Do You Know How to Recognize the Symptoms of High Cortisol?

Cortisol tends to get a bad rap. After all, it's known as the "stress hormone" because it's a steroid hormone that helps the body regulate when faced with stressful situations.

But how do you know if your cortisol levels really are too high? And what are the symptoms of high cortisol?

Social media might have you thinking that face puffiness - being touted as "cortisol face" or "moon face" - is the telltale sign. TikTok videos revealing posters' cortisol faces and moon faces have racked up hundreds of thousands of views. But experts want to set the facts straight.

First of all, know that the right amount of cortisol in the body helps regulate inflammation and helps us not get sick when we come in contact with bacteria or a virus, says Jeannette M. Bennett, PhD , an associate professor of psychological science at the University of North Carolina in Charlotte. "It really keeps the immune system in check."

Cortisol can also help with metabolism control, regulating blood pressure and blood sugar, and managing your sleep-wake cycle .

And when it comes to acutely stressful situations, cortisol helps the body respond more efficiently to potential dangers.

"A classic example is a life-threatening situation, like encountering a bear," says Nia Fogelman, PhD , associate research scientist at the Yale Stress Center in New Haven, Connecticut. Cortisol helps give us the energy to fight or flee from the stressor - whether that's a bear or a pressing deadline.

Sometimes, however, diseases do cause cortisol levels to be either too high or too low. For example, Cushing's syndrome is a serious but rare condition due to too much cortisol.

Addison's disease is a result of too little cortisol produced by the adrenal glands. And secondary adrenal insufficiency is too little cortisol as a result of the pituitary gland not working properly.

Read on to discover common signs and symptoms of high cortisol and how you can get your levels tested.

What Are the Symptoms of High Cortisol?

Elevated cortisol levels won't show up in the body as some discrete sign or symptom, so it's a little tricky to notice if yours are too high. Still, there are some tells.

Some potential symptoms of high cortisol include:

• Disrupted sleep has been linked to having higher cortisol levels, whether it's an inability to get to sleep , or falling asleep and then waking up in the middle of the night, Dr. Bennett says. Though research is unclear when it comes to which causes which.
• Physical changes, such as weight gain in your face and midsection, excessive hair growth, a fatty lump between your shoulders, and purple, stretch marks on your abdomen, are commonly found among people with high cortisol.

• Increased irritability may be a signal, too - as in, you find yourself snapping at people or overreacting to spilled coffee, Bennett says.
• Craving sugary, salty, and fat-filled foods can be a sign. "It may be [a way of] trying to soothe that discomfort that you're feeling that you might not be able to put your finger on," Bennett says.

• Headaches or fatigue are some other physical symptoms that can result from elevated cortisol levels, Bennett adds.
  Feeling weak in your arms and legs (particularly upper arms and thighs) may be hints, too.

• High blood pressure, high blood sugar, and weak bones are difficult for you to see, but can be a sign of high cortisol. These all can be diagnosed by your doctor.

Common Causes of High Cortisol

There are a few possible reasons you may be experiencing any of the above due to high cortisol levels, such as:

• Chronic Stress The effect of stress on cortisol levels is typically short-lived and subsides once the stressor goes away. For instance, one study found cortisol levels increased about 9 times during stressful periods compared with relaxing ones.
  But cortisol levels may remain elevated if stress becomes chronic, which can help in situations where the stressor sticks around, like if you experienced a traumatic event or feel overloaded by work or family responsibilities for long periods of time.
  If chronic stress is causing elevated cortisol, behavior changes to help manage stress can help you lower cortisol levels . Certain populations may be at higher risk for increased cortisol due to chronic stress, including people who experience major life traumas or have a substance use disorder, Fogelman adds.
• Chronic Alcohol Abuse, Depression, and Anxiety These conditions can also all contribute to heightened cortisol levels, similar to how chronic stress can raise cortisol.

• Cushing's Syndrome This condition is the result of high levels for a long time. Cushing's syndrome can lead to other health issues such as bone loss, high blood pressure, or, in some cases, type 2 diabetes .
  Cushing's syndrome can be causes by taking large doses of certain medications, such as corticosteroids (like prednisone and dexamethasone ).
  Some tumors (including pituitary gland tumors and other neuroendocrine tumors, like certain types of lung cancer ) can produce a cortisol-producing hormone called adrenocorticotropic hormone (ACTH), which can cause cortisol levels to be high. A tumor in your adrenal gland that is making too much cortisol can also cause cortisol levels to be high.

How to Test Cortisol Levels (and When You Should)

Most primary care providers (PCPs) will not routinely administer a test for cortisol levels. And unfortunately, there's no at-home test to make sure your cortisol levels are in check.

Most doctors don't recommend testing cortisol levels unless there is a suspicion for a condition like Cushing's syndrome, says Katie Guttenberg, MD , an endocrinologist at UT Health Houston.

So, when should you be concerned about the symptoms above? And when should you advocate for yourself at your doctor's office?

Many of these signs and symptoms - irritability, trouble sleeping, a predilection for junk food - are ones that can be linked to a variety of health issues.

Bennett offers a simple litmus test: Pay attention to the stressors in your life and how they may or may not trigger symptoms. Do the symptoms you're noticing subside when you're coping with fewer acute stressors? Do they ramp up when you have more on your plate? If the answers to these questions are yes and yes, take that as a reassuring signal you don't have chronically elevated cortisol (but do make sure you are finding ways to take "breaks" from your stressors - or build in more time for self-care - so these high-stress periods do not become prolonged), Bennett says.

If these periods do become prolonged and you're experiencing symptoms without stressors to point back to, it may be worth advocating for your doctor to test your cortisol levels. You can ask your PCP. Or if you can get a referral to an endocrinologist, Dr. Guttenberg says they tend to be more knowledgeable on these issues.

There are a few different ways to go about testing, and it typically calls for more than a one-time straightforward test because levels fluctuate during the day. Instead, your doctor may order one of the following:

• Blood Test This test can help diagnose adrenal insufficiency, as well as Cushing's syndrome – but there are variations to the test depending on which condition your doctor is testing for. In either case, the time of day the test is performed is important.
• ACTH Stimulation Test This test measures how well the adrenal glands respond to ACTH (a hormone produced in the pituitary gland that stimulates the adrenal glands to release cortisol).
  It involves getting an injection of ACTH and blood draws (both before and after the shot), so that your doctor can determine if cortisol was indeed produced in response to the ACTH injection.
• Urine Test You collect all of your urine over a 24-hour period and return it to your doctor's office or lab to be tested. (This is used to screen for Cushing's syndrome, but not adrenal insufficiency.)
• Saliva Test This is typically done at home before you go to bed. Instructions usually call for rolling the swab under your tongue for two minutes and placing it in a tube to be returned to your doctor's office or lab. This test is used to screen for Cushing's syndrome.

What Is Considered a ‘Normal' Cortisol Level?

Cortisol levels usually are highest in the morning and lower throughout the day. They're typically at their lowest level around midnight (though this may not be true if you work nights or don't sleep normal hours for another reason).

Normal versus abnormal ranges depend on which test you used to measure your cortisol. Talk with your doctor about any test results. He or she will help you understand what the numbers mean, and if your results are within or outside of what is considered a healthy range for cortisol levels.

The Takeaway

Cortisol is part of the body's natural stress response and other key bodily functions. But if levels are too high, you may experience headaches, fatigue, diet changes, weight gain, mood changes, and trouble sleeping. This could indicate a serious underlying health issue, so it's a good idea to reach out to your doctor if you suspect your cortisol levels may be out of normal range.

With additional reporting by Moira Lawler .

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy . We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

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5. Cay M et al. Effect of increase in cortisol level due to stress in healthy young individuals on dynamic and static balance scores. Northern Clinics of Istanbul . 2018.
6. Chronic stress puts your health at risk. Mayo Clinic . August 1, 2023.
7. Goldfarb M. How to Identify High Cortisol Levels: Cushing's Syndrome. Saint John's Cancer Institute . April 18, 2019.
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Elise M. Brett, MD

Medical Reviewer

Elise M Brett, MD, is a board-certified adult endocrinologist. She received a bachelor's degree from the University of Michigan and her MD degree from the Icahn School of Medicine at Mount Sinai. She completed her residency training in internal medicine and fellowship in endocrinology and metabolism at The Mount Sinai Hospital. She has been in private practice in Manhattan since 1999.

Dr. Brett practices general endocrinology and diabetes and has additional certification in neck ultrasound and fine-needle aspiration biopsy, which she performs regularly in the office. She is voluntary faculty and associate clinical professor at the Icahn School of Medicine at Mount Sinai. She is a former member of the board of directors of the American Association of Clinical Endocrinology. She has lectured nationally and published book chapters and peer reviewed articles on various topics, including thyroid cancer, neck ultrasound, parathyroid disease, obesity, diabetes, and nutrition support. See full bio

Melissa Dahl

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