Does the patient have any symptoms to suggest glucocorticoid, thyroxine or sex hormone deficiency?
Estrogen replacement therapy of any preparation will lead to elevations in cortisol binding globulin and so effect serum cortisol results. Inhaled and topical steroids also affect the hypothalamic-pituitary-adrenal axis, and steroids may occasionally be found in preparations thought by the patient to be ‘natural’ or ‘herbal’.
