High Cortisol Levels: 13 Signs and Symptoms, Causes & Treatment

High cortisol levels, also known as hypercortisolism, are most commonly caused by the prolonged use of corticosteroid medications, but they can also result from chronic stress or tumors in the adrenal glands or pituitary gland.

This condition can lead to symptoms like mood changes, weight gain, high blood pressure, diabetes, muscle weakness, and osteoporosis. To determine whether cortisol levels are high, a general practitioner or endocrinologist may evaluate symptoms and request blood, urine, or saliva tests to help guide treatment.

Cortisol is often referred to as the “stress hormone” and plays a role in regulating metabolism, supporting immune function, and helping the body respond to stress.

Common symptoms

Common signs and symptoms of high cortisol levels include:

1. Weight gain

High cortisol levels can lead to progressive weight gain, especially in the face, abdomen, and upper back due to increased fat accumulation and redistribution.

They may also cause fluid retention and swelling, which contributes to additional weight gain.

2. Diabetes

Excess cortisol can trigger the liver to produce more glucose, reduce insulin sensitivity, and lower insulin production in the pancreas. This can lead to high blood sugar levels and increase the risk of diabetes.

Symptoms may include excessive thirst, increased appetite, frequent urination, and the need to urinate more often. Read more about diabetes symptoms and how they can present with type 1 and type 2 diabetes.

3. Osteoporosis

Cortisol interferes with calcium absorption in the bones, increasing the risk of osteoporosis.
It also reduces the number and activity of bone-forming cells while enhancing bone resorption, leaving bones more fragile.

4. Mood changes

High cortisol levels may cause mood disturbances such as stress, anxiety, euphoria, irritability, and depression. This is due to adrenaline release and direct action on the brain.
In some cases, severe psychotic episodes may occur, even in people with no history of psychiatric illness.

5. High cholesterol

Cortisol can increase the liver’s production of fats and their release into the bloodstream. This can raise total cholesterol and LDL (bad cholesterol) levels, while lowering HDL (good cholesterol).

6. High blood pressure

High cortisol may raise or worsen blood pressure due to fluid retention in the blood vessels.
This occurs because cortisol influences the balance of water and electrolytes and increases adrenaline levels in the body.
High blood pressure may cause symptoms like headaches, dizziness, or blurry vision.

7. Muscle weakness

High cortisol reduces protein production and increases protein breakdown in tissues, which can lead to muscle weakness.
This may be noticed as difficulty climbing stairs or getting out of bed or a chair.

8. Irregular menstrual cycles

High cortisol can interfere with female reproductive hormones, causing irregular periods, missed periods, infrequent periods, or even infertility.
It can also increase male hormone levels in women, leading to symptoms like excess body hair, acne, deepening of the voice, and hair thinning.

9. Erectile dysfunction

In men, high cortisol levels may affect male hormones, potentially causing erectile dysfunction, reduced libido, fatigue, and muscle weakness.

10. Poor sleep quality

Elevated cortisol may reduce sleep quality or duration, leading to difficulty falling asleep, insomnia, vivid dreams, or nightmares.

11. Frequent infections

Cortisol can suppress immune responses and reduce inflammation, which may increase the risk of frequent infections.

12. Slow wound healing

Cortisol decreases collagen production, a protein that helps strengthen the skin and aids healing, resulting in delayed wound recovery.

13. Skin changes

High cortisol levels can thin and weaken the skin, increasing the risk of skin infections.
They may also raise the risk of stretch marks, skin discoloration, hair loss, acanthosis nigricans, and acne.

These symptoms are often linked to persistently elevated cortisol levels and may lead to Cushing’s syndrome.

How to confirm the diagnosis

When high cortisol levels or Cushing’s syndrome is suspected, a general practitioner or endocrinologist may order blood, urine, or saliva tests to check cortisol levels in the body.

Also recommended: Cortisol Test: What It's For, Types, Normal Levels & Results tuasaude.com/en/cortisol-test

If test results are high, the doctor will investigate the cause through a clinical evaluation and imaging tests such as CT scan or MRI of the abdomen and brain, or possibly PET scan or scintigraphy.

Possible causes

High cortisol levels can be caused by:

• Use of corticosteroid medications such as prednisone or dexamethasone for more than 15 days and/or in high doses

• Adrenal gland disorders, caused by tumors or cell dysfunction that leads to overproduction of cortisol

• Pituitary gland tumors in the brain that stimulate the adrenal glands to produce excess cortisol

• Adrenal gland tumors, which directly produce cortisol

• Chronic stress or poor sleep habits, which can disrupt cortisol regulation and increase production

Stress typically causes a mild increase in cortisol levels, while more severe or prolonged elevations are usually linked to adrenal or pituitary disorders.

Why cortisol increases during pregnancy

Cortisol levels rise during pregnancy, especially in the final weeks, in response to CRH, a hormone produced by the placenta.

This increase is important for the development of the baby’s cardiovascular, lung, and kidney systems. Babies born prematurely have a higher risk of breathing problems due to insufficient cortisol.
When there is a high risk of preterm birth, doctors may prescribe synthetic corticosteroids to help the baby’s lungs develop more quickly.

Complications from high cortisol levels, such as Cushing’s syndrome, are rare during pregnancy and postpartum, as cortisol levels usually return to normal after childbirth.

How to lower cortisol levels

High cortisol levels can be corrected with measures like:

1. Exercising regularly

Regular physical activity helps lower cortisol and reduce stress, which is a common cause of high cortisol levels.
Exercise also supports healthy weight management, lowers the risk of heart disease, and helps regulate blood sugar levels.
The general recommendation is 150 to 200 minutes of low to moderate intensity physical activity per week, depending on medical advice.

2. Sleeping 8 to 9 hours per night

Getting quality sleep for 8 to 9 hours each night helps lower cortisol, as the body reduces cortisol and adrenaline production during sleep.

To improve sleep quality, it may help to drink a calming tea, avoid using phones before bed, regulate bedroom temperature, and follow good sleep hygiene practices. Check-out other tips for falling asleep fast.

3. Following a nutritious diet

A balanced and nutritious diet, low in fat, sugar, and salt, can help reduce cortisol levels.

It's also important to eat foods high in protein and potassium, such as eggs, dairy products, fish, oats, almonds, walnuts, chia seeds, and flaxseeds.

4. Reviewing corticosteroid use

If high cortisol is due to long-term or high-dose corticosteroid use, it's important to speak to the prescribing doctor about gradually reducing the dosage over several days until it can be safely stopped.
Corticosteroids should never be discontinued abruptly or without medical supervision, as this may lead to adrenal insufficiency.

5. Taking medications

In more severe cases, medications may be prescribed to lower cortisol levels, such as metyrapone or ketoconazole, depending on the doctor’s recommendation.