What is Cortisol – And Why Are Cortisol Levels So Important? 

Right now, your body is pro­duc­ing dozens of hormones. 

Sci­en­tists have dis­cov­ered more than 50 of these chem­i­cal mes­sen­gers that trav­el through­out your blood­stream and deliv­er mes­sages to your organs and tis­sues. From hunger to sex to mood, hor­mones play sig­nif­i­cant roles in how you feel, func­tion, and respond to dif­fer­ent situations. 

One of these hor­mones is cor­ti­sol — often known as the stress hor­mone. How­ev­er, respond­ing to stress is just one of cortisol’s respon­si­bil­i­ties. Cor­ti­sol reduces inflam­ma­tion, con­trols blood pres­sure, and helps reg­u­late blood sug­ar and metab­o­lism (how your body con­verts food and drinks into energy). 

Here are 6 things you need to know about cortisol. 

Also read: 5 Hor­mone Imbal­ances to Be Aware Of”

1. You have your brain, pitu­itary gland, and adren­al glands to thank for cortisol. 

Here’s how the process works: 

  • Your brain deter­mines that your body is in need of cor­ti­sol. The area of your brain called the hypo­thal­a­mus releas­es cor­ti­cotropin-releas­ing hor­mone (CRH). 
  • CRH trig­gers the pitu­itary gland (a small gland in the brain) to make adreno­cor­ti­cotrop­ic hor­mone (ACTH).
  • The ACTH tells your adren­al glands to release cortisol. 

If there are prob­lems with the hypo­thal­a­mus or any of the glands involved in this process, your body might not pro­duce cor­ti­sol the way it should. 

2. Mak­ing enough cor­ti­sol is critical. 

Cor­ti­sol affects near­ly every organ sys­tem and tis­sue in your body, so it’s impor­tant that you make enough of it. If you don’t, you will devel­op a con­di­tion called adren­al insufficiency.” 

Depend­ing on where in your body the prob­lem occurs, adren­al insuf­fi­cien­cy can either be pri­ma­ry (com­mon­ly known as Addison’s dis­ease”) or sec­ondary. Pri­ma­ry orig­i­nates in your adren­al glands, and is often due to dam­age from con­di­tions like autoim­mune dis­eases, infec­tions, or can­cer. The dam­age caus­es them not to pro­duce enough cor­ti­sol. Sec­ondary starts in your pitu­itary gland. It occurs when the gland doesn’t make enough ACTH, which results in your adren­al glands not get­ting the mes­sage to pro­duce cortisol. 

In most cas­es, low cor­ti­sol lev­els are due to abrupt­ly stop­ping a steroid med­ica­tion that has been used for a long time. 

Both types of adren­al insuf­fi­cien­cy can cause symp­toms such as: 

  • Mus­cle weakness 
  • Weight loss
  • Loss of appetite 
  • Fatigue
  • Dizzi­ness
  • Gas­troin­testi­nal issues, like abdom­i­nal pain, diar­rhea, nau­sea, and vomiting

Addison’s dis­ease can also cause dark­en­ing of the skin, often vis­i­ble on skin folds, elbows, knees, knuck­les, toes, lips, and scars. 

If you are con­cerned about your cor­ti­sol lev­els, sched­ule an appoint­ment with your pri­ma­ry care provider or a Duly Health and Care endocri­nol­o­gist.

3. Mak­ing too much cor­ti­sol could be trou­ble too.

It’s all about the bal­ance. While your body can’t func­tion prop­er­ly with­out enough cor­ti­sol, it also can’t do so if you have too much of the hor­mone. High lev­els of cor­ti­sol for an extend­ed peri­od of time is called Cush­ing syn­drome (also known as hyper­cor­ti­solism”). 

Cush­ing syn­drome can be caused by fac­tors out­side of your body, like tak­ing cer­tain med­ica­tions (e.g., pred­nisone). Or, it could come from some­thing inside your body, like a non-can­cer­ous tumor in your adren­al glands or pitu­itary gland that’s mak­ing your adren­al glands pro­duce too much cortisol. 

There is also anoth­er form, called Cush­ing dis­ease. It’s sim­i­lar, but it doesn’t just involve cor­ti­sol. Cush­ing dis­ease occurs when your pitu­itary gland makes too much ACTH, which then makes your adren­al glands pro­duce large amounts of cortisol. 

Not every­one expe­ri­ences the same symp­toms, but some of the more com­mon symp­toms include: 

  • Round­ed face 
  • Excess fat above the col­lar­bones, on the upper back, and around the base of the neck 
  • Weight gain, par­tic­u­lar­ly in the upper body — but thin arms and legs 
  • A fat­ty hump locat­ed between the shoulders 
  • Wide and pur­ple stretch marks under the arms and on the hips, breasts, and abdomen 
  • Mus­cle weakness 
  • Easy bruis­ing
  • Irreg­u­lar peri­ods and excess facial hair in women

It’s also pos­si­ble not to have any symp­toms at all, which can make Cush­ing syn­drome a lit­tle dif­fi­cult to diag­nose sometimes. 

4. Don’t pan­ic if you find out that you have high or low cor­ti­sol levels. 

There’s good news — you don’t need to live with the symp­toms of too lit­tle or too much cortisol. 

Adren­al insuf­fi­cien­cy can’t nec­es­sar­i­ly be cured, but it can be man­aged. Low cor­ti­sol lev­els are treat­ed with cor­ti­cos­teroids (hor­mone med­ica­tions) that make up for your adren­al glands not pro­duc­ing enough. Addison’s dis­ease can some­times cause your adren­al glands to also not make enough of anoth­er hor­mone (aldos­terone) so you may need med­ica­tion to treat that, too. 

Cush­ing syn­drome, on the oth­er hand, is usu­al­ly cur­able. The exact treat­ment depends on the under­ly­ing cause. 

For exam­ple, if you have a tumor that’s caus­ing Cush­ing syn­drome, your provider may remove it sur­gi­cal­ly. Or, if you have been tak­ing steroids that have led to Cush­ing dis­ease, your provider may rec­om­mend decreas­ing your dosage. 

5. Skip­ping treat­ment isn’t a good idea. 

Whether you have low or high lev­els of cor­ti­sol, it is crit­i­cal to get treat­ment — even if you aren’t hav­ing any symptoms. 

If adren­al insuf­fi­cien­cy is left untreat­ed, it could turn into adren­al cri­sis — a severe lack of cor­ti­sol that can lead to life-threat­en­ing low blood pres­sure, kid­ney fail­ure, or shock. Adren­al cri­sis typ­i­cal­ly hap­pens when your body is under phys­i­cal stress, like after an injury, acci­dent, severe infec­tion, or surgery. It can be fatal with­out a cor­ti­cos­teroid shot, so it’s imper­a­tive to talk to your provider about hav­ing one on hand for emergencies. 

Get emer­gency med­ical treat­ment right away if you have adren­al insuf­fi­cien­cy. Adren­al cri­sis symp­toms include: 

  • Vom­it­ing and diarrhea 
  • Weak­ness
  • Con­fu­sion
  • Loss of consciousness 
  • Sud­den and severe pain in the legs, abdomen, or low­er back

Untreat­ed Cush­ing syn­drome can also lead to com­pli­ca­tions, such as infec­tions, high blood pres­sure, increased cho­les­terol, or type 2 dia­betes. It can even cause poten­tial­ly life-threat­en­ing com­pli­ca­tions like heart attack, stroke, and blood clots. 

6. There are mul­ti­ple ways to check your cor­ti­sol levels. 

If your provider sus­pects abnor­mal cor­ti­sol lev­els, they may order a blood test, urine test, or sali­va test. Since cor­ti­sol lev­els fluc­tu­ate through­out the day, you may need to take more than one type of test. 

Also read: Endocrinol­o­gy FAQ” 

When it comes to your hor­mones, it’s a bet­ter safe than sor­ry” sit­u­a­tion. If you are con­cerned about your cor­ti­sol lev­els, don’t hes­i­tate to talk to your provider. Abnor­mal cor­ti­sol lev­els can be dan­ger­ous, but they can also be treat­ed — and the symp­toms don’t need to stand in your way. 

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  • I believe communication, active patient participation and empathy are important for good medical care. I seek to understand each patient's unique circumstances and include them in the decision process when determining a treatment plan.