Adrenal
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June 3, 2024

Cortisol Dysregulation: Causes, Symptoms & Management

Medically Reviewed by
Updated On
September 17, 2024

Three-quarters of American adults are afflicted by stress that affects their mental, emotional, and physical health. This staggering number highlights just how pervasive stress has become in the modern world.Β 

Cortisol dysregulation, often a result of chronic stress, is a common yet frequently misunderstood condition. This stress hormone is meant to help us cope with life's challenges, but when it goes awry, it can wreak havoc on our physical and emotional well-being.Β 

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The Role of Cortisol in the Body

Cortisol is a steroid hormone produced by the adrenal glands in response to stress and other stimuli.

Cortisol has many important functions, regulating various aspects of human health:

Normal Cortisol Levels

Under normal conditions, cortisol exhibits a characteristic diurnal pattern, meaning it follows a peak-trough pattern throughout the day. The highest levels occur in the morning, about 30 minutes after waking up. After cortisol peaks, it gradually declines over the course of the day, reaching its lowest point in the late evening and early night. (19)Β 

This pattern is important to understand because normal cortisol levels are dependent upon the time of day cortisol levels are measured. Additionally, the method by which cortisol is measured will influence normal levels:

  • Serum Cortisol: AM 6.2-19.4 ΞΌg/dL; PM: 2.3βˆ’11.9 ΞΌg/dL
  • Urine Cortisol: AM 10-130 ng/mg; PM 0-14 ng/mg
  • Salivary Cortisol: AM 3.7-9.5 ng/mL; PM 0.4-1.0 ng/mL

Understanding Cortisol Dysregulation

Cortisol dysregulation encompasses irregularities in the body's production and control of cortisol. It spans a spectrum, with Addison's disease (insufficient cortisol) and Cushing's syndrome (excessive cortisol) at the extremes. Within this spectrum, cortisol can vary in quantity and timing of release, deviating from its typical patterns. This deviation can manifest as imbalances in cortisol levels throughout the day or in response to stressors.

What Causes Cortisol Dysregulation?

Pathologic cortisol dysregulation refers to abnormalities in cortisol secretion primarily caused by underlying medical conditions, such as Addison's disease or Cushing's syndrome. These conditions involve structural or functional changes in the adrenal glands or other parts of the endocrine system, leading to persistent and severe alterations in cortisol levels. (22, 24)Β 

In the absence of frank pathology, cortisol dysregulation can be attributed to hypothalamic-pituitary-adrenal (HPA) dysfunction (sometimes called "adrenal fatigue"). The HPA axis is the neuroendocrine system responsible for regulating cortisol production in response to stress.Β 

There are three stages of HPA dysfunction:Β 

What causes HPA dysfunction? Simply stated – chronic stress. Mental, emotional, and physical stressors continually signal the hypothalamus to activate the HPA axis to fight the perceived danger. Stressors include (9, 16):Β Β 

  • Emotional stress (e.g., high-stress jobs, grief, and other major life changes)
  • Inadequate sleepΒ 
  • High-intensity exercise without adequate recoveryΒ 
  • Poor diet and nutrient insufficiencies
  • Chronic infections
  • Exposure to environmental toxins

The Impact of Dysregulated CortisolΒ 

Cortisol dysregulation, whether due to excessive or insufficient levels, can have profound effects on both mental and physical health, contributing to the development and progression of chronic diseases. Sustained cortisol abnormalities have been associated with (12, 13):Β Β 

  • Advanced aging
  • Chronic inflammation
  • Mood disorders, such as depression and anxiety
  • Chronic fatigue syndromeΒ 
  • Neurodegeneration and cognitive decline
  • Metabolic dysfunctionΒ 
  • Cardiovascular disease
  • Immune dysfunctionΒ 

Symptoms of Cortisol Dysregulation

Cortisol dysregulation can manifest through a variety of symptoms, reflecting the hormone's widespread influence on bodily functions.

The following signs and symptoms are hallmarks of high cortisol levels:Β 

  • Weight gain, particularly in the upper body, face, and abdomen
  • High blood pressure
  • Muscle wastingΒ 
  • Easy bruising
  • Slow wound healingΒ 
  • Menstrual irregularities
  • Excessive hair growth (hirsutism)
  • Increased risk of osteoporosis and bone fractures

Characteristic signs and symptoms of insufficient cortisol levels include:

  • Chronic fatigue and weakness
  • Weight loss and decreased appetite
  • Low blood pressure and blood sugar
  • Darkening of the skin (hyperpigmentation)
  • Nausea, vomiting, and diarrhea
  • Muscle or joint pain

Medical Treatments for Cortisol Dysregulation

Pathologic cortisol dysregulation (i.e., Cushing's syndrome and Addison's disease) requires medical interventions to normalize cortisol levels.

If the underlying cause of Cushing's syndrome is a hormone-secreting tumor, surgery or radiation therapy may be necessary to remove or shrink the tumor. In cases where Cushing's syndrome is due to exogenous use of glucocorticoid medications, modifying the type and dose of medication is necessary. (22)Β 

The cornerstone of treatment for Addison's disease involves replacing the deficient hormones, particularly cortisol and aldosterone.

Lifestyle modifications, such as stress reduction techniques, maintaining a balanced diet, regular exercise, and avoiding excessive alcohol and caffeine consumption, can support standard medical management and improve the quality of life for individuals with cortisol dysregulation. (22, 24)Β 

Prevention Strategies

The prevention and treatment of functional cortisol abnormalities revolve around preserving normal HPA axis signaling. Treatment strategies should encompass healthfully managing stress, reducing inflammation, and optimizing nutrition:

  • Avoid and remove stressors when possible
  • Practice stress management techniques, such as deep breathing, meditation, and yoga, to reduce stress caused by unavoidable triggers
  • Maintain healthy relationships
  • Prioritize quality sleep
  • Exercise regularlyΒ 
  • Eat a balanced, anti-inflammatory diet that is built around unprocessed, nutrient-dense foods
  • In some cases, stress-relieving and anti-inflammatory supplements can complement these foundational lifestyle habits to establish healthy cortisol levels.

[signup]

Key Takeaways

  • Cortisol dysregulation represents a complex interplay of hormonal imbalances that can profoundly impact physical and mental health. The manifestations of cortisol dysregulation are diverse and often challenging to navigate.Β 
  • Effective management of cortisol dysregulation involves a multifaceted approach, including stress reduction techniques, adequate sleep, healthy nutrition, and regular exercise. In some cases, hormone replacement therapy and surgical interventions may be required to restore hormonal balance.

Three-quarters of American adults experience stress that can affect their mental, emotional, and physical health. This significant number highlights just how common stress has become in the modern world.Β 

Cortisol dysregulation, often a result of chronic stress, is a common yet frequently misunderstood condition. This stress hormone is meant to help us cope with life's challenges, but when it functions abnormally, it can impact our physical and emotional well-being.Β 

[signup]

The Role of Cortisol in the Body

Cortisol is a steroid hormone produced by the adrenal glands in response to stress and other stimuli.

Cortisol has many important functions, regulating various aspects of human health:

Normal Cortisol Levels

Under normal conditions, cortisol exhibits a characteristic diurnal pattern, meaning it follows a peak-trough pattern throughout the day. The highest levels occur in the morning, about 30 minutes after waking up. After cortisol peaks, it gradually declines over the course of the day, reaching its lowest point in the late evening and early night. (19)Β 

This pattern is important to understand because normal cortisol levels are dependent upon the time of day cortisol levels are measured. Additionally, the method by which cortisol is measured will influence normal levels:

  • Serum Cortisol: AM 6.2-19.4 ΞΌg/dL; PM: 2.3βˆ’11.9 ΞΌg/dL
  • Urine Cortisol: AM 10-130 ng/mg; PM 0-14 ng/mg
  • Salivary Cortisol: AM 3.7-9.5 ng/mL; PM 0.4-1.0 ng/mL

Understanding Cortisol Dysregulation

Cortisol dysregulation encompasses irregularities in the body's production and control of cortisol. It spans a spectrum, with Addison's disease (insufficient cortisol) and Cushing's syndrome (excessive cortisol) at the extremes. Within this spectrum, cortisol can vary in quantity and timing of release, deviating from its typical patterns. This deviation can manifest as imbalances in cortisol levels throughout the day or in response to stressors.

What Causes Cortisol Dysregulation?

Pathologic cortisol dysregulation refers to abnormalities in cortisol secretion primarily caused by underlying medical conditions, such as Addison's disease or Cushing's syndrome. These conditions involve structural or functional changes in the adrenal glands or other parts of the endocrine system, leading to persistent and severe alterations in cortisol levels. (22, 24)Β 

In the absence of frank pathology, cortisol dysregulation can be attributed to hypothalamic-pituitary-adrenal (HPA) dysfunction (sometimes called "adrenal fatigue"). The HPA axis is the neuroendocrine system responsible for regulating cortisol production in response to stress.Β 

There are three stages of HPA dysfunction:Β 

What causes HPA dysfunction? Simply stated – chronic stress. Mental, emotional, and physical stressors continually signal the hypothalamus to activate the HPA axis to manage perceived challenges. Stressors include (9, 16):Β Β 

  • Emotional stress (e.g., high-stress jobs, grief, and other major life changes)
  • Inadequate sleepΒ 
  • High-intensity exercise without adequate recoveryΒ 
  • Poor diet and nutrient insufficiencies
  • Chronic infections
  • Exposure to environmental toxins

The Impact of Dysregulated CortisolΒ 

Cortisol dysregulation, whether due to excessive or insufficient levels, can have significant effects on both mental and physical health, potentially contributing to the development and progression of various health issues. Sustained cortisol abnormalities have been associated with (12, 13):Β Β 

  • Advanced aging
  • Chronic inflammation
  • Mood disorders, such as depression and anxiety
  • Chronic fatigue syndromeΒ 
  • Neurodegeneration and cognitive decline
  • Metabolic dysfunctionΒ 
  • Cardiovascular disease
  • Immune function challengesΒ 

Symptoms of Cortisol Dysregulation

Cortisol dysregulation can manifest through a variety of symptoms, reflecting the hormone's widespread influence on bodily functions.

The following signs and symptoms are hallmarks of high cortisol levels:Β 

  • Weight gain, particularly in the upper body, face, and abdomen
  • High blood pressure
  • Muscle wastingΒ 
  • Easy bruising
  • Slow wound healingΒ 
  • Menstrual irregularities
  • Excessive hair growth (hirsutism)
  • Increased risk of osteoporosis and bone fractures

Characteristic signs and symptoms of insufficient cortisol levels include:

  • Chronic fatigue and weakness
  • Weight loss and decreased appetite
  • Low blood pressure and blood sugar
  • Darkening of the skin (hyperpigmentation)
  • Nausea, vomiting, and diarrhea
  • Muscle or joint pain

Medical Treatments for Cortisol Dysregulation

Pathologic cortisol dysregulation (i.e., Cushing's syndrome and Addison's disease) requires medical interventions to help manage cortisol levels.

If the underlying cause of Cushing's syndrome is a hormone-secreting tumor, surgery or radiation therapy may be necessary to address the tumor. In cases where Cushing's syndrome is due to exogenous use of glucocorticoid medications, modifying the type and dose of medication is necessary. (22)Β 

The cornerstone of treatment for Addison's disease involves replacing the deficient hormones, particularly cortisol and aldosterone.

Lifestyle modifications, such as stress reduction techniques, maintaining a balanced diet, regular exercise, and avoiding excessive alcohol and caffeine consumption, can support standard medical management and improve the quality of life for individuals with cortisol dysregulation. (22, 24)Β 

Prevention Strategies

The prevention and management of functional cortisol abnormalities revolve around supporting normal HPA axis signaling. Strategies may include managing stress, reducing inflammation, and optimizing nutrition:

  • Avoid and remove stressors when possible
  • Practice stress management techniques, such as deep breathing, meditation, and yoga, to help manage stress caused by unavoidable triggers
  • Maintain healthy relationships
  • Prioritize quality sleep
  • Exercise regularlyΒ 
  • Eat a balanced, anti-inflammatory diet that is built around unprocessed, nutrient-dense foods
  • In some cases, stress-relieving and anti-inflammatory supplements can complement these foundational lifestyle habits to support healthy cortisol levels.

[signup]

Key Takeaways

  • Cortisol dysregulation represents a complex interplay of hormonal imbalances that can impact physical and mental health. The manifestations of cortisol dysregulation are diverse and often challenging to navigate.Β 
  • Effective management of cortisol dysregulation involves a multifaceted approach, including stress reduction techniques, adequate sleep, healthy nutrition, and regular exercise. In some cases, hormone replacement therapy and surgical interventions may be required to help manage hormonal balance.
The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or on this website.

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  1. Addison's Disease. (2022, July 6). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/15095-addisons-disease#management-and-treatment
  2. Addison's Disease. (2022, December 8). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/addisons-disease/symptoms-causes/syc-20350293
  3. Bethune, S. (2022, October). Stress in America 2022. American Psychological Association. https://www.apa.org/news/press/releases/stress/2022/concerned-future-inflation
  4. Blake, K. (2023, May 22). Anti Inflammatory Diet 101: What to Eat and Avoid Plus Specialty Labs To Monitor Results. Rupa Health. https://www.rupahealth.com/post/anti-inflammatory-diet
  5. Cloyd, J. (2023, October 16). Top 10 herbs for intestinal inflammation. Rupa Health. https://www.rupahealth.com/post/top-10-herbs-for-intestinal-inflammation
  6. Cortisol. Rupa Health. https://www.rupahealth.com/biomarkers/cortisol
  7. Creedon, K. (2022, July 14). Simple lifestyle changes that can help keep high blood pressure under control. Rupa Health. https://www.rupahealth.com/post/simple-lifestyle-changes-that-can-help-control-high-blood-pressure
  8. Cushing syndrome. (2021, April 30). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/cushing-syndrome/symptoms-causes/syc-20351310
  9. Diorio, B. (2023, March 17). How to test for hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Rupa Health. https://www.rupahealth.com/post/what-is-the-hypothalamic-pituitary-adrenal-hpa-axis
  10. Fishman, S. (2023, August 28). General Adaptation Syndrome: Understanding Your Body's Response to Stress. Psych Central. https://psychcentral.com/stress/general-adaptation-syndrome#stages-of-gas
  11. Garrison, K. (2024, February 6). The Cortisol-Aging Connection: Can Lowering Stress Hormones Slow Aging? Rupa Health. https://www.rupahealth.com/post/the-cortisol-aging-connection-can-lowering-stress-hormones-slow-aging
  12. Jones, C., & Gwenin, C. (2020). Cortisol level dysregulation and its prevalenceβ€”Is it nature's alarm clock? Physiological Reports, 8(24). https://doi.org/10.14814/phy2.14644
  13. Knezevic, E., Nenic, K., Milanovic, V., et al. (2023). The Role of Cortisol in Chronic Stress, Neurodegenerative Diseases, and Psychological Disorders. Cells, 12(23), 2726–2726. https://doi.org/10.3390/cells12232726
  14. LoBisco, S. (2022, December 19). How to naturally balance melatonin and cortisol levels. Rupa Health. https://www.rupahealth.com/post/how-to-balance-melatonin-and-cortisol-naturally-for-better-health
  15. Maholy, N. (2023, April 14). How to reduce stress through mind-body therapies. Rupa Health. https://www.rupahealth.com/post/how-to-reduce-stress-through-mind-body-therapies
  16. Maholy, N. (2023, April 21). A Functional Medicine Protocol for Hyper Responsiveness Adrenal Dysregulation. Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-protocol-for-hyper-responsiveness-adrenal-dysregulation
  17. Maholy, N. (2023, April 24). A Functional Medicine Protocol for Hypo-Responsiveness Adrenal Dysregulation. Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-protocol-for-hypo-responsiveness-adrenal-dysregulation
  18. Preston, J. (2023, September 5). The Top 10 Evidence-Based Supplements for Stress and Anxiety. Rupa Health. https://www.rupahealth.com/post/the-top-10-evidence-based-supplements-for-stress-and-anxiety
  19. Ross, K. M., Murphy, M., Adam, E. K., et al. (2014). How stable are diurnal cortisol activity indices in healthy individuals? Evidence from three multi-wave studies. Psychoneuroendocrinology, 39, 184–193. https://doi.org/10.1016/j.psyneuen.2013.09.016
  20. Sweetnich, J. (2023, February 28). How to Balance Cortisol Levels Naturally. Rupa Health. https://www.rupahealth.com/post/how-to-balance-cortisol-levels-naturally
  21. Sweetnich, J. (2023, February 28). Using The DUTCH Cortisol Awakening Response (CAR) Test in Clinic: 101. Rupa Health. https://www.rupahealth.com/post/dutch-cortisol-awakening-response-car-test-101
  22. Weinberg, J. L. (2023, June 26). Top functional medicine labs that can help individualize integrative treatment options for Cushing's disease patients. Rupa Health. https://www.rupahealth.com/post/top-functional-medicine-labs-that-can-help-individualize-integrative-treatment-options-for-cushings-disease-patients
  23. Weinberg, J. L. (2023, December 19). The Science of Sleep: Functional Medicine for Restorative Sleep. Rupa Health. https://www.rupahealth.com/post/the-science-of-sleep-functional-medicine-for-restorative-sleep
  24. Yoshimura, H. (2023, July 3). 5 Functional Medicine Lab Tests That Can Help Individualize Care for Addison's Disease Patients. Rupa Health. https://www.rupahealth.com/post/integrative-medicine-approaches-to-addison-disease
  25. Yoshimura, H. (2023, November 7). The remarkable power of exercise on our health: A comprehensive overview. Rupa Health. https://www.rupahealth.com/post/the-remarkable-power-of-exercise-on-our-health-a-comprehensive-overview
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