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Cortisol Level: Normal Values, Causes & Treatment

The cortisol level measures the concentration of the stress hormone cortisol in the blood. It plays a key role in metabolism, immune function, and mental well-being.

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Things worth knowing about "Cortisol Level"

The cortisol level measures the concentration of the stress hormone cortisol in the blood. It plays a key role in metabolism, immune function, and mental well-being.

What Is the Cortisol Level?

The cortisol level refers to the concentration of the hormone cortisol in the blood, saliva, or urine. Cortisol is a vital steroid hormone produced by the adrenal cortex. It is often called the stress hormone because it is released in greater amounts during physical and psychological stress. At the same time, it regulates a wide range of essential bodily functions.

Biological Functions of Cortisol

Cortisol plays many important roles in the body:

Regulation of blood sugar levels by promoting gluconeogenesis
Modulation of the immune system and suppression of inflammatory responses
Support of the cardiovascular system through blood pressure regulation
Influence on the sleep-wake cycle (circadian rhythm)
Involvement in fat, protein, and carbohydrate metabolism

Normal Values of Cortisol Levels

Cortisol levels follow a natural daily rhythm: they are highest in the morning and decline throughout the day. Typical reference values in blood serum are:

Morning (8:00 a.m.): approx. 140 to 690 nmol/l (5 to 25 mcg/dl)
Evening (8:00 p.m.): approx. 80 to 330 nmol/l (3 to 12 mcg/dl)

Exact normal ranges may vary slightly depending on the laboratory and measurement method used.

Causes of Elevated Cortisol Levels

Persistently elevated cortisol levels, also known as hypercortisolism, can have several causes:

Chronic psychological or physical stress
Cushing syndrome: a disorder of the adrenal glands or pituitary gland
Use of corticosteroid medications (drugs with cortisol-like effects)
Sleep deprivation and an unhealthy lifestyle
Certain tumors (ACTH-producing tumors)

Causes of Low Cortisol Levels

Abnormally low cortisol levels, also called hypocortisolism, can occur in:

Addison disease: a condition involving underactivity of the adrenal cortex
Long-term use of corticosteroids followed by abrupt discontinuation
Disorders of the pituitary gland or hypothalamus
Chronic fatigue and certain autoimmune conditions

Symptoms of Abnormal Cortisol Levels

Symptoms of High Cortisol Levels

Weight gain, especially around the abdomen (central obesity)
High blood pressure and elevated blood sugar
Sleep disturbances and inner restlessness
Muscle weakness
Mood swings, anxiety, or depression
Weakened immune system (frequent infections)

Symptoms of Low Cortisol Levels

Chronic fatigue and exhaustion
Low blood pressure and dizziness
Loss of appetite and weight loss
Nausea and digestive problems
Darkening of the skin (in Addison disease)

Diagnosis of Cortisol Levels

Cortisol levels can be measured through several methods:

Blood test: Measurement of serum cortisol, ideally taken in the morning between 7 and 9 a.m.
Saliva test: A convenient home-based method, particularly for measuring evening cortisol
24-hour urine test: Captures total cortisol excretion over an entire day
Dexamethasone suppression test: A specialized test used to evaluate Cushing syndrome

Treatment and Normalization of Cortisol Levels

Treatment depends on the underlying cause:

Stress management: Relaxation techniques such as meditation, yoga, or progressive muscle relaxation can help lower cortisol levels
Sleep hygiene: Sufficient and regular sleep stabilizes the cortisol rhythm
Diet: A balanced diet rich in omega-3 fatty acids, magnesium, and vitamin C can support cortisol regulation
Physical activity: Regular, moderate exercise helps regulate cortisol levels
Medical therapy: Conditions such as Cushing syndrome or Addison disease require targeted medical treatment

References

Speiser, P.W. et al. - Endocrine Society Clinical Practice Guideline: Diagnosis and Treatment of Primary Adrenal Insufficiency. Journal of Clinical Endocrinology and Metabolism, 2016.
Nieman, L.K. et al. - The Diagnosis of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism, 2008.
World Health Organization (WHO) - Mental Health and Stress-Related Disorders: Biological Markers and Cortisol Regulation. WHO Technical Report, 2022.

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