Do you sometimes think, "Oh my god, why am I getting older so fast?" Or has your face become rounder and a small lump of fat has appeared on the back of your neck? Maybe you also feel tired and dizzy all the time. If you have one or more of these symptoms, the reason may be a change in the level of the hormone cortisol in your body. So today, let's talk about cortisol and the test that measures it in detail, very simply.
Simply put, what is cortisol?
Cortisol is an essential hormone for our body. Think of it as our body's main "stress response" hormone. When we are stressed or under pressure, cortisol is what prepares our body to deal with it. In addition, this hormone contributes to many other important functions in our body.
- Controls blood pressure.
- Helps maintain blood sugar levels.
- The carbohydrates, proteins, and lipids in the food we eat help us metabolize them into energy.
- Controls inflammation in the body.
- It also helps with the sleep-wake cycle that controls our sleep and wakefulness.
This cortisol hormone is produced by two small glands located above our kidneys. We call these the adrenal glands. So if there is a problem with these glands, or with the pituitary gland at the base of the brain, cortisol levels can either be too high or too low. If your doctor asks you about these symptoms, he or she may ask you to take a cortisol test.
What are the symptoms of high and low cortisol?
When cortisol levels change, our body sends out different signals. Let's see what these signs are. I'll show you this in a table so that you can understand it easily.
| When cortisol levels are high (High Cortisol) | When cortisol levels drop (Low Cortisol) |
|---|---|
| Rapid weight gain (especially in the stomach, chest, and face) | Constant fatigue |
| Round face | Dizziness |
| Formation of a fatty lump on the back of the neck or between the shoulders | Weight loss |
| High blood pressure | Low blood pressure |
| Increased blood sugar levels | Muscle weakness |
| Skin changes (bruising easily, purple streaks) | Vomiting, nausea, and stomach pain |
| Irregular menstrual cycles in women | Salt craving in the body |
What are the causes of increased cortisol?
If cortisol levels are very high, we call that condition Cushing's syndrome . There can be several main causes for this:
- Taking high doses of steroid medications (e.g. prednisone) for a long time for other diseases.
- A tumor in the pituitary gland in the brain. This gland is the one that "commands" the other glands.
- A tumor in the adrenal glands.
What are the causes of low cortisol?
The main condition that causes low cortisol levels is Addison's disease . This is when our own immune system attacks the adrenal glands. In addition,
- Infection or damage to the adrenal glands.
- Pituitary gland not functioning properly.
- Sudden discontinuation of a steroid medication that has been used for a long time.
Important: If you are taking any steroid medication, never stop taking it suddenly without consulting your doctor. Doing so can cause your cortisol levels to drop suddenly, which can be dangerous.
How is the cortisol test done?
There are three main ways to check your cortisol levels: blood, saliva, and urine tests. Your doctor will prescribe the most appropriate test based on your symptoms.
Cortisol levels typically fluctuate throughout the day, with levels highest in the early morning and lowest in the middle of the night . This is why some tests need to be done at specific times of the day.
1. Cortisol Blood Test
This is the most common test. It is usually done twice a day.
- The first one: around 8 am (when cortisol levels are highest)
- Second: Around 4pm (when cortisol levels drop)
It's very simple. The lab just takes a small sample of blood from a vein in your arm.
2. Cortisol Saliva Test
This is also a very accurate and easy method. This is especially important for diagnosing Cushing's syndrome. The doctor will give you a small kit.
- This is usually done between 11 and 12 pm , before going to bed. This is because that is when a healthy person's cortisol levels are at their lowest. If the levels are still high at that time, it's a sign of a problem.
- You should avoid eating, drinking, or brushing your teeth 30 minutes before the test.
- You have to hold the swab in your mouth for about 2 minutes to collect saliva, then put it back in the tube and send it to the lab.
3. Cortisol Urine Test
Sometimes your doctor will ask you to collect a 24-hour urine sample.
- What happens in this is that you have to collect a sample of every urine you pass over a 24-hour period in a special bottle that you are given.
- This bottle should always be kept in the refrigerator or in a box with ice.
- When the 24 hours are up, it has to be sent to the lab.
What other special tests are done?
Sometimes, further testing is needed to find the exact cause of your abnormal cortisol levels.
- ACTH Stimulation Test: This tests how your adrenal glands respond to a hormone called ACTH, which comes from the pituitary gland. This is often done when cortisol levels are low.
- Dexamethasone Suppression Test: This is like the other side of the test above. It is done to find the cause of high cortisol levels. Here, a small amount of a steroid called `Dexamethasone` is given, and the cortisol levels are checked the next morning.
The results of these tests will help your doctor determine whether the problem is in your pituitary gland, adrenal gland, or something else. Sometimes, if a tumor is suspected , a CT scan or MRI scan may be ordered.
Remember, an abnormal cortisol level on a test report is not always a sign of a serious illness. Cortisol levels can also change due to things like high stress, exercise, pregnancy, and certain medications.
Take-Home Message
- Cortisol is a hormone that controls stress in our body and performs many other important functions.
- Symptoms such as sudden weight gain, fatigue, and dizziness can be caused by changes in cortisol levels.
- Cortisol levels can be measured through blood, saliva, or urine tests. Its levels vary depending on the time of day.
- If cortisol levels are too high, it may be a symptom of Cushing's syndrome , and if they are too low, it may be a symptom of Addison's disease .
- If you have any of these symptoms or are concerned about your test results, be sure to talk to your doctor . Avoid self-diagnosis and self-treatment.
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