A healthy living blog from Marshfield Clinic Health System

Cortisol: Our body’s natural stress hormone

Cortisol is a hormone produced by your adrenal glands, which sit on top of each kidney. It’s considered the body’s natural stress hormone and helps our bodies regulate stress and maintain healthy blood pressure. Having lower cortisol levels can impact our health.

It is regulated by your pituitary gland, which is located at the base of your brain. Your pituitary gland reacts to things like waking up, exercise or stressful events. This sends a signal to your adrenal glands to produce the right amount of cortisol.

Cortisol has many important functions

“Our bodies naturally regulate our cortisol levels. During periods of personal or physical strain or infections, our body will increase or decrease our levels as needed,” said Dr. Odette Morgan, endocrinologist with Marshfield Clinic Health System.

Middle-aged lady holding cup as she ponders how lower cortisol levels impact her health 

Cortisol is a hormone produced by your adrenal glands, which sit on top of each kidney. It’s considered the body’s natural stress hormone and helps our bodies regulate stress and maintain healthy blood pressure.

The hormone affects almost every organ and tissue in your body.

Cortisol can help regulate:

  • Your body’s response to stress or danger
  • Blood sugar
  • Blood pressure
  • Inflammation
  • The sleep-wake cycle

Lower cortisol levels can impact our health

Typically, your body regulates cortisol production to keep you healthy. In some cases, your body may produce lower cortisol levels, causing Addison’s disease. Addison’s disease is an uncommon illness, but can affect anyone and can be life-threatening.

The symptoms of Addison’s disease can develop slowly. Due to the slower progression, people may not realize that their symptoms are signaling Addison’s disease and the symptoms may be initially ignored. An acute illness or injury may cause symptoms to progress.

If levels are low and someone is facing adrenal insufficiency, they may experience:

  • Extreme fatigue
  • Dizziness
  • Low blood pressure or fainting
  • Nausea or vomiting
  • Depression
  • Feeling generally unwell
  • Failure to thrive in children

“If low cortisol levels go unrecognized, a person could become very sick, face infections or could end up in the hospital in a severe state known as adrenal crisis,” Dr. Morgan said.

Lower cortisol levels can impact men and women equally and cause similar symptoms. However, women are more likely than men to develop Addison’s disease, largely due to the fact that autoimmune diseases are more common in women.

Reasons your cortisol levels may be too low

Lower than normal levels are considered adrenal insufficiency. There are many reasons you may be facing adrenal insufficiency.

Adrenal insufficiency can be due to a disorder directly affecting the adrenal glands, known as primary adrenal insufficiency. It also can be due to medications, illness or damage to the pituitary gland, causing secondary adrenal insufficiency. Secondary adrenal insufficiency is a common disorder.

Common causes of primary adrenal insufficiency are congenital, meaning it is something they were born with. Other causes include autoimmune diseases, where the immune system launches an attack on the adrenal glands, viral infections such as cytomegalovirus (CMV), HIV, COVID-19, and fungal infections.

Trauma that causes bleeding into the adrenal glands or cancers that spread to the adrenal glands, such as lymphoma or kidney cancer, also may impact cortisol levels.

Common causes of secondary adrenal insufficiency include pituitary tumors, bleeding into the pituitary gland or taking certain medications over a prolonged period of time. The medications include prescription steroids or narcotics that suppress the pituitary gland from making ACTH, the hormone that regulates cortisol.

It can be treated

If you are living with low cortisol levels, it is vital you receive treatment, as the condition can be life-threatening.

“Treatments are available after an initial evaluation with a provider,” Dr. Morgan said. “We will check blood cortisol levels and do an ACTH check and do confirmatory tests, as needed.”

Treatments may include replenishing the cortisol levels with pharmaceutical steroids, like hydrocortisone.

“Your endocrinologist or provider will determine what is the best option for you,” Dr. Morgan said.

Since low cortisol levels are not due to an unhealthy lifestyle, it can’t be treated by lifestyle changes.

“However, it’s always recommended to live a healthy lifestyle, if you are diagnosed with adrenal insufficiency,” Dr. Morgan said. “Steroid therapy can be associated with weight gain, a rise in blood sugar and an increased risk of infection by suppression of the immune system, making it important to continue healthy habits.”

For questions about cortisol, talk to a Marshfield Clinic Health System provider.

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