Elevated Cortisol: Symptoms in Women and Possible Causes

Cortisol is a hormone that the adrenal glands produce every day, and its level changes over the course of 24 hours. When cortisol becomes too high for a long time, this is called Cushing's syndrome (hypercortisolism). In women, this condition occurs about three times more often than in men, and symptoms develop gradually.

What cortisol is and why the body needs it

Cortisol is produced by the adrenal glands — two small glands above the kidneys. It helps the body respond to stress, reduces inflammation, and is involved in controlling blood glucose, metabolism, and blood pressure. The adrenal glands are regulated by the pituitary gland: its hormone ACTH signals them to produce cortisol. As long as this chain works smoothly, the hormone level remains within the normal range.

Symptoms of elevated cortisol in women

The signs of high cortisol in women are varied, and not everyone has the same ones. More often noticed are weight gain around the abdomen and upper body with thin arms and legs, a rounded face with redness, and a fat pad at the base of the neck. The skin becomes thin, bruises appear easily, and wide purplish-red striae appear on the abdomen, breasts, thighs, and under the arms. Marked fatigue and muscle weakness are possible, especially in the upper arms and legs, as are mood changes — irritability, anxiety, low mood, and decreased libido. Women may experience excessive hair growth on the face, neck, chest, abdomen, or thighs, and menstruation becomes irregular or stops.

• weight gain predominantly on the abdomen and upper body
• red rounded face, easy bruising, striae
• muscle weakness and marked fatigue
• mood changes, decreased libido
• menstrual irregularities, excessive hair growth

Cortisol surge: what it means

Cortisol naturally rises in response to stress and normally decreases in the evening. A rare cyclic variant of hypercortisolism is distinguished separately, in which hormone production periodically increases and decreases; it is diagnosed when at least three peaks of cortisol secretion with intervening dips are detected. An episodic rise by itself does not equal Cushing's syndrome — what matters is a persistent elevation of the level.

Why cortisol rises

The most common cause is long-term use of high doses of glucocorticoid medications (for example, prednisolone) in the form of tablets, injections, inhalers, or creams. Less often, excess cortisol occurs due to a tumor: a pituitary adenoma that produces too much ACTH (this is called Cushing's disease), an adrenal tumor, or a tumor at another site, more often in the lungs. Cortisol elevation also occurs with obesity, chronic alcohol intoxication, pregnancy, and certain psychiatric and neurological diseases — this condition is called functional hypercortisolism.

How cortisol levels are determined

First, the doctor asks about health and medications being taken, including creams and inhalers, and performs an examination. Then tests for cortisol in urine, saliva, or blood are ordered — usually at least two tests: a 24-hour urine test, an evening saliva test, or a dexamethasone suppression test, which shows whether cortisol decreases after taking the medication. If elevation is confirmed, ACTH levels are checked and imaging is performed — MRI or CT of the brain and kidneys to find the cause. After that, follow-up is managed by an endocrinologist.

Risks of prolonged elevation and when to see a doctor

Without treatment, persistent excess cortisol can lead to heart attack and stroke, high blood pressure, type 2 diabetes, an increased risk of blood clots, bone weakening (osteoporosis), and kidney stones. Make an appointment with a doctor if you notice signs of hypercortisolism in yourself, especially while taking steroid medications.

An elevated cortisol level by itself is not a reason to call an ambulance; call 103 or 112 if you suspect a heart attack or stroke.

This material is for reference: it helps to navigate the symptoms but does not replace a doctor's consultation — final conclusions are made by a specialist after examination and testing.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer