sleep or recent night shifts (rhythm shifted, not lost)
- Oral estrogens or pregnancy (raised binding protein, total cortisol high, free normal)
- Alcohol, depression, obesity, uncontrolled diabetes (pseudo-Cushing's)
- Cushing's syndrome: pituitary adenoma, adrenal tumor, ectopic ACTH, or high-dose steroid medication
- Draw before ~10 pm or after caffeine or exercise
What symptoms go with high Cortisol PM?
- Weight gain around the trunk and face, thin skin and easy bruising, purple stretch marks, muscle weakness, high blood pressure and glucose (Cushing's)
- Often none when the cause is stress or timing
What do clinicians usually check next?
- Repeat properly: seated, rested, 11 pm–midnight; or a late-night salivary cortisol on two nights
- 1 mg overnight dexamethasone suppression test or 24-hour urine free cortisol
- Medication review for steroid exposure (creams, inhalers, injections count)
- Endocrinology referral if two screening tests are abnormal
Follow-up tests available at TestWell: Cortisol ($32.99).
How do you recheck Cortisol PM?
Prices are cash-pay; every order adds one $6 lab processing fee. Physician authorization is included; no insurance or referral needed.
| Test or panel | Type | Price | Fasting | Results |
|---|---|---|---|---|
| Men's Hormone Panel | Panel · 7 tests | $199.99 | No | 3–5 business days |
| Metabolism & Weight Loss Panel | Panel · 8 tests | $119.99 | Yes | 2–5 business days |
| Fitness & Performance Panel | Panel · 8 tests | $119.99 | Yes | 2–5 business days |
| Cortisol (AM) | Test | $26.99 | No | 2–4 business days |
Common questions
What's a normal cortisol at night?
Well under half the morning value — typically below ~7 mcg/dL by late evening, and salivary cortisol near the detection limit at midnight. Loss of that drop, confirmed twice, is what prompts a Cushing's work-up.
I work nights — is my evening cortisol meaningful?
Only against your own rhythm. Cortisol peaks after waking whenever that is; for shift workers the 'evening' sample should be timed to your bedtime and interpreted accordingly.
Educational content, not a diagnosis. Lab results are one input; a clinician interprets them with your history and exam.