What happens when the level of cortisol in the blood adequately meets the bodys metabolic needs?

Cortisol is a hormone that is mainly released at times of stress. Cortisol has many important functions in the body. Having the right cortisol balance is essential for human health and you can have problems if you produce too much or too little cortisol.

Table of Contents Show

What is cortisol?
What triggers the adrenal glands to produce cortisol?
What happens when you produce too much or little cortisol?
What are corticosteroids?
Are there any side effects of corticosteroid therapy?

What is cortisol?

Cortisol is a steroid hormone that is produced by the adrenal glands, which sit on top of each kidney. When released into the bloodstream, cortisol can act on many different parts of the body and can help:

the body respond to stress or danger
increase the body’s metabolism of glucose
control blood pressure
reduce inflammation

Cortisol is also needed for the fight or flight response, which is a healthy, natural response to perceived threats. The amount of cortisol produced is highly regulated by your body to ensure the balance is correct.

What triggers the adrenal glands to produce cortisol?

Cortisol production by the adrenal glands is regulated by the pituitary gland. The pituitary is a pea-sized gland at the base of the brain that is sometimes referred to as the "master gland" because of its wider effects on the body.

When you wake up, exercise or you’re facing a stressful event, your pituitary gland reacts. It sends a signal to the adrenal glands to produce just the right quantity of cortisol.

What happens when you produce too much or little cortisol?

The body usually produces the right amount of cortisol. In a condition such as Cushing’s syndrome, it produces too much. In a condition such as Addison’s disease, it produces too little.

Symptoms of too much cortisol include:

weight gain, particularly around the abdomen and face
thin and fragile skin that is slow to heal
acne
for women, facial hair and irregular menstrual periods

Symptoms of not enough cortisol include:

If you experience any of these symptoms, your doctor may suggest you have a blood test to measure your cortisol levels.

What are corticosteroids?

If your body does not produce enough cortisol, your doctor may prescribe corticosteroids for you. Corticosteroids are synthetic versions of cortisol that can be used to treat a variety of conditions including:

inflammatory conditions (such as asthma)
Addison’s disease
skin conditions (such as psoriasis)

Some people take anabolic steroids to build muscles, without a doctor’s prescription. This is risky. Anabolic steroids are different to corticosteroids.

Are there any side effects of corticosteroid therapy?

Because corticosteroids are powerful medications, side effects are quite common. These may include:

thinning skin
osteoporosis
weight gain, especially around the face, and increased appetite
high blood sugar or diabetes
rapid mood changes, feeling irritable and anxious
an increased chance of infections
Cushing's syndrome
eye conditions, such as glaucoma and cataracts
depression or suicidal thoughts
high blood pressure

Definition:
Acute adrenal crisis is a life-threatening state caused by insufficient levels of cortisol, which is a hormone produced and released by the adrenal gland.

Alternative Names: Adrenal crisis; Addisonian crisis; Acute adrenal insufficiency

Causes, incidence, and risk factors:
The two adrenal glands are located on top of the kidneys. They consist of the outer portion, called the cortex, and the inner portion, called the medulla. The cortex produces three types of hormones, all of which are called corticosteroids.

Cortisol is a glucocortoid, a corticosteroid that maintains glucose (blood sugar) regulation, suppresses the immune response, and is released as part of the body's response to stress. Cortisol production is regulated by a small gland just below the brain called the pituitary gland. Cortisol is essential for life. Acute adrenal crisis is a medical emergency caused by a lack of cortisol. Patients may experience lightheadedness or dizziness, weakness, sweating, abdominal pain, nausea and vomiting, or even loss of consciousness.

Adrenal crisis occurs if the adrenal gland is deteriorating (Addison's disease, primary adrenal insufficiency), if there is pituitary gland injury (secondary adrenal insufficiency), or if adrenal insufficiency is not adequately treated. Risk factors for adrenal crisis include physical stress such as infection, dehydration, trauma, or surgery, adrenal gland or pituitary gland injury, and ending treatment with steroids such as prednisone or hydrocortisone too early.

Symptoms:

Headache
Profound weakness
Fatigue
Slow, sluggish movement
Nausea
Vomiting
Low blood pressure
Dehydration
High fever
Shaking chills
Confusion or coma
Darkening of the skin
Rapid heart rate
Joint pain
Abdominal pain
Unintentional weight loss
Rapid respiratory rate (see tachypnea)
Unusual and excessive sweating on face and/or palms
Skin rash or lesions may be present
Flank pain
Loss of appetite

Signs and tests:

An ACTH (cortrosyn) stimulation test shows low cortisol.
The baseline cortisol level is low.
Fasting blood sugar may be low.
Serum potassium is elevated ( usually primary adrenal insufficiency).
Serum sodium is decreased (usually primary adrenal insufficiency).

Treatment:
In adrenal crisis, an intravenous or intramuscular injection of hydrocortisone (an injectable corticosteroid) must be given immediately. Supportive treatment of low blood pressure with intravenous fluids is usually necessary. Hospitalization is required for adequate treatment and monitoring. If infection is the cause of the crisis, antibiotic therapy may be needed.

Expectations (prognosis):
Death may occur due to overwhelming shock if early treatment is not provided.

Complications:

Calling your health care provider:
Call your health care provider if you have Addison's disease and are unable to retain usual medications because of vomiting.Go to the emergency room or call the local emergency number (such as 911) if symptoms of acute adrenal crisis develop.

Prevention:
People who have Addison's disease should be taught to recognize signs of potential stress that may cause an acute adrenal crisis. Most people with Addison's disease are taught to give themselves an emergency injection of hydrocortisone or increase their dose of oral prednisone in times of stress.

It is important for the individual with Addison's disease to always carry a medical identification card that states the type of medication and the proper dose needed in case of an emergency.

Never omit medication. If unable to retain medication due to vomiting, notify the health care provider.

URL of this page: https://medlineplus.gov/lab-tests/cortisol-test/

A cortisol test measures the level of cortisol in your blood, urine, or saliva to see if your levels are normal. Cortisol is a hormone that affects almost every organ and tissue in your body. It helps your body:

Respond to stress (cortisol is sometimes called the "stress hormone")
Reduce inflammation
Regulate blood sugar and metabolism (how your body uses food for energy)
Control blood pressure

Cortisol is made by your adrenal glands, two small glands that sit above the kidneys. A gland in your brain, called the pituitary gland, makes a hormone that tells your adrenal glands how much cortisol to make. If your cortisol levels are too high or too low, it may mean you have a disorder of your adrenal glands, a problem with your pituitary gland, or a tumor that makes cortisol.

High levels of cortisol may also happen if you take large doses of certain steroid medicines, such as prednisone, for a long time. And low levels may happen if you stop the medicine suddenly.

Without treatment, cortisol levels that are too high or too low can be very serious.

Other names: urinary cortisol, salivary cortisol, free cortisol, blood cortisol, plasma cortisol

A cortisol test is used to help diagnose medical conditions that cause too much or too little cortisol. These conditions include disorders that affect the adrenal glands:

Cushing's syndrome is a disorder that happens when your body has too much cortisol over a long period of time.
Addison disease is a condition in which your adrenal glands are damaged and can't make enough cortisol.
Secondary adrenal insufficiency is a condition in which your adrenal glands don't make enough cortisol because your pituitary gland isn't working properly.

Cortisol testing is also used to monitor treatment for these conditions.

You may need a cortisol test if you have symptoms of a condition that affects cortisol levels.

Symptoms of Cushing's syndrome (too much cortisol) may include:
- Weight gain
- Thin arms and legs
- Round face
- Increased fat around the base of the neck or between the shoulder blades
- Easy bruising
- Wide purple streaks on the stomach, breasts, hips, and under the arms
- Muscle weakness
Common symptoms of Addison disease and adrenal insufficiency (not enough cortisol) may include:

A cortisol test often uses a sample of blood drawn at a lab. But the test may also be done on urine or saliva collected at home. Normally, cortisol levels vary during the day, so your provider may order more than one type of test to get more information about your cortisol levels.

For a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

Blood samples are usually taken twice during the day--once in the morning when cortisol levels are at their highest, and again around 4 p.m., when levels are much lower.

For a cortisol urine test, your provider may ask you to collect all your urine during a 24-hour period. This is called a "24-hour urine sample test." For this test, you'll be given a special container and instructions for how to collect and store your urine sample. Your provider will tell you what time to start. The test usually includes the following steps:

To begin, urinate in the toilet as usual. Do not collect this urine. Write down the time you urinated.
For the next 24 hours, collect all your urine in the container.
Store the urine container in a refrigerator or in a cooler with ice during the collection period.
24 hours after starting the test, try to urinate if you can. This is the last urine collection for the test.
Return the container with your urine to your provider's office or the laboratory as instructed.

In certain cases, a urine test for cortisol may be done on one sample of urine collected in the morning.

A cortisol saliva test is usually done at home with a kit to collect a saliva sample. Your provider will tell you what time to collect your sample. It's often done at night before you go to bed when cortisol levels are normally lower.

Most kits include a swab and a container to store it. Be careful to follow the instructions that come with your kit. They usually include these general steps:

Do not eat, drink, brush, or floss your teeth for 30 minutes before the test.
Wash and dry your hands.
Open the tube that holds the swab and let the swab fall into your mouth without touching it with your hands.
Roll the swab in your mouth or hold it under your tongue for about 2 minutes until it is soaked with saliva.
Spit the swab back into the tube without touching it and close the tube.
Label the tube with the time you collected the sample.
Take your saliva sample to your doctor's office or the lab the next day as instructed.

The preparations will depend on the type of test you are having. Be sure to follow all the instructions that your provider gives you.

Stress can raise your cortisol levels, so you may need to rest before your test. A blood test will require you to schedule two appointments at different times of the day. Before a saliva test, you may need to stop using certain medicines. Let your provider know about all medicines you use, including skin creams. But don't stop using any medicines without talking with your provider first.

There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.

There are no known risks to a urine or saliva test.

A cortisol test alone can't diagnose the cause of abnormal cortisol levels. If your cortisol level isn't normal, you will usually have more tests to find out what is causing the problem.

High levels of cortisol may be a sign that you have Cushing's syndrome. It may be caused by:

Taking high doses of certain steroid medicines for a long time to treat conditions, such as asthma, rheumatoid arthritis, and lupus
Tumors in your pituitary gland or other parts of your body that make too much of the hormone that tells your adrenal glands to make cortisol
Tumors in your adrenal glands that make extra cortisol

Low levels of cortisol may mean you have Addison disease or secondary adrenal insufficiency:

Common causes of Addison's disease include damage to the adrenal glands from conditions, such as:
Common causes of secondary adrenal insufficiency include:

The most common cause of low cortisol levels is suddenly stopping steroid medicines after using them for a long time.

If your cortisol results aren't normal, it doesn't always mean you have a medical condition that needs treatment. Cortisol levels can be affected by:

Stress
Pregnancy
Exercise
Serious illness
Hot and cold temperatures
Certain thyroid diseases
Obesity
Certain medicines, such as birth control pills

To learn what your test results mean, talk with your health care provider.

Learn more about laboratory tests, reference ranges, and understanding results.

A cortisol test is one of the tests that may be used to help diagnose congenital adrenal hyperplasia (CAH). CAH is a group of inherited disorders in which the adrenal glands don't make enough cortisol.

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