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Cortisol

The role of cortisol in the body

Cortisol is a stress hormone produced by the adrenal cortex under the control of the hypothalamic-pituitary system ( HPA axis: hypothalamus → ACTH → adrenalglands).

Main functions:

  1. Regulation of metabolism:
  • Increases the level of glucose in the blood (stimulates gluconeogenesis in the liver).
  • Reduces glucose uptake by cells (an insulin antagonist).
  • Promotes protein breakdown (catabolic effect).
  • It affects lipolysis (fat breakdown).
  1. Anti-inflammatory and immunosuppressive effects:
  • Suppresses immune responses (used in medicine to treat autoimmune diseases).
  1. Stress response:
  • Mobilizes the body in critical situations (increases blood pressure, increases heart function).
  1. Impact on the central nervous system:
  • May cause anxiety, insomnia in excess.
  1. Regulation of the water-salt balance:
  • Weak mineralocorticoid effect (sodium and water retention).

Symptoms of cortisol deficiency (hypocorticism)

Reasons:

  • Addison’s disease (primary adrenal insufficiency).
  • Secondary insufficiency (pituitary/hypothalamic problems).
  • Abrupt withdrawal of glucocorticoids after prolonged use.

Symptoms:

  • Chronic fatigue, weakness.
  • Hypoglycemia (dizziness, trembling, sweating).
  • Weight loss, decreased appetite.
  • Hyperpigmentation of the skin (in Addison’s disease).
  • Low blood pressure (hypotension), fainting spells.
  • Nausea, vomiting, abdominal pain.
  • Depression, irritability.

Acute deficiency (Addison’s crisis) is a dangerous condition!

  • Sudden drop in pressure, shock.
  • Severe abdominal pain, vomiting.
  • Loss of consciousness, possible death.

Symptoms of excess cortisol (hypercorticism)

Reasons:

  • Cushing’s disease (pituitary adenoma that secretes ACTH).
  • Cushing’s syndrome (a tumor of the adrenal glands or prolonged use of glucocorticoids).
  • Functional hypercorticism (chronic stress, obesity, alcoholism).

Symptoms:

  • Central obesity (belly fat, thin arms/legs).
  • ‘Moon-shaped face’, ‘buffalo hump’ (deposition of fat on the neck).
  • Stretch marks (striae) purple color on the stomach, thighs.
  • Muscle weakness (due to protein catabolism).
  • High blood pressure (hypertension).
  • Osteoporosis (frequent fractures).
  • Diabetes mellitus (steroid).
  • Immune disorders (frequent infections).
  • Depression, anxiety, insomnia.
  • For women: violation of the cycle, hirsutism.

The norm of cortisol in the blood

Cortisol has a circadian rhythm of secretion:

  • Maximum – in the morning (7-9 hours).
  • Minimum – in the evening (after 22:00).

Reference values:

Time of dayCortisol (nmol / l)Cortisol (mcg / dl)
Morning (7: 00-9: 00)138–6905–25
Evening (16: 00-20: 00)<50% of the morning value<10

Important:

  • If a violation is suspected ,a daily salivatest, a daily urine test for cortisol or a desmopressin test are prescribed.
  • In Cushing’s syndrome , the morning cortisol may be normal, but it does not decrease in the evening.

What should I do if there are deviations?

  • In case of excess: Pituitary/adrenal MRI, ACTH test, dexamethasone test.
  • In case of deficiency: ACTH-stimulation test, check of electrolytes (Na↓, K↑).

Treatment:

  • Hypercorticism – surgery (removal of the tumor), cortisol synthesis blockers.
  • Hypocorticism – lifelong replacement therapy (hydrocortisone).