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What are Common Symptoms of High Cortisol?

By Geisha A. Legazpi
Updated Mar 03, 2024
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A person who is on long-term corticosteroid medication or has a pituitary tumor, adrenal hyperplasia, or adrenal tumor may suffer from symptoms of high cortisol. Normally, cortisol levels rise when the body is challenged by physical or psychological stress, infection, or any other event that strains the body’s resources. As a stress hormone, cortisol increases blood sugar; suppresses the immune system; and promotes metabolism of carbohydrates, fats, and proteins. Predictably, symptoms of high cortisol levels are secondary to these actions or are exaggerated sympathetic responses of the body to these elevations. Such symptoms include skin and hair changes, poorly controlled blood sugar, weight gain, high risk for infections, endocrine abnormalities, and increased heart rate and blood pressure.

The hypothalamus-pituitary-adrenal (HPA) axis controls the secretion of cortisol. As the hypothalamus secretes corticotropin-releasing hormone (CRH), the CRH in turn stimulates the pituitary gland to secrete the adrenocorticotropic hormone (ACTH). When ACTH is released to the blood, it is carried to the adrenal glands where it stimulates the cortex or outermost layer to produce cortisol.

High cortisol levels are present in the blood shortly after waking, in preparation for the stresses of the day. The lowest levels are present during the night, a few hours after bedtime, to promote relaxation. Any abnormality in the HPA axis, loss of the diurnal pattern of cortisol release, or intake of external sources of cortisol, such as hydrocortisone, can lead to symptoms of high cortisol and Cushing’s syndrome.

If a person has elevated cortisol levels for a long time, symptoms of cortisol excess become apparent. Common nonspecific symptoms, which are due to the over-activation of the sympathetic nervous system, include fatigue, weakness, increased thirst and urinary frequency, irritability, and depression. Another common symptom is weight gain due to increased fat and carbohydrate metabolism. Increased fat deposition often occurs in the abdomen, which makes a person prone to cardiovascular complications.

Insomnia often occurs as well, due to the disruption of the normal diurnal pattern of release. Additionally, a person with chronic high cortisol levels can suffer from high blood pressure and increased blood glucose, which increase the risk for heart attack and diabetes mellitus, respectively. The sympathetic nervous system is chronically activated as well. Therefore, lower sex drive could also be experienced.

Cushing’s syndrome is a disorder composed of a constellation of symptoms of high cortisol. Symptoms of Cushing’s syndrome include abdominal obesity, a round face or “moon face,” and “buffalo hump” or increased fat pads along the nape and upper back, despite having relatively thin arms and legs. The skin becomes thin and fragile, leading to easy bruising and poor wound healing. Unique to Cushing’s syndrome are skin manifestations called purple striae. These are purple-red, or violaceous, stretch marks that commonly occur on the abdomen as well as on the chest, face, neck, and thighs.

A woman with Cushing’s syndrome could experience hirsutism, or excessive hair growth, above the lips and along the midline of her body. She could also experience irregular menstruation. A man with Cushing’s syndrome could have diminished libido or erectile dysfunction. Therefore, people with high cortisol levels or Cushing’s syndrome often have difficulty conceiving or suffer from infertility.

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Discussion Comments
By bluedolphin — On Feb 28, 2014

I've never had problems with topical corticosteroids, but oral corticosteroids cause many side effects. What I hate most is the weight gain and the bloating. I actually think that some of what appears to be weight gain during corticosteroid use is actually bloating. Because when I'm off of the medication, I see a significant reduction in my abdomen in just a few days. I'm not sure if fat loss can occur so quickly, but it may be possible. My face also becomes very bloated and round and I eat more than usual.

My sister was also on hydrocortisone once and she told me that the medication caused her blood sugar to increase. She has diabetes and checks her blood sugar often. I never checked my blood sugar when I was on hydrocorisone but the same probably happened to me.

By discographer — On Feb 28, 2014

@ddljohn-- Yes, anxiety is a fairly common symptom of high cortisol. You may experience this as a side effect of medications. Cortisol hormone is what prepares us for danger, so it's normal to feel restless and anxious when cortisol levels are high. You may feel wired or you may feel like something bad is about to happen. Just keep in mind that this is the medication, not you.

Talk to your doctor if these symptoms become bothersome. Also avoid stimulants like caffeine at this time because they will worsen these symptoms.

By ddljohn — On Feb 27, 2014

Can high cortisol levels cause anxiety symptoms? I'm on hydrocortisone tablets and have been feeling anxious, moody ad nervous lately.

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