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Cortisol

Author: Dr. George Shanlikian, M.D.  |   Last Updated: January 1st, 2024

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What is Cortisol?

Cortisol is the most important human glucocorticoid (a class of steroid hormones) produced in the cortex of the adrenal glands. In times of stressful situations, the adrenal glands secrete the “stress hormone” cortisol as part of your coping mechanism. This hormone is also released when your blood sugar levels fall below normal in order to maintain homeostasis (balance). In the morning, cortisol levels are at their highest and gradually decline throughout the day.
The primary functions of cortisol are the following:

  • Energy regulation and mobilization by promoting glycogenolysis (conversion of the primary carbohydrate glycogen into blood sugar).
  • Helps the body responds to stress or danger by providing a quick burst of energy (“fight or flight response”).
  • Controls blood pressure.
  • Reduces inflammation.

Overall Cortisol Health Benefits

  • Improves blood sugar levels [1-11]
  • Fights cancer [12-52]
  • Boosts immune function [53-78]
  • Fights inflammation [79-106]

Cortisol Imbalance

In order to cope up with stressful situations, your body produces the right amount of cortisol. However, if you have a medical condition known as Cushing’s syndrome, your cortisol levels will remain elevated for prolonged periods of time. In this case, you may experience the following symptoms:

  • Acne
  • Facial hair in women
  • High blood pressure
  • Increased thirst
  • Irregular menstrual periods.
  • Mood changes
  • Muscle weakness
  • Osteoporosis
  • Rapid weight gain, particularly in the face, chest and abdomen contrasted with slender arms and legs.
  • Skin bruises
  • Thinning of the skin results in delayed wound healing.
  • Urinary frequency

Cortisol Level

On the other hand, some people can also experience cortisol deficiency. Medical conditions such as adrenal insufficiency and Addison’s disease can cause low cortisol levels. If you have these conditions, you may experience the following symptoms:

  • Abdominal pain
  • Darkening of regions of the skin
  • Extreme fatigue
  • Muscle weakness
  • Nausea and vomiting
  • Weight loss

If you experience any of these symptoms, consult with your doctor immediately to determine the best course of action. Typically, your doctor will conduct blood test, saliva test, and urine test to determine your cortisol levels. Your doctor may also order an MRI or CT scan if he or she suspects that a tumor is causing your cortisol imbalance.

Proven Benefits of Cortisol Replacement Therapy

If your body is not producing sufficient amounts of cortisol, your doctor may prescribe cortisol replacement therapy. When used as a medication, cortisol is known as hydrocortisone or corticosteroids. There is compelling evidence that restoring cortisol to healthy levels yields diverse health benefits:

Improves Blood Sugar Levels

One of the vital functions of cortisol is to restore body homeostasis by regulating blood sugar levels. Because of this ability, cortisol may help bring down elevated blood sugar levels, making it beneficial in patients with diabetes and those with uncontrolled blood sugar levels. There are several studies supporting the anti-diabetic effects of cortisol:

  1. Cortisol reduces blood sugar levels by increasing glucose uptake and usage in the brain, heart, and muscles. [1]
  2. In older men and women, higher cortisol levels were associated with decreased insulin levels, suggesting that cortisol improves blood sugar level by allowing insulin to enter into the cells. [2]
  3. In patients with Schmidt syndrome, a combination of autoimmune adrenal insufficiency (Addison’s disease), hypothyroidism and/or type 1 diabetes mellitus, cortisol replacement therapy prevented the incidence of hypoglycemia (low blood sugar levels). [3]
  4. A 2018 study published in the Frontiers in Endocrinology found that cortisol replacement therapy reduces the risk of impaired glucose tolerance. [4]
  5. In hypopituitary adults, cortisol replacement therapy improved glucose tolerance. [5]
  6. A 2009 study published in the European Journal of Clinical Investigation found that cortisol replacement therapy can help prevent insulin resistance and glucose intolerance. [6]
  7. A 2019 study published in the Endocrinology and Metabolism found that patients with severe hypoglycemia had an impaired cortisol response. [7-11]

Fights Cancer

Cortisol, along with other glucocorticoids, can potentially improve the health of cancer patients. Evidence suggests that cortisol targets malignant cells and suppresses their reproduction:

  1. A 2017 study published in Oncotarget found that cortisol and other glucocorticoids enhance the effect of cytotoxic anti-cancer drugs by affecting glucose breakdown of cancer cells. [12]
  2. A 2018 study published in Cell Death & Disease found that glucocorticoids induce apoptosis (programmed cell death) thus inhibiting tumor growth. [13]
  3. In a mouse model of lymph node cancer, glucocorticoids caused tumor regression. [14]
  4. In various tumor systems, pharmacologic doses of glucocorticoids also inhibited growth of malignant cells. [15]
  5. Tissue culture studies confirmed that glucocorticoids can kill malignant cells by affecting their DNA, RNA, and protein synthesis. [16]
  6. In certain lymphoid cell populations, glucocorticoids have been found to induce apoptosis and impaired glucose transport of cancer cells. [17-18]
  7. In patients with acute lymphoblastic leukemia, glucocorticoids treatment resulted in significant improvement of symptoms. [19-27]
  8. When combined with chemotherapeutic drugs, glucocorticoids prevent relapse with little toxicity. [28-33]
  9. In patients with Hodgkin disease, glucocorticoid therapy is associated with a complete response rate around 30 to 50%. [34-36]
  10. When combined with interferon-α2b, glucocorticoids is associated with 85% overall response rate and 86% 3-year survival rate. [37]
  11. Glucocorticoids also improved general feeling of well-being and appetite in cancer patients. [38-39]
  12. Glucocorticoids also reduced excess calcium levels in cancer patients undergoing chemotherapy. [40]
  13. In patients with primary and metastatic brain and spinal cord tumors, glucocorticoids ameliorated symptoms such as edema after several days of treatment. [41-46]
  14. Glucocorticoids also decreased the severity of vomiting in cancer patients undergoing chemotherapy. [47-50]
  15. In patients with nonsmall-cell lung cancer, glucocorticoid administration prevented lung injury associated with the treatment. [51-52]

Boosts Immune Function

Studies show that cortisol and other glucocorticoids can help ward off a wide array of diseases by boosting the immune function:

  1. Glucocorticoids have been shown to play a role in the development and homeostasis of T lymphocytes. [53]
  2. Cortisol mobilizes immune cells, preparing the body to mount an immune response. [54-57]
  3. Cortisol augments the immune function by suppressing early proinflammatory responses. [58]
  4. Cortisol boosts immune function by increasing blood T-cell and NK cell numbers. [59]
  5. Cortisol increases glucose metabolism and cardiovascular activity to support the “fight or flight” response. [60-61]
  6. Cortisol can enhance the function of the immune cell Th2, such as production of immunoglobulin E (IgE). [62-66]
  7. Cortisol modulates the production of pro-inflammatory cytokines in the body. [67-70]
  8. In an animal model of stimulated stress, it has been found that cortisol increases the immune cells Mx and IL-1β. [71]
  9. Cortisol activates cellular immunity to provide defense against many kinds of infection by promoting Th1-to-Th2 shift. [72-74]
  10. Stress-induced increases in cortisol may help reduce the risk of infections by mobilizing cells of innate immunity into sites of inflammation. [75-77]
  11. In HIV-infected patients, cortisol has been found to regulate immune function by stimulating humoral immunity. [78]

Fights Inflammation

There’s also strong scientific evidence suggesting that cortisol is a potent anti-inflammatory hormone which is known to protect against a wide array of inflammatory conditions:

  1. Cortisol protects against nerve damage caused by inflammation. [79]
  2. Cortisol has been found to work like nonsteroidal anti-inflammatory drugs (NSAIDs) by inhibiting prostaglandins and leukotrienes, which are the two main products of inflammation. [80]
  3. Cortisol also suppresses cyclooxygenase, a key enzyme involved in the inflammatory process. [81]
  4. A 2007 study published in the Journal of Internal Medicine found that impaired cortisol response is associated with increased risk for inflammatory conditions such as coronary heart disease. [82]
  5. Several studies found that low-grade inflammation is highly associated with impaired cortisol response during acute and chronic stress. [83-88]
  6. Studies also found that various inflammatory markers such as IL-6, IL-10, and TNF-α are all sensitive to the anti-inflammatory effects of cortisol. [89-94]
  7. Studies found that cortisol suppresses the production of pro-inflammatory cytokines and chemokines, cell adhesion molecules, and key enzymes involved in the inflammatory process.[95-97]
  8. Several studies also found that cortisol inhibits the production of inflammatory markers such as NFκB, AP-1, and annexin AI (AnxA1). [98-101]
  9. In a mouse model of inflammation, cortisol suppressed carrageenin-induced edema, zymosan-induced peritonitis, and antigen-induced arthritis. [102-103]
  10. A 2010 study published in the Current Vascular Pharmacology found that cortisol prevents the progression of atherosclerosis and the development of acute coronary syndrome. [104]
  11. A 2019 study published in Medicine Baltimore found that glucocorticoids are associated with inhibiting excessive inflammatory response in patients with community acquired pneumonia. [105]
  12. A 2009 study published in Annals of Medicine found that impaired cortisol response is associated with higher incidence of coronary artery disease. [106]

References

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