High Cortisol Symptoms: Signs, Causes and How to Lower It

What is cortisol?

Cortisol is a hormone made by your two adrenal glands, which sit on top of your kidneys. It helps your body respond to stress or danger, controls heart rate and blood pressure, and reduces inflammation. You need it to stay healthy.¹

Cortisol follows a daily pattern. It peaks in the morning and falls through the evening. It also rises for a while whenever you are under stress. Both are normal.¹

Symptoms of high cortisol

When cortisol stays high for a long time, the condition is called Cushing’s syndrome. Symptoms include:²

• Weight gain, especially around the middle
• A rounded face
• A hump of fat between the shoulders
• Skin that bruises easily, heals slowly and develops stretch marks on the tummy and thighs
• Feeling tired or moody
• In women, more hair on the face and body, and irregular periods

Over time it can lead to high blood pressure, high blood sugar and thinning bones.²

How common is it?

Cushing’s syndrome is rare, and it affects more women than men.² The kind caused by the body making too much cortisol affects about two to eight people per million each year.³

What causes high cortisol?

• Steroid medicines taken at high doses for a long time. If you take them, don’t stop suddenly. This can make you very unwell. Talk to your doctor first²
• A growth on the pituitary gland in the brain that tells the adrenal glands to make more cortisol. This is called Cushing’s disease²
• A growth on an adrenal gland, or occasionally elsewhere in the body²

Does stress cause high cortisol?

Stress raises cortisol, but not in the way social media posts about “cortisol face” or “cortisol belly” suggest.

A meta-analysis of 66 studies measured cortisol in hair, which reflects levels over months. People living with ongoing major stress had hair cortisol about 43 per cent higher than comparison groups. Once the stress had passed, levels were no different. Interestingly, people’s own ratings of how stressed they felt did not line up with their cortisol.⁴

So chronic stress produces a real but modest shift. It is not Cushing’s syndrome, which has specific physical signs and a specific medical cause.²

What about “adrenal fatigue”?

The idea is that long-term stress wears out the adrenal glands, leaving cortisol too low. It is not a recognised medical condition.⁵ A systematic review of 58 studies found no evidence to support it and concluded that it does not exist.⁶

The symptoms people put down to it, such as tiredness, are real and have many possible causes that are worth finding. See why am I always tired? There is also a rare condition where the adrenal glands truly make too little cortisol. It is diagnosed with blood tests, and those tests are usually normal in people told they have adrenal fatigue.⁵

How is cortisol tested?

If you have symptoms that suggest a cortisol problem, your doctor may order a blood test. Because levels change through the day, they may take several measurements at different times.¹

International guidelines recommend testing for Cushing’s syndrome in people who have several of its features that are getting worse over time, after first ruling out steroid medicines as the cause. The first-line tests are a urine collection, a late-night saliva sample, or a blood test taken the morning after a tablet that should switch cortisol off. An abnormal result is confirmed with a second test and a referral to an endocrinologist.⁷

A single cortisol reading from a wellness test, taken without those symptoms, is hard to interpret and rarely useful.

How to lower cortisol

If Cushing’s syndrome is the cause, it needs medical treatment, usually an operation to remove the growth that is driving it.³ For the everyday ups and downs of a stressed body, these help keep cortisol in its normal rhythm:

• Sleep. In a laboratory study of healthy young men, losing part or all of a night’s sleep raised cortisol the following evening by 37 to 45 per cent.⁸ See sleep hygiene
• Regular activity. A meta-analysis found that more active people have a slightly healthier daily cortisol pattern, with a steeper fall from morning to night. The effect was small.⁹
• Meditation and relaxation. In a meta-analysis of randomised trials, meditation programs lowered cortisol, mainly in people who were already unwell or living under stress.¹⁰
• Watch the caffeine. Caffeine raises cortisol. Regular coffee drinkers build up a partial tolerance, but the effect doesn’t disappear.¹¹
• Reduce the load. See stress and burnout

When to see a doctor

• You have several of the physical signs above, especially easy bruising, new stretch marks or a changing face shape
• You have gained weight around the middle along with high blood pressure or high blood sugar
• You take steroid medicines and have noticed these changes
• You have ongoing tiredness with no clear reason

References

1. healthdirect. The role of cortisol in the body.
2. healthdirect. Cushing’s syndrome.
3. Reincke M, Fleseriu M. Cushing Syndrome: A Review. JAMA. 2023;330(2):170-181.
4. Stalder T, Steudte-Schmiedgen S, Alexander N, et al. Stress-related and basic determinants of hair cortisol in humans: A meta-analysis. Psychoneuroendocrinology. 2017;77:261-274.
5. healthdirect. Adrenal fatigue.
6. Cadegiani FA, Kater CE. Adrenal fatigue does not exist: a systematic review. BMC Endocr Disord. 2016;16(1):48.
7. Nieman LK, Biller BM, Findling JW, et al. The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008;93(5):1526-40.
8. Leproult R, Copinschi G, Buxton O, et al. Sleep loss results in an elevation of cortisol levels the next evening. Sleep. 1997;20(10):865-70.
9. Moyers SA, Hagger MS. Physical activity and cortisol regulation: A meta-analysis. Biol Psychol. 2023;179:108548.
10. Koncz A, Demetrovics Z, Takacs ZK. Meditation interventions efficiently reduce cortisol levels of at-risk samples: a meta-analysis. Health Psychol Rev. 2021;15(1):56-84.
11. Lovallo WR, Whitsett TL, al'Absi M, et al. Caffeine stimulation of cortisol secretion across the waking hours in relation to caffeine intake levels. Psychosom Med. 2005;67(5):734-9.