Table of ContentsView AllTable of ContentsWhat Is Cortisol?FunctionAssociated Conditions: High CortisolAssociated Conditions: Low CortisolTestsFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
What Is Cortisol?
Function
Associated Conditions: High Cortisol
Associated Conditions: Low Cortisol
Tests
Frequently Asked Questions
Cortisolis the main stress hormone in your body. In your brain, cortisol helps control your mood. It’s also involved in fear and motivation.
Cortisol plays many other roles as well. This article will detail the many functions of cortisol, how it’s made, medical conditions associated with it, how levels are tested, and more.
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These three structures together are called thehypothalamus-pituitary-adrenal axis(HPA axis).
Most of the cells in your body have cortisol receptors. That means cortisol has body-wide effects.
What Are Cell Receptors?Cell receptors are proteins on the surface of a cell or inside a cell. They receive chemical messages that control cellular activity. It’s through receptors that hormones like cortisol are able to regulate and change processes in your body such as metabolism and the immune response. The cell’s response to cortisol varies with the type of cell.
What Are Cell Receptors?
Cell receptors are proteins on the surface of a cell or inside a cell. They receive chemical messages that control cellular activity. It’s through receptors that hormones like cortisol are able to regulate and change processes in your body such as metabolism and the immune response. The cell’s response to cortisol varies with the type of cell.
What Is the Function of Cortisol?
Cortisol is a crucial hormone for many functions. It’s involved in:
Cortisol levels fluctuate during the day. In general, they’re high when you wake up and drop throughout the day.
When you deal with stress, your body releases extra cortisol to get you through it. This is called the acute stress response or “fight-or-flight” response.
Fight-or-Flight Response
The fight-or-flight response is the reason cortisol is called the stress hormone. The response happens when something appears to threaten you in some way.
Basically, this response gives you the necessary physical resources to either fight your way out of a dangerous situation or get away from it. It’s a chain reaction that happens almost instantaneously.
What happens is:
During the high-stress situation, the body also shuts down autonomic functions to conserve energy. That makes more resources available for your body to use. For example, it may slow down digestion or pause your immune system.
As the threat passes, cortisol then helps the body return to its natural state.
Endocrine System: How Hormones Work
Recap
Your body functions best when cortisol is at optimal levels. Both high and low cortisol levels are tied to medical conditions.
High cortisol levels may be a sign ofCushing’s syndrome, or an effect of chronic stress, which can have other health consequences.
Chronic Stress
Chronic stress can lead to high cortisol levels. That can have a negative impact on your health.
The stress can come from a difficult ongoing situation, such as a job or caring for a sick loved one. It can also come from excessive worry.
This keeps the body in a high-alert state. That makes you over-respond to added stressors that you encounter throughout the day. Maybe a small delay in your busy schedule sends your anxiety into overdrive.
Symptoms of chronic stress include:
When the chronic stress continues long-term, it can lead to:
Stress-Induced Infectious Diseases
Chronic stress, cortisol levels, and mental disorders like depression and anxiety have a well-established link.So far, though, experts don’t have a good understanding of the link.
If you’re diagnosed with chronic stress, your healthcare provider may recommend:
You may also benefit from lifestyle changes that help alleviate your stress, such as exercising and meditation, or making life changes that reduce stress, such as switching jobs or eliminating unnecessary obligations.
Cushing’s Syndrome
A rare disease calledCushing’s syndromecan result from prolonged high cortisol levels. Usually, the levels are elevated due to a tumor that produces ACTH or taking corticosteroid drugs (synthetic forms of cortisol).
Symptoms of Cushing’s syndrome include:
Tumors of the pituitary gland that lead to Cushing’s are typically not cancerous, but tumors that develop outside of the pituitary gland (in thepancreas,thyroid, orthymus glands) may be cancerous.
Treatments for tumor-related Cushing’s are:
Because that process can take a long time to show results, you might be given other medications to control symptoms. These may include drugs forhigh blood pressure,high blood sugar, orhigh cholesterol.
If you need treatment for anxiety or depression, you may be referred to a mental health specialist.
How to Lower Cortisol
Low cortisol levels also are linked to health problems. These includeAddison’s disease,fibromyalgia, andmyalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
Addison’s Disease
Addison’s is a rare disease. It’s also called primary adrenal insufficiency and hypocortisolism.
Addison’s is most often due to anautoimmune diseasethat attacks the adrenal glands. Symptoms tend to come on slowly and may come and go. They include:
Addison’s disease is treated with hormone replacement. Usually, that involves oral steroid medications such as:
These medications will be adjusted until your hormone levels are in the normal range.
Adrenal CrisisAdrenal crisis, or Addisonian crisis, is a rapid, severe drop in cortisol levels. It can be life-threatening. Symptoms include:Severe vomiting or diarrhea that can lead to dehydrationPain in the abdomen, lower back, or legsFaintingMuscle spasmsConfusion and disorientationExtreme thirstInability to urinateAbnormal heart rhythmIntermittent muscle paralysisHypotensive shock (due to low blood pressure)Respiratory failureIf you experience these symptoms, seek medical help right away. Adrenal crisis leads to death in one out of 16 cases.It’s treated with intravenous (IV) steroids, saline (salt water), and dextrose (a type of sugar).
Adrenal Crisis
Adrenal crisis, or Addisonian crisis, is a rapid, severe drop in cortisol levels. It can be life-threatening. Symptoms include:Severe vomiting or diarrhea that can lead to dehydrationPain in the abdomen, lower back, or legsFaintingMuscle spasmsConfusion and disorientationExtreme thirstInability to urinateAbnormal heart rhythmIntermittent muscle paralysisHypotensive shock (due to low blood pressure)Respiratory failureIf you experience these symptoms, seek medical help right away. Adrenal crisis leads to death in one out of 16 cases.It’s treated with intravenous (IV) steroids, saline (salt water), and dextrose (a type of sugar).
Adrenal crisis, or Addisonian crisis, is a rapid, severe drop in cortisol levels. It can be life-threatening. Symptoms include:
If you experience these symptoms, seek medical help right away. Adrenal crisis leads to death in one out of 16 cases.It’s treated with intravenous (IV) steroids, saline (salt water), and dextrose (a type of sugar).
Fibromyalgia and ME/CFS
The related conditions fibromyalgia and ME/CFS both feature low cortisol levels and reduced HPA-axis function. However, increasing cortisol levels with medication doesn’t improve symptoms.
That’s led experts to suspect that HPA-axis dysfunction and low cortisol are the results of the disease process in fibromyalgia and ME/CFS and not a cause of the illnesses.
Causes and Risk Factors of Chronic Fatigue Syndrome
RecapLow cortisol is often due to Addison’s disease, which is most often an autoimmune disorder. It’s treated with hormone replacement (corticosteroid drugs). Fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome are tied to low cortisol. But it’s not believed to cause these conditions.
Low cortisol is often due to Addison’s disease, which is most often an autoimmune disorder. It’s treated with hormone replacement (corticosteroid drugs). Fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome are tied to low cortisol. But it’s not believed to cause these conditions.
How Are Cortisol Levels Tested?
If you have symptoms that could point to a cortisol problem, your healthcare provider can order a blood test to look at your levels. You can also order anat-home cortisol test.
Typically, you’ll have blood drawn for testing twice in one day. The first test is done in the morning, when cortisol is at its peak. The second one is often done around 4 p.m., when levels are expected to be much lower.
If you’re a shift worker or have a non-standard schedule for any reason, let your healthcare provider know. The timing of the tests may need to be adjusted.
Your cortisol may also be tested in saliva or urine. For a saliva test, you’ll be given a kit to collect a sample at night, when levels should be low.
For a urine test, you’ll be asked to collect your urine for 24 hours. You’ll get a container and instructions for this.
Be certain to follow the directions carefully and to promptly return your tests to the lab for analysis.
Abnormal cortisol levels may mean Addison’s, Cushing’s, another medical condition, or a temporary change due to:
Your healthcare provider can explain to you what your results mean and what, if any, treatments you may need. You may require more testing before they can make a diagnosis.
What to Expect From a Cortisol Test
Summary
Cortisol is a hormone that deals with your stress response, metabolism, and many other important functions.
High cortisol is tied to chronic stress and Cushing’s syndrome. Cushing’s is usually treated with surgery or tapering off of the medication that caused it.
Low cortisol is tied to Addison’s disease. It’s usually treated with corticosteroid drugs.
Cortisol problems are diagnosed with blood, saliva, and/or urine tests.
A Word From Verywell
Symptoms of high or low cortisol should be taken seriously. At the least, you may need to make some lifestyle changes to control stress. At their worst, symptoms could point to a serious health problem or life-threatening crisis.
The good news is that cortisol-related problems are treatable and the results are usually good. Talk to your healthcare provider to start the process of figuring out what’s causing your symptoms.
Frequently Asked QuestionsA morning cortisol level in a healthy person is between 10 and 20 micrograms per deciliter (mcg/dL).Steroids are hormones that occur naturally in your body. They include sex hormones like estrogen and testosterone as well as cortisone and others. Synthetic steroids are used as medications. The most common use is as an anti-inflammatory.Yes, most of the time Cushing’s can be cured. It may take a while for your symptoms to go away completely, though. You may also be left with related health problems, such as diabetes or depression.
A morning cortisol level in a healthy person is between 10 and 20 micrograms per deciliter (mcg/dL).
Steroids are hormones that occur naturally in your body. They include sex hormones like estrogen and testosterone as well as cortisone and others. Synthetic steroids are used as medications. The most common use is as an anti-inflammatory.
Yes, most of the time Cushing’s can be cured. It may take a while for your symptoms to go away completely, though. You may also be left with related health problems, such as diabetes or depression.
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13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Thau L, Gandhi J, Sharma S.Physiology, cortisol. In:StatPearls. Treasure Island (FL): StatPearls Publishing; September 6, 2021.National Center for Biotechnology Information, U.S. National Library of Medicine: StatPearls.Physiology, cortisol. Updated September 6, 2021.Thau L, Gandhi J, Sharma S.Physiology, cortisol. In:StatPearls. Treasure Island (FL): StatPearls Publishing; September 6, 2021.Yale Medicine.Chronic stress.Yale Medicine.Chronic stress.Russell G, Lightman S.The human stress response.Nat Rev Endocrinol. 2019;15(9):525-534. doi:10.1038/s41574-019-0228-0National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.Cushing’s syndrome. Updated May 2018.National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms and causes of adrenal insufficiency and Addison’s disease. Updated September 2018.National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.Treatment for adrenal insufficiency and Addison’s disease. Updated September 2018.Hahner S, Spinnler C, Fassnacht M, et al.High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study.J Clin Endocrinol Metab. 2015;100(2):407-416. doi:10.1210/jc.2014-3191National Center for Biotechnology Information, U.S. National Library of Medicine: Endotext.Chronic fatigue syndrome. Updated April 20, 2017.MedlinePlus.Cortisol test. Updated July 31, 2020.National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development.Is there a cure for Cushing syndrome?Updated May 9, 2019.Additional ReadingEndocrine Society: Hormone Health Network.What is cortisol?Updated November 2018.Society for Endocrinology: You and Your Hormones.Cortisol. Updated January 2019.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Thau L, Gandhi J, Sharma S.Physiology, cortisol. In:StatPearls. Treasure Island (FL): StatPearls Publishing; September 6, 2021.National Center for Biotechnology Information, U.S. National Library of Medicine: StatPearls.Physiology, cortisol. Updated September 6, 2021.Thau L, Gandhi J, Sharma S.Physiology, cortisol. In:StatPearls. Treasure Island (FL): StatPearls Publishing; September 6, 2021.Yale Medicine.Chronic stress.Yale Medicine.Chronic stress.Russell G, Lightman S.The human stress response.Nat Rev Endocrinol. 2019;15(9):525-534. doi:10.1038/s41574-019-0228-0National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.Cushing’s syndrome. Updated May 2018.National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms and causes of adrenal insufficiency and Addison’s disease. Updated September 2018.National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.Treatment for adrenal insufficiency and Addison’s disease. Updated September 2018.Hahner S, Spinnler C, Fassnacht M, et al.High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study.J Clin Endocrinol Metab. 2015;100(2):407-416. doi:10.1210/jc.2014-3191National Center for Biotechnology Information, U.S. National Library of Medicine: Endotext.Chronic fatigue syndrome. Updated April 20, 2017.MedlinePlus.Cortisol test. Updated July 31, 2020.National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development.Is there a cure for Cushing syndrome?Updated May 9, 2019.
Thau L, Gandhi J, Sharma S.Physiology, cortisol. In:StatPearls. Treasure Island (FL): StatPearls Publishing; September 6, 2021.
National Center for Biotechnology Information, U.S. National Library of Medicine: StatPearls.Physiology, cortisol. Updated September 6, 2021.
Yale Medicine.Chronic stress.
Russell G, Lightman S.The human stress response.Nat Rev Endocrinol. 2019;15(9):525-534. doi:10.1038/s41574-019-0228-0
National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.Cushing’s syndrome. Updated May 2018.
National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms and causes of adrenal insufficiency and Addison’s disease. Updated September 2018.
National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.Treatment for adrenal insufficiency and Addison’s disease. Updated September 2018.
Hahner S, Spinnler C, Fassnacht M, et al.High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study.J Clin Endocrinol Metab. 2015;100(2):407-416. doi:10.1210/jc.2014-3191
National Center for Biotechnology Information, U.S. National Library of Medicine: Endotext.Chronic fatigue syndrome. Updated April 20, 2017.
MedlinePlus.Cortisol test. Updated July 31, 2020.
National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development.Is there a cure for Cushing syndrome?Updated May 9, 2019.
Endocrine Society: Hormone Health Network.What is cortisol?Updated November 2018.Society for Endocrinology: You and Your Hormones.Cortisol. Updated January 2019.
Endocrine Society: Hormone Health Network.What is cortisol?Updated November 2018.
Society for Endocrinology: You and Your Hormones.Cortisol. Updated January 2019.
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