Summary

Cortisol, often referred to as the "stress hormone," plays a crucial role in the body's stress response and regulation of various physiological processes. It is produced by the adrenal glands, situated on top of the kidneys. Cortisol levels during the daytime follow a natural rhythm known as the circadian rhythm, influencing a range of bodily functions and overall well-being.

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Overview

Cortisol participates in various functions in the human body. Its secretion is linked to the hypothalamic-pituitary-adrenal (HPA) axis, a complex network involving the hypothalamus, pituitary gland, and adrenal glands. The adrenal glands release cortisol in response to signals from the HPA axis, which is activated during stressful situations as well as part of the body's natural daily rhythm.

Cortisol can affect almost any organ and tissue in the body. It takes part in responding to stress, reducing inflammation, regulating blood sugar and metabolism, and controlling blood pressure. The concentration of cortisol in the bloodstream is influenced by various factors, including stressors, physical activity, sleep patterns, and certain medical conditions or medications.^[1-3] 

The levels of cortisol fluctuate throughout the day. It typically peaks in the morning, right after waking up. This surge of cortisol helps kickstart your day by providing a boost of energy and alertness. As the day progresses, cortisol levels tend to gradually decrease. Nighttime cortisol levels should be at their lowest, facilitating rest and sleep. This drop in cortisol supports the body's efforts to wind down and recover.

If cortisol levels are too high or too low, it may indicate a problem with the adrenal glands, pituitary gland, or a cortisol-secreting tumor. It can be used to diagnose and monitor diseases such as a set of diseases causing Cushing's syndrome (too much cortisol), Addison's disease (adrenal glands do not make enough cortisol), or secondary insufficiency due to a dysfunctional pituitary gland.

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What should you know about cortisol levels?

A cortisol test measures the level of cortisol in your blood, urine, or saliva to see if your levels are normal. Analyzing cortisol levels at different times of the day provides insights into your stress response and adrenal health, helping to identify potential imbalances.^[4-6]

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Morning Cortisol 

• Low Levels

Lower-than-normal morning cortisol levels might point toward adrenal insufficiency, fatigue, or disrupted sleep patterns. 

• High Levels

Elevated morning cortisol levels could indicate excessive stress or overactivation of the adrenal glands. This might result in symptoms like restlessness, anxiety, and insomnia.

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Afternoon Cortisol

• Stable Levels

A steady decline in cortisol during the afternoon is generally indicative of a balanced stress response and healthy adrenal function.

• Disrupted Levels

A sudden increase or decrease in afternoon cortisol levels might signal an irregular stress pattern, potentially linked to chronic stress, poor sleep, or hormonal imbalances.

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Night Cortisol

• Stable Levels

Adequately reduced cortisol levels at night support quality sleep, allowing your body to rest and recharge.

• Disrupted Levels

Extremely low or high night cortisol levels might indicate disruptions in the circadian rhythm, which could contribute to sleep disorders and impact overall health. Elevated levels during the night cause difficulty falling asleep, staying asleep and reaching deeper stages of sleep.

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What are the possible causes?

High levels of cortisol over a long period of time can cause Cushing's syndrome, a set of symptoms caused by a number of external factors and diseases. The most common cause is taking high doses of steroid medications for a long period of time. Alternatively, it can result from a tumor in the pituitary gland, causing it to produce too much ACTH – a hormone that signals your adrenals to release cortisol. Another possibility is a tumor in the adrenal glands that causes excessive production of cortisol directly. It’s important to consult a doctor for proper evaluation and guidance. 

Cushing's syndrome is characterized by a distinctive appearance that can be identified by slender arms and legs, a rounded face, increased fat around the abdomen and neck, and prominent broad purple stretch marks. Additionally, high cortisol levels can contribute to other health issues, including high blood pressure, elevated blood sugar levels, muscle weakness, osteoporosis, acne, and irregular menstruation.

Low cortisol levels can sometimes indicate problems with adrenals, like Addison’s disease (primary adrenal insufficiency). Alternatively, it might arise due to a malfunction of the pituitary gland, resulting in insufficient production of ACTH (secondary adrenal insufficiency). However, the main reason for low cortisol levels is often the sudden discontinuation of steroid drugs after long-term use. 

Low cortisol can lead to fatigue, loss of appetite, weight loss, muscle weakness, and abdominal pain. 

If you experience any of these symptoms, please contact your healthcare provider for further evaluation.

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Diurnal cortisol response^[13-16]

1. The Optimal Response

Morning cortisol levels usually reach their peak shortly after waking, usually within 30 to 45 minutes. Cortisol levels gradually decrease during the day and reach their lowest point late in the evening or at night. This drop prepares the body for rest and sleep.

Fig. 1: The Optimal cortisol response curve.
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2. The Flattened Curve

The flattened diurnal cortisol curve is characterized by less variation in cortisol levels during the day. This can mean a lower morning cortisol level, a smaller drop during the day, or both. It can be caused by several factors, such as chronic stress, irregular sleep patterns, certain health problems, or medications.

Fig. 2: The Flattened curve of the cortisol response.
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3. ‍The Inverted Curve

An inverted curve may indicate a circadian rhythm disorder, which can be caused by long-term stress, shift work, sleep disorders, or other factors. It may also indicate underlying health problems that affect cortisol regulation.

Fig. 3: The Inverted curve of the cortisol response.
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4. Chronic Stress Curve (one of several curve variants)

The cortisol curves in chronic stress reactions may show, for example, relatively high morning levels followed by disproportionately low afternoon and nighttime levels. This pattern reflects an altered body response to stress, which may be related to circadian rhythm disturbances or health problems that affect cortisol regulation.

Fig. 4: Salivary cortisol response to chronic stress.

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Genetics

Certain genetic differences impact how our bodies produce, utilize, and metabolize cortisol. For instance, variations in the gene encoding the glucocorticoid receptor can modify how sensitive the receptor is to cortisol. These genetic variances shape how individuals react to stress and their sensitivity to conditions linked with imbalances in cortisol.^[7,8]

Recommendations

Maintaining balanced cortisol levels is an important aspect of good health. The following techniques are evidence-based and are also well-known for to their simplicity and effectiveness:

• The basis of a healthy lifestyle and well-being is regular physical activity, a balanced diet, sufficient sleep, and hydration.
• Consult your healthcare provider if you experience any symptoms of high or low cortisol levels. 
• Stress management is essential. Techniques like meditation, deep-breathing exercises, and guided imagery can help manage stress levels.
• Excessive caffeine can disrupt your sleep cycle and increase cortisol levels. If you consume more caffeine than recommended during the day, reducing your intake could be very beneficial.
• A regular sleep schedule aligns with your body's circadian rhythm, helping regulate cortisol production.
• An interesting effect of aromatherapy has been observed. In some studies, the use of lavender and rosemary scents had the effect of lowering serum cortisol levels and relieving anxiety.^[9,10] 
• Laughter has been shown to reduce stress and cortisol release. For example, watching an entertaining movie or enjoying time with family and friends can be beneficial.^[11,12]

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The information and tests provided on our website are for educational purposes only and are not a substitute for professional medical advice. Always consult with your healthcare provider before making health decisions. Our tests do not diagnose or treat diseases. Individual results may vary and should be discussed with a healthcare provider.

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