- Cortisol is the body’s most potent glucocorticoid. Glucocorticoid is the “family name” for a group of hormones that increase the blood glucose to prevent hypoglycemia (low blood sugar). Glucocortocoids are either made by the adrenal cortex in the form of “natural” cortisol or are synthetically derived from natural cortisol. There are many forms of synthetically derived cortisol available on the market, some common names include: hydrocortisone, prednisone, prednisolone, methylprednisolone and dexamethasone
- Cortisol has many important effects on the body. There are three effects of cortisol that are essential for survival: blood sugar control, blood pressure control and neutralization of inflammation. The beneficial effects or cortisol such as mood enhancement, increased work capacity, stress resistance, stimulation of immune defenses, anti-pain action and anti-rheumatic action depend on the first three essential effects.
- Cortisol also acts to calm down any excessive activity of the sympathetic nervous system (adrenaline). Often, when a person has low cortisol they have high adrenaline which results in physical “burn-out” and emotional outbursts.
Factors that increase cortisol production
- Stress
- Activity
- Certain emotions
- Bright sunlight –especially morning sunlight
- Low levels of nighttime Melatonin and growth hormone
Factors that Decrease Cortisol Production
- Melatonin and growth hormone are secreted at nighttime to reduce cortisol levels (promotes sleep)
- Prolonged stress, PTSD
- Excess sugar, environmental toxins, nutrient deficiency
- Age
Signs and Symptoms of Cortisol Deficiency
Physical
- Fatigue, low energy
- Getting light headed easily
- Getting low blood sugar easily
- Nausea and/or abdominal pain
- Cravings for sugar and/or salt
- Dark circles under the eyes or “tired look”
- Skin rashes (eczema, psoriasis, brown spots, white spots)
- Predisposition to inflammatory diseases (rheumatoid arthritis, Lupus, etc)
- Prone to infections
- Allergies- environmental or food
- Unable to tolerate medications
Mental
- Poor resistance to stress
- Easily distracted, absent minded
- Memory loss and/or confusion – especially in stressful situations
- Anxiety and irritability
- Excessive emotions
- Negativism
Treatment of Cortisol Deficiency
Medication
- The goal of medication therapy is to “match” normal cortisol production taking into consideration the fluctuations in cortisol needs (recent illness, stress, etc)
- The daily cortisol production in young, healthy persons is about 15-25mg for women and 25-35mg for men
- Cortisol levels are highest in the morning about 30-40 minutes after awakening and lowest gently drop to a low around midnight
- The goal of cortisol treatment is replace sufficient amounts to promote health and quality of life. Over-treatment of cortisol can depress the immune system, promote osteoporosis and create other ailments and should never be done.
- High dosages of cortisol are sometimes used in emergencies or for certain diseases (i.e. autoimmune disorders) but not for maintenance dosage.
Cortisol replacement is available in many forms, the best route is chosen based on patient needs and severity of symptoms. Doses may be adjusted to obtain positive effects and prevent unwanted side effects.
- Oral tablets (e.g. Cortef, Hydrocortisone 5mg and 25mg)
Signs and Symptoms of Too Much Cortisol Replacement
- Obesity – with fat around the main body area (trunk) rather than the arms and legs. The arms and legs can become quite thin compared with the obese body.
- Facial puffiness and the face often looking redder than usual.
- Diabetes.
- Facial hair in women.
- High blood pressure.
- Muscle weakness. In particular a proximal muscle weakness.
- Thin skin which bruises easily.
- Purple/pink stretch marks (striae) may appear – similar to those seen on some pregnant women.
- Tiredness.
- Aches and pains – particularly backache.
- Mood swings – such as being more irritable, depressed or anxious than usual.
- Lack of sex drive (libido).
- Periods may become irregular, or stop, in women.
- ‘Thinning’ of the bones (osteoporosis). You may fracture a bone more easily than usual.
- ‘Water retention’ (edema) around the ankles.
- Excess thirst.
- Increased susceptibility to infections.
Risks and Benefits of Treatment
Risks:
- Seen with excess replacement, as noted above
- Secondary adrenal insufficiency
- Electrolyte disturbances
- Others – see package insert
Contraindications:
- Use caution in patients with psychiatric disorders, ulcerative colitis, low thyroid, certain infections and immune suppression
Benefits:
- Improvements of symptoms associated with low cortisol production
