Abbott Laboratories (ABT) had a rough Thursday, with shares tumbling after the healthcare giant delivered fourth-quarter sales that missed expectations and issued profit guidance for early 2026 that left Wall Street wanting more.

The Numbers Tell a Mixed Story

Abbott reported quarterly sales of $11.46 billion, falling short of the $11.80 billion analysts were expecting. That represented a 4.4% increase on a reported basis and 3% organic growth—or 3.8% if you strip out COVID-19 testing sales, which continue to fade into the background.

On the earnings front, Abbott hit the mark with adjusted earnings of $1.50 per share, matching Wall Street's estimates exactly. But meeting expectations on the bottom line wasn't enough to offset the sales miss and what came next in the guidance.

"In 2025, we expanded margins and achieved double-digit earnings per share growth, our new product pipeline was highly productive, and we took important strategic steps to shape the company for the future," said Robert Ford, chairman and CEO of Abbott. "We're well-positioned for accelerating growth in 2026."

Where the Growth Showed Up

Medical Devices was the star performer, with sales jumping 12.3% on a reported basis and 10.4% organically to $5.68 billion. The quarter saw double-digit growth across electrophysiology, heart failure, diabetes care, and rhythm management—all areas where Abbott has been pushing hard with new products.

In January, Abbott teamed up with AtaCor Medical to develop a next-generation extravascular implantable cardioverter defibrillator system designed to treat life-threatening heart rhythms. And in December 2025, the FDA approved Abbott's Volt PFA System for treating patients with atrial fibrillation, expanding treatment options in the U.S. market.

Diabetes Care also delivered solid results, with continuous glucose monitor sales hitting $2.0 billion and growing 15% (12.2% organic). Though it's worth noting the segment faced some turbulence—the FDA issued a safety alert in December for FreeStyle Libre 3 sensors after the company linked the devices to seven deaths and hundreds of serious injuries.

The Struggles Were Real Too

Global Diagnostics sales fell 2.5% (-3.6% organic) to $2.46 billion, though they were essentially flat when you exclude COVID-19 testing. Speaking of COVID, those testing-related sales came in at just $89 million in the quarter, down from $176 million a year earlier—a reminder of how much the pandemic tailwind has dissipated.

Within Diagnostics, Core Laboratory sales grew 5.3% on a reported basis and 3.6% organically, but growth in some regions was offset by tough market conditions in China, including the impact of volume-based procurement programs that pressure pricing.

Nutrition was the biggest drag, with worldwide sales plummeting 8.9% (-9.1% organic) to $1.94 billion. Abbott attributed this to lower sales volumes compared to last year and strategic price cuts designed to boost volume growth down the road. The company is banking on several new product launches in 2026 to turn things around in this segment.

Established Pharmaceuticals offered a bright spot, with sales rising 9% (7% organic) to $1.38 billion.

And then there's the big strategic move: In November 2025, Abbott announced the largest deal of the year in global healthcare—a $21 billion acquisition of cancer screening company Exact Sciences Corp (EXAS). That deal signals Abbott's ambitions to become a major player in cancer diagnostics.

The Guidance That Spooked Investors

Here's where things got uncomfortable for shareholders. Abbott said it expects first-quarter 2026 adjusted earnings of $1.12-$1.18 per share, well below the $1.20 consensus estimate. For the full fiscal year 2026, the company projects adjusted earnings of $5.55-$5.80 per share, compared to Wall Street's expectation of $5.67.

Abbott did forecast organic sales growth between 6.5% and 7.5% for 2026, which isn't terrible, but investors clearly wanted more given the premium valuation healthcare stocks have been commanding.

Market Reaction

Abbott Laboratories shares were down 7.37% at $111.63 at the time of publication Thursday, hitting a new 52-week low. It's a sharp reminder that even established healthcare giants aren't immune to missing estimates and issuing cautious guidance in an environment where investors are increasingly selective about where they put their money.