Normal cortisol levels may vary among individuals. Increased or decreased cortisol levels can be assessed only if cortisol level in blood does not follow the diurnal pattern as it should.

Cortisol levels may fall outside the normal range for the time of day due to diseases or due to lifestyle factors such as irregular sleeping times.

 

Causes of increased cortisol levels:

·    Long term treatment with glucocorticosteroid hormones like prednisone, dexamethasone, etc.

·       Pituitary tumors that increase ACTH production

·       ACTH producing tumors in other parts of the body

·       Adrenal tumors that increase cortisol secretion

·      Congenital Adrenal Hyperplasia, a disease which causes excessive growth of adrenal gland cells

·    Recent surgery, illness, injury, or sepsis

·        CRH producing tumors in rare cases

 

Causes of decreased cortisol levels:

·         Reduced cortisol production due to damage or diseases of the adrenal gland (primary adrenal insufficiency) like Addisons disease

·         Reduced ACTH production due to reduced activity of pituitary gland or pituitary tumors (secondary adrenal insufficiency)

 

 

 

Cortisol is a hormone secreted by the adrenal glands that helps in the metabolism of carbohydrates, fats, and proteins. It also plays a regulatory role in maintaining the blood sugar levels, water balance of the body, and is also essential in the maintenance of a healthy immune system. Most cortisol in the body is found bound to proteins, and only a small portion remains free and metabolically active.

Level of cortisol hormone rises and falls during the course of a day following a diurnal pattern. Cortisol levels are highest in the early morning, drops slowly throughout the day reaching its lowest around midnight, and again increases slowly through the night to reach its highest early next morning. This diurnal pattern of cortisol secretion is maintained by the hypothalamus in the brain and pituitary gland located just below the below the brain. Fall in the blood cortisol levels stimulates the production of Corticotropin Releasing Hormone (CRH) from the hypothalamus. CRH stimulates the pituitary gland to secrete the Adrenocorticotropic Hormone (ACTH), which in turn stimulates the production of cortisol from the adrenal glands to increase cortisol levels in blood. Cortisol levels are regulated by a feedback mechanism. When cortisol levels rise to the required levels, CRH secretion from hypothalamus is stopped, which in turn stops ACTH secretion from pituitary, thereby stopping cortisol secretion from the adrenal glands. Symptoms associated with increased or decreased levels of cortisol hormone appear when this feedback mechanism is disturbed due to diseases or lifestyle.

This test is performed on a blood sample. A syringe with a fine needle attached is used to withdraw blood sample from a blood vessel in your arm generally from the inner side of the elbow area. The doctor, nurse or the phlebotomist will tie an elastic band around your arm which will help the blood vessels to swell with blood and hence makes it easier to withdraw blood. You may be asked to tightly clench your fist. Once the veins are clearly visible, the area is cleaned with an antiseptic solution and then the needle is inserted into the blood vessel to collect the sample. You may feel a tiny pinprick during the procedure. Blood sample once collected is then sent to the laboratory.

There is no risk associated with the test. However, as this test involves a needle prick to withdraw the blood sample, rarely, a patient may experience increased bleeding, hematoma (blood collection under the skin) formation, bruising or infection at the site of needle prick.

Inform the doctor about any medications you may be taking. No other specific preparations are usually required before this test.

The cortisol test results can be affected by a number of factors, including: A lifestyle that does not allow a regular sleeping pattern Stress Certain medications like birth control pills, glucocorticoids, and steroid hormone based medications Physical trauma Final trimester of pregnancy High physical activity in trained athletes Alcoholism Malnutrition

Additional tests that may be prescribed in case of abnormal cortisol test result are: Urine Cortisol Test Salivary Cortisol Test Dexamethasone Suppression Test ACTH Stimulation Test CT scan or MRI for suspected tumors

Cushings syndrome refers to a group of conditions caused due to a sustained increase in the levels of cortisol hormone in the body. Increased levels of cortisol are most commonly caused due to corticosteroid medications used to treat other diseases, but it may also be caused due to overproduction of cortisol from the adrenal glands due to ACTH secreting tumor in the pituitary gland or elsewhere in the body, or adrenal gland diseases like adrenal hyperplasia. Symptoms include fat deposition between the shoulders (buffalo hump), puffy face, purple or pink stretch marks on the abdomen, high blood pressure, loss of bone density, slow wound healing, increased body hair in females, weakness, fatigue, growth impairment, etc.

Addisons disease, also called primary adrenal insufficiency, is a condition where the adrenal glands do not produce sufficient quantities of cortisol hormone due to damage to the adrenal glands, diseases affecting the adrenal glands, or tumors in the adrenal glands. Symptoms include fatigue and weakness, rapid weight loss, appearance of dark patches of skin, low blood pressure, diarrhea, nausea and vomiting, abdominal pain, etc. Addisons disease can be life threatening, and can produce severe symptoms suddenly in a condition called addisonian crisis or acute adrenal failure.

Higher than normal cortisol levels in blood can show the following symptoms: Hypertension or high blood pressure Hyperglycemia or high blood sugar Obesity Fragile skin Appearance of purplish lines on the skin of abdomen Weakness and muscular degeneration Osteoporosis Irregular menstruation

Lower than normal cortisol levels in blood can show the following symptoms: Rapid weight loss Fatigue and muscle weakness Low blood pressure Pain in the abdomen Dark patches of skin in Addisons disease