High Cortisol Levels: Causes, Symptoms, and Solutions

In modern life, chronic stress, lack of sleep, and certain lifestyle habits can artificially increase your cortisol levels, with potentially harmful consequences for your physical and mental health. The goal of this article is to help you understand: – What cortisol is and how it is measured; – The causes of high cortisol levels, whether physiological or pathological; – The symptoms and risks associated with excess cortisol; – Solutions to bring your cortisol back to a healthy level.

What is cortisol?

Cortisol, often referred to as the “stress hormone,” is a steroid hormone produced by the adrenal glands. It plays a central role in regulating the stress response, managing blood sugar, blood pressure, and the metabolism of fats, proteins, and carbohydrates. While low cortisol levels are problematic (adrenal insufficiency), high cortisol levels can also signal a hormonal imbalance or the presence of another condition.

Role in the body

The main functions of cortisol are:

The stress response: increased alertness, release of energy.

Regulation of blood sugar: promotes gluconeogenesis and glucose utilization;

metabolism management: mobilization of fats and proteins during fasting;

Maintenance of blood pressure: potentiates the action of catecholamines;

anti-inflammatory effect: limits the immune reaction and the formation of cytokines.

Cortisol follows a circadian rhythm: it peaks in the morning (6–8 a.m.), gradually declines throughout the day, and is at its lowest at the beginning of the night. This variation is essential for a regular sleep-wake cycle.

How to measure cortisol?

Several dosage methods are used depending on the clinical context:

Blood test

Venous sampling in the morning on an empty stomach, when cortisol is at its highest.

Normal range: approximately 100–250 µg/L (depending on the laboratory).

Salivary dosage

Measures free, non-protein-bound cortisol, which reflects the active hormone.

Useful for assessing circadian rhythm in several samples (morning, noon, evening).

24-hour urine test

Measures the amount of cortisol excreted, a good indication of overall circulating levels.

Before any interpretation, it is essential to take into account the time of the sample (normal morning cortisol, but abnormal at the end of the day), current medication (corticosteroids, contraceptives ), intense physical effort before the test (this increases cortisol), and physiological factors such as pregnancy.

What causes high cortisol levels?

Physiological causes (reversible)

Certain situations can cause a temporary increase in cortisol:

chronic stress: prolonged stress stimulates the production of cortisol;

Lack of sleep: Insufficient sleep disrupts the circadian rhythm of cortisol;

chronic pain : persistent pain ( arthritis , back pain ) maintains increased production of cortisol;

Persistent pain can increase cortisol.

Taking certain medications: Systemic, inhaled, or topical corticosteroids can add to endogenous cortisol. Some oral contraceptives (birth control pills) increase cortisol bound to corticosterone-binding globulin (CBG), sometimes distorting the dosage.

Pathological causes

High cortisol levels can also result from conditions such as:

Cushing’s syndrome: characterized by excessive production of cortisol, often due to a pituitary or adrenal tumor;

Hyperthyroidism: Excess thyroid hormones can influence cortisol.

Severe depression and anxiety disorders: These conditions can disrupt cortisol regulation.

What are the symptoms of excess cortisol?

High cortisol levels can manifest through various symptoms:

persistent fatigue: difficulty recovering even after rest;

Weight gain: This is gradual, especially in the face (“moon face”), neck, and abdomen. High cortisol levels can also lead to fluid accumulation and swelling.

anxiety, irritability, sleep disturbances (insomnia, frequent awakenings);

loss of muscle mass: wasting of arms and legs, weakness;

skin fragility: thin skin, easy bruising, delayed healing;

High blood pressure: Cortisol interferes with the amount of water and mineral salts in the body, increasing the release of adrenaline into the circulation. High cholesterol can therefore cause or worsen high blood pressure;

menstrual disorders in women: irregularities, amenorrhea;

decreased immunity: repeated infections, delayed healing;

cognitive disorders: difficulty concentrating, short-term memory disorders;

erectile dysfunction: Some men may experience a change in male hormones, which leads to erectile dysfunction, decreased libido, and muscle weakness;

Frequent infections: Cortisol lowers the body’s defenses by inhibiting inflammation and immunity, thus increasing the risk of frequent infections.

Slow and difficult healing: High cortisol levels can also make wound healing difficult because they decrease collagen in the body.

Is high cortisol dangerous?

In the short term

A temporary increase in cortisol can lead to discomfort such as fatigue, irritability, and sleep disturbances. These symptoms are usually reversible once the trigger is removed.

In the long term

Chronically elevated cortisol levels can have serious consequences:

Type 2 diabetes: High cortisol levels stimulate the liver to produce glucose, increase insulin resistance, or reduce insulin production by the pancreas, which leads to increased blood sugar levels and increases the risk of diabetes.

cardiovascular diseases: hypertension, accelerated atherosclerosis;

Osteoporosis: High cortisol levels increase the risk of osteoporosis, as this hormone decreases calcium absorption by bones. It also decreases the number and activity of cells responsible for bone formation, in addition to increasing bone resorption, which makes bones more fragile.

psychiatric disorders: depression, chronic anxiety, mood swings that can lead to serious psychotic disorders, even in the absence of psychiatric illness;

metabolic disorders: metabolic syndrome (abdominal obesity, dyslipidemia)

In the event of an organic cause (Cushing’s syndrome, adenoma), treatment must be rapid to avoid these complications.

What to do if you have high cortisol?

Consult a professional

It is recommended to consult a doctor for:

carry out a complete hormonal assessment (ACTH, aldosterone, DHEA, androstenedione dosage);

identify the cause of excess cortisol: brain MRI (pituitary adenoma), abdominal CT scan (adrenal adenoma);

Implement endocrinological treatment and monitoring.

Adapt your lifestyle

Lifestyle changes can help regulate cortisol:

stress management: relaxation practices, meditation, etc..

quality sleep: respect regular schedules, limit screens before bedtime ;

balanced diet: reduce refined sugars, consume foods rich in omega-3.

Moderate physical activity: avoid overtraining.

Medical treatments in case of pathology

If a pathology is the cause of the excess cortisol, specific treatments may be necessary:

Cushing’s syndrome: surgery to remove the tumor, radiation therapy, or medications to inhibit cortisol production;
Medication adjustment: reduction or discontinuation of corticosteroids under medical supervision.