What Is Cortisol?

You may have heard of cortisol as the body's stress hormone. In periods of physical or mental stress, the adrenal glands release cortisol to provide energy and put your body into high-alert mode.

However, cortisol has many functions. The hormone regulates metabolism, inflammation, and the immune response, among other systems in the body. When your cortisol levels remain high for an extended period of time, it can cause complications in these areas.

Several factors can raise or lower your cortisol levels such as stress, sleeping patterns, and certain health conditions. Taking a cortisol test can help you determine your levels so you can better manage them.

What Does Cortisol Do?

Cortisol has multiple functions and affects almost every organ system in the body, including the nervous, immune, cardiovascular (heart), respiratory (lungs), reproductive, musculoskeletal (bones), and integumentary (hair, skin, nails) systems.

The hormone is most well known for its role in the nervous system as part of the stress response. When a person is exposed to stress, the body creates a physical response to deal with the perceived threat. This is sometimes called the "fight or flight" response.

The brain sends a message to the adrenal glands to release the cortisol hormone. Cortisol helps the body stay on high alert. Cortisol also has a mechanism that increases the production of glucose (sugar) in the liver. This gives the body more energy to cope with the stressor.

Along with acting on the liver, cortisol also works in the pancreas, muscles, and fat tissues. There, the hormone regulates the body's metabolism of fats, sugars, and proteins.

Another major function of cortisol is to lower inflammation and the immune response. Inflammation is the body's natural response to an injury or disease. However, inflammation can cause harm to the body when it lasts for too long, as it might in autoimmune diseases or other persistent conditions.

People with conditions that cause chronic inflammation might take a drug called corticosteroids to increase cortisol and reduce inflammation. However, sometimes these drugs can cause an excess amount of cortisol in the body.

What Affects Your Cortisol Levels?

Your cortisol levels naturally fluctuate throughout the day. Typically, cortisol levels are highest in the early morning and lowest in the late evening.

However, cortisol can change due to certain health conditions and medications as well as situational factors like stress, exercise, and hot and cold temperatures.

Things That Can Raise Your Cortisol Levels

It's normal for cortisol levels to increase slightly from time to time, especially as a response to stress. Once the stressful event has passed, your levels will return to normal. In some cases, however, cortisol levels can remain elevated due to an underlying health condition.

Conditions or 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.
• Sleep disturbances: Since cortisol release varies throughout the day, an abnormal sleep pattern can impact your levels. Also, long periods of sleep deprivation can cause stress in the body, leading to an increase in cortisol. In turn, reducing your cortisol levels can help ease sleep disturbances.
• Long-term steroid use: Taking certain corticosteroid medications such as prednisone for a long period of time can increase your cortisol levels.
• Tumors: Tumors in the adrenal glands can cause the glands to produce too much cortisol. Tumors in the pituitary gland (located in the brain) can also lead to an increase in cortisol, since the pituitary gland makes hormones that influence the adrenal glands.

 Things That Can Lower Cortisol Levels

Conditions and other factors that can cause a decrease in cortisol levels include:

• Autoimmune diseases: Some autoimmune diseases can damage the adrenal glands, causing a decrease in the amount of cortisol produced.
• Infections: Infections including tuberculosis (TB) and HIV/ AIDS can also impact the adrenal glands, causing a decrease in cortisol levels.
• Traumatic brain injury: Trauma to the brain can result in damage to the pituitary gland in the brain. Since the pituitary gland helps regulate the adrenal glands, this could result in a drop in production of cortisol.
• Suddenly stopping steroid medication: Taking steroids for a long time can increase cortisol levels, so suddenly stopping the medication can cause a drop in cortisol.

What Is a Cortisol Test?

A cortisol test measures the amount of cortisol within a sample of your blood, urine, or saliva.

During a blood test for cortisol, a healthcare provider will take two samples of your blood at different times of 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 is lower.

Your provider will usually have you take a urine or saliva test at home. During a urine test for cortisol, you may need to collect all of your urine (pee) throughout a 24-hour period. During a saliva test for cortisol, you will collect your saliva (spit) using a swabbing kit before you go to bed.

Typically, a healthcare provider will use a cortisol test to diagnose or monitor health conditions that have too high or too low of cortisol levels, such as:

• Cushing's syndrome: This disorder happens when the body produces an increased amount of cortisol for an extended period of time. Other symptoms include easy bruising, weight gain, and muscle weakness.
• Addison's disease: In this condition, the adrenal glands get damaged or infected so they can't produce enough cortisol. Other symptoms include loss of appetite, weight loss, and muscle weakness.
• Secondary adrenal insufficiency: The adrenal glands don't make enough cortisol. This could happen as a result of damage to the pituitary gland.
• Congenital adrenal hyperplasia: This condition is a group of inherited disorders that decrease production in the adrenal glands.
  

If your cortisol test shows levels that are too high or too low, it doesn't always mean you have an underlying condition. Your healthcare provider can talk to you about your results and whether or not you'll need further testing. From there, they can discuss ways to lower or increase your cortisol.

How Can You Manage Cortisol Levels?

Some changes in cortisol levels are normal and don't require intervention. However, if your cortisol levels are very high or low for extended periods, you may need medical treatment.

How to Lower Cortisol Levels

When your cortisol levels are mildly elevated, such as during a period of stress, getting regular sleep can help keep your levels down. Exercise can also help in regulating your cortisol levels. When you exercise, your cortisol levels are initially raised and then become lowered to a normal level.

In Cushing's syndrome where cortisol levels are much higher, you may need medical or surgical treatment depending on what is causing the raised levels. For instance, if the increased cortisol is caused by a tumor in the adrenal glands, you may need surgery to remove the tumors. Other methods to remove the tumors might include chemotherapy and radiation therapy.

If the high cortisol levels are caused by long-term use of steroids, your healthcare provider will have you slowly reduce your dose of the drugs. In some cases, they may replace your steroid with another drug that will not increase cortisol.

How to Raise Cortisol Levels

If your cortisol levels are consistently low due to Addison's disease or damage to the adrenal glands, you will likely need medical treatment to address the underlying condition.

Typically, treatment for Addison's disease includes hormone replacement therapy. Your healthcare provider will prescribe an oral steroid called a corticosteroid to replace the function of cortisol in your body.

In some cases, a person's cortisol can suddenly drop to a very low level. This is known as an adrenal crisis and requires emergency medical treatment.

Treatment for adrenal crisis includes immediate intravenous (IV) injections of saline to hydrate, dextrose (sugar) to raise low blood sugar, and corticosteroids to boost cortisol levels.

A Quick Review

Cortisol is a stress hormone that gets released from the adrenal glands at times of physical, emotional, or physiological stress. Cortisol also has several other functions, including regulating metabolism and reducing inflammation.

Cortisol levels can increase from stress, sleep disturbances, steroid use, and tumors in the adrenal glands. Cortisol can decrease as a result of autoimmune diseases, infection, damage to the adrenal or pituitary glands, and more.

You can check your cortisol levels by taking a cortisol test. Typically, your healthcare provider will use this test to diagnose or monitor health conditions relating to high or low cortisol levels.