High Cortisol Symptoms: Causes and When to See a Doctor

Acute stress, chronic stress

Cortisol that rises is not a problem; cortisol that no longer comes down is.

Cortisol is made by the adrenal glands, which sit on top of the kidneys. It follows a very marked daily rhythm: it climbs towards the end of the night, peaks 30 to 45 minutes after waking, then falls to its lowest point around midnight. That morning peak is what gets you going, and that evening dip is what lets sleep come.

Faced with stress, an exam, an argument or an intense effort, cortisol rises within minutes, then falls back within an hour or two. This peak is useful: it mobilises sugar for the muscles and the brain, and calms inflammation. There is no reason to try to prevent it.

So when people talk about “high cortisol”, they often mix up two very different things: a rhythm thrown off by stress and lack of sleep, which is very common, and a genuine hormonal disease, which is rare. The symptoms are not the same, and neither is what you should do about them.

The symptoms, ranked

High cortisol symptoms, from the most ordinary to the most telling.

Most lists online line up ten or fifteen signs without saying which ones matter. Yet many of these symptoms have dozens of other causes: lack of sleep, iron deficiency, thyroid problems, depression, too much coffee. Here are the symptoms sorted by area, with what they are really worth.

The most discriminating signs according to the Endocrine Society guideline on diagnosing Cushing's syndrome (Nieman, 2008): easy bruising, facial redness, proximal muscle weakness and purple stretch marks.

If you only recognise yourself in the first four rows, the most likely explanation is long-running stress and too little sleep, not a disease. If several of the “Yes” rows apply to you, especially if they appeared recently, talk to your doctor.

Sleep and mood

Too much cortisol: the symptoms often start at night.

The first place you feel cortisol that does not come down is your sleep. In the evening, the body should be at the bottom of its curve. If it stays on alert, falling asleep drags on, thoughts keep spinning and sleep stays light. The second half of the night is often the worst affected, with early waking that is hard to make up for.

• You are tired in the evening, but “wide awake” as soon as you lie down.
• You wake around 3 or 4am, your mind already busy.
• You get up tired, even after a night of reasonable length.
• You need a coffee to get going, then another to get through the afternoon.
• You are more irritable, less patient, and find it hard to concentrate.

This picture is typical of prolonged stress, and it feeds itself: a short night pushes up cortisol the following evening, which spoils the next night. In a Belgian study from 1997, evening cortisol was 37% higher after a partial night's sleep. Coffee plays a part too: our article on coffee and cortisol explains how.

Be careful not to blame everything on cortisol. A persistently low mood, losing interest in everything or dark thoughts call for a medical appointment, not hormonal rebalancing. If you are in distress, Samaritans can be reached day and night on 116 123, free of charge.

The body and metabolism

Belly, face, blood pressure: what cortisol does to the body.

Cortisol mobilises sugar and directs fat storage towards the abdomen. That is why a genuine, lasting excess, as in Cushing's syndrome, produces a particular silhouette: the belly and upper back thicken while the arms and legs get thinner. With everyday stress the effect is much more modest, and it works mainly through sleep and appetite.

Other signs add up in true excess: slow wound healing, more frequent infections, irregular periods, lower libido, bones that become fragile. Taken one by one, none is specific. It is their accumulation, and their appearance within a few months, that should raise the alarm.

Videos about “cortisol belly” or “cortisol face” often mix up these two levels. Remember one rule: a face or a belly that changes without the other signs in the table above is almost always a matter of lifestyle.

Causes

High cortisol causes, from the most common to the rarest.

The vast majority of “high” cortisol results come down to lifestyle. Medical causes exist, but they are rare and come with clear physical signs.

Pseudo-Cushing's and the effect of pregnancy are described in the Endocrine Society guideline (Nieman, 2008), which lists them as diagnostic pitfalls.

For lifestyle causes, the good news is that they can be corrected. We have ranked the levers by strength of evidence in our guide on how to lower cortisol: sleep, morning light and the timing of your coffee come out on top.

Medication and the pill

Cortisone, the leading cause of excess cortisol.

It is often forgotten: cortisone and its derivatives, corticosteroids, are copies of cortisol. Taken for a long time or at high doses, they reproduce the effects of an excess: a rounder face, weight gain around the abdomen, thin skin, rising blood pressure and blood sugar. According to the Endocrine Society, this is the most common cause of Cushing's syndrome.

• Steroid tablets taken for several weeks, for asthma, an inflammatory disease or an allergy.
• High-dose inhaled corticosteroids over a long period.
• Steroid creams over large areas of skin.
• Repeated injections into the joints.

The contraceptive pill is another trap. Oestrogens increase the protein that carries cortisol in the blood. Total cortisol measured by a blood test then looks higher, without any genuine excess of active hormone. Always tell the laboratory and your doctor about your contraception.

High cortisol and cancer

High cortisol and cancer: a rare link, not to be turned around.

The question comes up often, because some search results mix cortisol and cancer together. Two things need to be kept apart.

First, some tumours can produce cortisol or the hormone that controls it, ACTH: a pituitary adenoma (usually benign, this is Cushing's disease proper), a tumour of the adrenal gland or, more rarely, a tumour elsewhere in the body, for example in the lung. These situations are rare, and they cause the physical signs described above, often quickly and markedly.

Second, the reverse idea, that everyday stress and its cortisol “cause” cancer, has not been shown. Chronic stress has real effects on health, but cortisol that is slightly high because of work or poor sleep is not a sign of cancer.

If physical signs suggesting excess cortisol appear quickly, within weeks or months, see a doctor without waiting: they will order the right tests and, if needed, refer you to an endocrinologist.

Reading an 8am test

High cortisol at 8am proves almost nothing.

Many people receive a blood test result with cortisol “at the upper limit” and start to worry. There are three things to know. The test is done in the morning, around 8am, because that is when cortisol is at its highest. Reference ranges depend on the laboratory and the method: as a rough guide, they often sit between about 140 and 600 nmol/L, the equivalent of 5 to 22 µg/dL. And a stressful blood draw, after a bad night or a coffee, can be enough to push the figure up.

Indicative values: only the ranges printed on your report, and your doctor's opinion, count.

To look for a genuine excess, the Endocrine Society recommends three tests, which all look for the same thing: cortisol that does not come down when it should.

The saliva tests sold online to “track” your cortisol day to day do not have this value. A single measurement, taken at home with no clinical framework, says very little about the curve.

When to see a doctor

When high cortisol means seeing a doctor.

Your doctor will start with an examination and questions about your medication, then order, if necessary, the tests described above. If a result is abnormal, follow-up is with an endocrinologist. For tiredness with no physical signs, our article on persistent fatigue helps you prepare for the appointment.

As for what forum testimonials often call “high cortisol levels”, the vast majority of stories describe the same thing: a period of overload, broken nights, too much coffee, and a slow improvement once the pace of life changes. We do not publish testimonials about cortisol: none of our products has been studied on this point.

What next?

If it is stress, the curve can recover.

If your doctor has ruled out a hormonal cause, or if your symptoms are clearly down to stress and sleep, the priority is to give the curve back its shape: a real peak in the morning and a real dip in the evening.

The details of these levers, with their level of evidence, are in our guide on how to lower cortisol. Some people add a plant studied for stress, such as ashwagandha, whose benefits and studies and side effects we have reviewed. Our Anti-Stress formula contains it, along with reishi, holy basil and vitamin B6, which contributes to the reduction of tiredness and fatigue. For the evening, our habits for better sleep are the best place to start.

Sources

1. Nieman L. K. et al. (2008). The diagnosis of Cushing's syndrome: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism, 93(5).
2. Clow A., Thorn L., Evans P., Hucklebridge F. (2004). The awakening cortisol response: methodological issues and significance. Stress, 7(1).
3. Leproult R., Copinschi G., Buxton O., Van Cauter E. (1997). Sleep loss results in an elevation of cortisol levels the next evening. Sleep, 20(10).
4. Dickerson S. S., Kemeny M. E. (2004). Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research. Psychological Bulletin, 130(3).
5. Miller G. E., Chen E., Zhou E. S. (2007). If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychological Bulletin, 133(1).
6. Kumari M. et al. (2011). Association of diurnal patterns in salivary cortisol with all-cause and cardiovascular mortality: findings from the Whitehall II study. Journal of Clinical Endocrinology & Metabolism, 96(5).
7. Adam E. K. et al. (2017). Diurnal cortisol slopes and mental and physical health outcomes: a systematic review and meta-analysis. Psychoneuroendocrinology, 83.
8. Lovallo W. R. et al. (2005). Caffeine stimulation of cortisol secretion across the waking hours in relation to caffeine intake levels. Psychosomatic Medicine, 67(5).
9. Badrick E. et al. (2008). The relationship between alcohol consumption and cortisol secretion in an aging cohort. Journal of Clinical Endocrinology & Metabolism, 93(3).

Keep reading

Further reading.

Cortisol is linked to sleep, coffee and stress. Explore our other guides, or try Anti-Stress.