Cortisol, often referred to as the body's stress hormone, plays a vital role in managing your body’s response to stress. It is released by the adrenal glands and helps regulate various bodily functions, including metabolism, immune response, and energy production. However, when cortisol levels are consistently too high or too low, it can lead to a variety of health problems. In this article, we will explore what cortisol does, how it impacts your health, and how you can manage your cortisol levels for optimal well-being.

What Does Cortisol Do in the Body?

Cortisol is a hormone that affects nearly every organ system in the body. Its main role is to help your body respond to stress, but it also has many other essential functions, including regulating metabolism, controlling inflammation, and maintaining cardiovascular health.

Functions of Cortisol

  • Controlling the stress response: When you're faced with a stressful situation, your brain sends a signal to the adrenal glands to release cortisol. This triggers the "fight-or-flight" response, which prepares your body to deal with the perceived threat. Cortisol increases glucose production in the liver, providing energy to your body to help you face the stressor.

  • Lowering inflammation: Inflammation is your body’s natural response to injury or infection. While short-term inflammation is helpful, chronic inflammation can be harmful. Cortisol helps to regulate inflammation by suppressing the immune system when necessary. However, prolonged use of corticosteroid medications can cause excessive cortisol production, which may contribute to other health issues.

  • Regulating metabolism: Cortisol plays a role in the metabolism of fats, sugars, and proteins in the body. It helps regulate blood sugar levels and ensures your body has enough energy during periods of stress.

The levels of cortisol in your body are regulated by the hypothalamus and pituitary gland. When cortisol levels are low, the hypothalamus releases corticotropin-releasing hormone (CRH), which signals the pituitary gland to produce adrenocorticotropic hormone (ACTH). ACTH then stimulates the adrenal glands to produce more cortisol.

What Are Normal Cortisol Levels?

Cortisol levels naturally fluctuate throughout the day. They tend to be highest in the morning and decrease throughout the day, reaching their lowest levels at night. This daily pattern is referred to as the cortisol diurnal rhythm.

Normal Range for Cortisol

  • Morning levels: Typically between 5–25 micrograms per deciliter (mcg/dL) around 8 a.m.

  • Evening levels: Cortisol levels should be lower in the evening as your body prepares for rest.

Healthcare providers can measure cortisol levels through blood tests taken at different times of the day to check for any abnormalities. Additionally, urine and saliva tests can provide information about cortisol levels throughout a 24-hour period.

What Causes Too Much Cortisol?

Cortisol levels are typically elevated in response to stress, but chronic stress or other health conditions can lead to consistently high cortisol levels.

Factors That Can Increase Cortisol Levels:

  • Chronic stress: Prolonged exposure to stress, whether physical, emotional, or mental, can keep cortisol levels elevated. Chronic stress, in turn, increases the risk of anxiety, depression, and cardiovascular diseases.

  • Cushing's syndrome: This condition occurs when the body produces excessive amounts of cortisol, often due to tumors on the adrenal glands or pituitary gland.

  • Long-term steroid use: Medications like prednisone, used to treat inflammation, can increase cortisol levels if taken for extended periods.

  • Sleep disturbances: Irregular sleep patterns or sleep deprivation can elevate cortisol levels. Poor sleep increases stress on the body and can lead to higher cortisol production.

  • Tumors: Growths in the adrenal glands or pituitary gland may lead to an overproduction of cortisol.

Signs of Too Much Cortisol:

Excess cortisol levels can lead to a variety of physical and psychological symptoms, including:

  • Fatty deposits around the neck and upper back

  • Easy bruising and thin skin

  • High blood pressure (hypertension)

  • Excessive hair growth (hirsutism)

  • Muscle weakness and fragile bones (osteoporosis)

  • Purple stretch marks on the body

  • Weight gain around the midsection

  • Mood swings and irritability

What Causes Too Little Cortisol?

Just as high cortisol levels can be problematic, too little cortisol can also disrupt your health. Low cortisol levels are often linked to conditions that affect the adrenal glands.

Factors That Can Lower Cortisol Levels:

  • Addison's disease: A condition where the adrenal glands do not produce enough cortisol, often due to autoimmune damage.

  • Autoimmune disorders: These can damage the adrenal glands, reducing cortisol production.

  • Traumatic brain injury: Damage to the brain's pituitary gland can interfere with cortisol production.

  • Sudden withdrawal from steroids: If you have been using corticosteroids for a long period and suddenly stop, it can cause a drop in cortisol levels.

Signs of Too Little Cortisol:

Low cortisol can lead to symptoms such as:

  • Abdominal pain

  • Fatigue and low energy levels

  • Dark patches of skin (hyperpigmentation)

  • Low blood sugar (hypoglycemia)

  • Low blood pressure (hypotension)

  • Weight loss and loss of appetite

How to Control Cortisol Levels

While some fluctuations in cortisol levels are normal, prolonged high or low cortisol levels require management. Here are some strategies to help regulate cortisol.

Lower Cortisol Levels:

  • Manage stress: Engage in stress-reducing activities such as meditation, yoga, tai chi, and deep breathing exercises.

  • Regular exercise: Physical activity helps lower cortisol levels and supports overall health.

  • Sleep well: Getting enough sleep each night helps regulate cortisol production.

  • Social support: Spending time with friends, family, or support groups can help reduce stress.

If your high cortisol levels are due to a medical condition like Cushing's syndrome, medical treatment, including surgery or medication, may be necessary.

Raise Cortisol Levels:

In cases of low cortisol, treatment typically involves hormone replacement therapy, especially if you have conditions like Addison’s disease. A healthcare provider may prescribe corticosteroids to replace the cortisol your body isn’t producing.

In severe cases, such as an adrenal crisis, immediate medical intervention with intravenous (IV) fluids and corticosteroids is required.

When to Contact a Healthcare Provider

If you experience symptoms of too much or too little cortisol, it's important to consult a healthcare provider. Immediate medical attention is necessary if you are experiencing an adrenal crisis.

Symptoms of an Adrenal Crisis:

  • Abdominal pain

  • Dizziness or lightheadedness

  • Low blood pressure

  • Reduced consciousness

  • Difficulty breathing

A healthcare provider can conduct a cortisol test and determine whether further testing or treatment is required.

A Quick Review

Cortisol plays a critical role in your body's response to stress, regulating metabolism, inflammation, and energy production. However, both high and low cortisol levels can lead to various health issues. Regular cortisol fluctuations are normal, but when levels remain abnormal for extended periods, it can be a sign of an underlying health problem.

If you suspect you have abnormal cortisol levels, talk to a healthcare provider who can help assess your health and guide you toward proper treatment.