Elevated Cortisol: What It Means, Causes and Signs

High cortisol on a test is not yet a diagnosis, but a signal that requires investigation. The hormone is produced by the adrenal glands, and its level changes throughout the day, so a single measurement says little. Below — what this hormone is, why it rises and how an excess is assessed.

What cortisol is and why the body needs it

Cortisol is produced by the adrenal glands — two small glands above the kidneys. It is called the "stress hormone": it helps the body respond to stress, reduces inflammation, and is involved in controlling blood glucose, metabolism and blood pressure.

What to remember: cortisol is needed every day; the question is not whether it is present, but how much there is and for how long.

Why cortisol rises: physiological and pathological causes

The most common cause of persistently high cortisol is taking high doses of glucocorticoid medications (for example, hydrocortisone or prednisolone) over a long period. Such agents are used for asthma, rheumatoid arthritis, lupus, and also to prevent the body from rejecting a transplanted organ; they come in forms for oral use, injections, inhalers and creams.

Less often, an excess arises from a tumor that makes the body produce the hormone on its own — a rare endogenous variant. A pituitary tumor produces ACTH and pushes the adrenal glands to produce more cortisol — this is Cushing's disease, the most common variant when medications are not to blame. Tumors outside the pituitary, more often in the lungs, also produce ACTH, and an adrenal tumor produces cortisol autonomously.

A separate group is conditions with a similar picture without a tumor: obesity, chronic alcohol intoxication, pregnancy, some psychiatric and neurological diseases. This is functional hypercortisolism.

What to remember: first the doctor clarifies which medications you are taking, and only then looks for tumors.

Signs of cortisol excess in women and men

Symptoms increase gradually, and not everyone has all of them. Common features: weight gain mainly on the abdomen and upper body, a rounded face, thin arms and legs, a fat pad at the base of the neck, wide purplish stretch marks on the abdomen, chest, thighs and under the arms, pronounced fatigue and muscle weakness, easy bruising, high blood pressure and blood glucose, mood changes — irritability, anxiety, low mood, decreased libido.

In women, there is additionally excessive hair growth on the face, neck, chest, abdomen or thighs and irregular periods or their cessation. In men — decreased interest in sex, erectile dysfunction, fertility problems. In children, weight gain and slower growth are more often noted.

What to remember: each sign on its own is common; the combination matters.

How cortisol level is assessed: blood, saliva, urine

The doctor asks about health, including glucocorticoids in any form — oral, injections, inhalers, creams — and performs an examination. Then tests are ordered, usually at least two from the list:

• a 24-hour urine test — urine collection over 24 hours;
• a late-evening saliva test — the level is checked at the hours when cortisol is usually at its lowest;
• a dexamethasone test — a blood test showing whether cortisol decreases after a medication that normally lowers it.

If the results indicate an excess, additional investigations are done: a blood test for ACTH and imaging — MRI or CT of the pituitary, adrenal glands and other organs.

What to remember: cortisol changes over the course of a day, so the conclusion is drawn from several different samples.

Why persistently high cortisol is dangerous

Without treatment, a persistent excess has serious consequences: heart attack and stroke, high blood pressure, type 2 diabetes, increased risk of blood clots, weakened bones (osteoporosis), kidney stones. The skin thins, wounds heal slowly, and due to reduced immune defense the susceptibility to infections increases.

What to remember: the longer the hormone remains high, the more organs are involved.

When to see an endocrinologist

A reason for consultation is a combination of signs of cortisol excess, especially if you are taking steroid medications. If tests show high cortisol, the doctor may refer you to an endocrinologist: they conduct further tests to check the pituitary and adrenal glands.

Elevated cortisol on its own is not a reason to call an ambulance. 103/112 — if signs of a heart attack or stroke appear.

The material is for reference and does not replace a doctor's consultation: interpreting tests and planning investigations should be done by a specialist.

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