University exams are well-established stressors that can provoke psychosocial strain and physiological endocrine responses in students, including increased cortisol release.

Borghi et al. have examined the short- and long-term effects of exam-related stress on hypothalamic-pituitary-adrenal (HPA) axis activity by simultaneously assessing cumulative cortisol (from hair samples) and diurnal cortisol patterns (from saliva). 

In their study of 27 undergraduate students, they show significantly higher hair cortisol concentrations during an exam month compared with the preceding month, suggesting sustained HPA axis activation throughout the exam period. By contrast, salivary cortisol samples collected over three consecutive weekdays during the final examination week displayed a normal diurnal rhythm and a stable cortisol awakening response. Although morning cortisol levels showed a non-significant increase across days, overall daily cortisol output remained unchanged.

Based on these findings, the authors conclude that exam periods are associated with increased cumulative cortisol exposure, while short-term HPA axis rhythmicity remains preserved. The authors propose that hair cortisol measurement may help identify students experiencing chronic stress accumulation, even when daily functioning appears preserved.

Read the full article in Clinical Endocrinology https://doi.org/10.1111/cen.70083