What Is Cortisol?
Medically reviewed by Danielle Weiss, MD
Cortisol, or hydrocortisone, is the body's stress hormone. The adrenal glands, located on top of the kidneys, release cortisol to provide energy and increase alertness in response to stress. The hormone regulates metabolism and the immune response, among other bodily functions.
Too high and too low cortisol levels may cause complications over time. Stress, sleep disturbances, and tumors in the adrenal glands can increase cortisol levels. The hormone may decrease as a result of autoimmune disorders or damage to the adrenal glands.
Several factors, such as stress, sleeping patterns, and certain health conditions, can raise or lower your cortisol levels. Taking a cortisol test can help you figure out your cortisol levels so you can manage them. Read on to learn how cortisol works and how to regulate it.
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Related: Understanding TSH Levels and Their Ranges
What Does Cortisol Do in the Body?
Cortisol has multiple functions and affects almost every organ system in the body. The hormone plays essential roles in the cardiovascular, immune, and nervous systems.
Functions of cortisol include:
Controlling the stress response: Your body creates a physical response to deal with a perceived threat, or the "fight-or-flight" response. Your brain sends a message to the adrenal glands to release the hormone. Cortisol helps your body stay on high alert. The hormone also helps increase glucose (sugar) production in the liver, which gives you energy.
Lowering inflammation: Inflammation is your body's natural response to injury or disease. Long-term inflammation can harm your body. People with autoimmune disorders and other illnesses that cause long-term inflammation might take corticosteroids. These drugs increase cortisol and reduce inflammation. Corticosteroids can sometimes cause too much cortisol in the body.
Regulating metabolism: Cortisol works in the pancreas, muscles, and fat tissues. The hormone regulates your body's metabolism of fats, sugars, and proteins.
Small structures in the brain called the hypothalamus and pituitary gland regulate cortisol levels. If cortisol levels are low, the hypothalamus releases corticotropin-releasing hormone (CRH). CRH tells the pituitary gland to secrete adrenocorticotropic hormone (ACTH), which signals the adrenal glands to make more cortisol.
What Are Normal Cortisol Levels?
Normal cortisol levels will range from 5–25 micrograms per deciliter (mcg/dL) around 8 a.m. Cortisol levels usually change throughout the day. The hormone peaks in the morning and then steadily decreases until it reaches its lowest point at night.
A cortisol test measures the amount of the hormone in your body. A healthcare provider will take two samples of your blood at different times of the day. The first will be in the morning when your cortisol levels are highest. The second will be later in the day or evening when cortisol levels are lower.
You can also take a urine or saliva test at home. You may need to collect all of your urine during a 24-hour period. A saliva test involves collecting your spit using a swabbing kit before you go to bed.
What Causes Too Much Cortisol?
It's normal for cortisol levels to increase slightly from time to time, especially as a response to stress. Your levels will return to normal once the stressful event has passed. Cortisol levels can sometimes remain elevated.
Health conditions and other factors that might raise your cortisol include:
Chronic stress: Prolonged periods of stress can cause cortisol levels to stay high. This stress can be physical, mental, or psychological.
Cushing's syndrome: This disorder happens when the body produces excess cortisol for an extended period.
Long-term steroid use: Taking certain corticosteroids, such as prednisone, for a long time can raise cortisol levels.
Sleep disturbances: Cortisol release varies throughout the day, so an abnormal sleep pattern can impact your levels. Long periods of sleep deprivation place stress on the body, leading to an increase in cortisol.
Tumors: Growths in the adrenal glands may cause them to produce too much cortisol. Tumors in the pituitary gland, which is located in the brain, can also lead to excess cortisol. The pituitary gland makes hormones that influence the adrenal glands.
Signs of Too Much Cortisol
Excess cortisol levels may cause signs and symptoms like:
A fatty deposit at the base of the neck and between the shoulder blades
Bruising easily
Hypertension, or high blood pressure
Hirsutism, or excess hair growth
Muscle weakness
Osteoporosis, which causes brittle bones and increases fracture risk
Purple streaks on the breasts, hips, stomach, and under the arms
Thin arms and legs
Weight gain
What Causes Too Little Cortisol?
It's also possible to have too little cortisol. Health conditions and other factors that might result in decreased cortisol levels include:
Autoimmune disorders: These disorders cause the body to mistakenly target and attack healthy cells. Some autoimmune disorders can damage the adrenal glands, causing a decrease in cortisol.
Infections: Infections like tuberculosis (TB) and human immunodeficiency virus (HIV) can impact the adrenal glands.
Traumatic brain injury: Trauma to the brain can damage the pituitary gland, which helps regulate the adrenal glands.
Suddenly stopping steroid medication: Taking corticosteroids for a long time can increase cortisol levels. Suddenly stopping the drug can cause a drop in cortisol.
Addison's disease: The adrenal glands are damaged or infected, so they cannot produce enough cortisol. Other symptoms include loss of appetite, weight loss, and muscle weakness.
Secondary adrenal insufficiency: This causes the adrenal glands not to make enough cortisol.
Congenital adrenal hyperplasia: This is a group of inherited disorders that decreases adrenal gland function.
Hypoglycemia:
Signs of Too Little Cortisol
Decreased cortisol levels may cause signs and symptoms like:
Abdominal pain
Fatigue
Hyperpigmentation, or dark patches of skin
Hypoglycemia, or low blood sugar
Hypotension, or low blood pressure
Loss of appetite
Weight loss
How To Control Cortisol
Some changes in cortisol levels are normal and do not require intervention. You may need treatment if your cortisol levels are very high or low for extended periods.
Lower Cortisol Levels
If stress is the culprit, you can take several steps to get your cortisol levels down. You can manage stress by:
Avoiding stressful situations if possible
Eating a nutrient-rich diet
Hanging out with family or friends
Making time for the things you enjoy
Practicing relaxation techniques (e.g., meditation, tai chi, or yoga)
Reframing negative thoughts
Regularly getting plenty of sleep
You may require medical or surgical treatment if you have Cushing's syndrome, depending on the cause. Surgery, for example, can remove a tumor in the adrenal glands. Other methods to remove a tumor might include chemotherapy and radiation therapy.
If corticosteroids are the cause, a healthcare provider will have you slowly reduce the use of them. They may replace the drug with another that will not increase cortisol.
Raise Cortisol Levels
You will likely need medical treatment to treat Addison's disease or damage to the adrenal glands. Treatment for Addison's disease typically involves hormone replacement therapy. A healthcare provider can prescribe a corticosteroid to replace the function of cortisol in your body.
An adrenal crisis is a medical emergency that occurs if your cortisol levels suddenly drop very low. Treatment for an adrenal crisis includes intravenous (IV) injections of saline to hydrate, dextrose (sugar) to raise blood sugar, and corticosteroids to boost cortisol levels.
When To Contact a Healthcare Provider
Contact a healthcare provider if you have symptoms of too much or too little cortisol. Get medical attention right away if you have an adrenal crisis. Symptoms include:
Dizziness or lightheadedness
Low blood pressure
Reduced consciousness
Trouble breathing
A healthcare provider will administer a cortisol test to check how much of the hormone is in your body. If your cortisol levels are too high or too low, it does not always mean you have an underlying illness. A healthcare provider can talk to you about your results and whether or not you need further testing. They can also discuss ways to lower or increase your cortisol.
Related: What is Progesterone?
A Quick Review
Cortisol is the body's stress hormone. The adrenal glands, located on top of the kidneys, release cortisol during physical, emotional, or physiological stress. The hormone also regulates metabolism and reduces inflammation.
It's normal for cortisol levels to fluctuate from time to time. However, if your cortisol level is regularly too high or too low, it can be a sign of an underlying health condition. You may experience symptoms like fatigue, weight gain or loss, abdominal pain, and muscle weakness.
You can check your cortisol levels by taking a cortisol test. A healthcare provider typically uses this test to diagnose or monitor health conditions that cause high or low cortisol levels.
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