Cortisol

[Darlene]

At my last neurology visit, she wrote me out a slip to get some labs done, my lyme titer came back positive, and mythyroid came back low. She referred me to an endocrinologist. He said that he seen from a lab a while back that my cardiologist had wrote, that my cortisol was high. That was my first time hearing about it, I never knew my cardiologist wrote out a lab for cortisol, and was never told it was high, and I am assuming it must not be to important if it's the endocrinologist that had to tell me about it, if my cardiologist knew a few years ago. What is cortisol? And what causes it to be high? Anyway, this endocrinologist wrote out a lab slip, and told me to have my labs done right away, several tubes were drawn. He said to call him in 3 weeks if I haven't heard from him...

[firewatcher]

Cortisol is a stress hormone. Many things from stress to lack of sleep can increase it.

From Labtestsonline.org:

In normal people, cortisol levels are very low at bedtime and at their highest just after waking. This pattern will change if a person works irregular shifts (such as the night shift) and sleeps at different times of the day. With Cushing?s syndrome, this pattern is typically lost.

Increased or normal cortisol concentrations in the morning along with levels that do not drop in the afternoon and evening suggest an overproduction of cortisol. If this excess cortisol is suppressed during a dexamethasone suppression test, it suggests that the excess cortisol is due to increased pituitary ACTH production. If it is not suppressed, then the increased cortisol could be due to an ACTH-producing tumor outside of the pituitary, due to a problem with the adrenal gland, or due to a medication that the patient is taking.

If the adrenal glands are overactive, then a patient may have Cushing?s syndrome, with symptoms and signs caused by prolonged exposure to the effects of too much cortisol. This may be due to excess production of cortisol by the adrenal glands (which is frequently due to a benign adrenal tumor) or excess ACTH stimulation (due to a pituitary or other ACTH-producing tumor). It can also be seen in patients who must take corticosteroid medications, such as those used to treat asthma. If insufficient cortisol is present and the patient responds to an ACTH stimulation test, then the problem is likely due to insufficient ACTH production by the pituitary. If cortisol levels do not respond to the ACTH stimulation test, then it is more likely that the problem is based in the adrenal glands. If the adrenal glands are underactive, due to adrenal damage or insufficient ACTH production, then the patient is said to have adrenal insufficiency. If decreased cortisol production is due to adrenal damage, then the patient is said to have Addison?s disease.

Once an abnormality has been identified and associated with the pituitary gland, adrenal glands, or other cause, then the doctor may use other testing such as CT (computerized tomography) or MRI (magnetic resonance imaging) scans to locate the source of the excess (such as a pituitary, adrenal, or other tumor) and to evaluate the extent of any damage to the glands.

Is there anything else I should know?

Pregnancy, physical and emotional stress, and illness can increase cortisol levels. Cortisol levels may also increase as a result of hyperthyroidism or obesity. A number of drugs can also increase levels, particularly oral contraceptives (birth control pills), hydrocortisone (the synthetic form of cortisol), and spironolactone. Adults have slightly higher cortisol levels than children do.

Hypothyroidism may decrease cortisol levels. Drugs that may decrease levels include some steroid hormones.

Salivary cortisol testing is being used more frequently to help diagnose Cushing's syndrome and stress-related disorders but still requires specialized expertise to perform.

[carinara]

i remember having a routine blod test a few years ago and my cortisol was sky high. In fact my doctor said that she never seen such a high cortisol reading. I went through more testing then but somehow they never found anything. Since then i must have had at least 10 more bloodtests (due to hospital stays before i got diagnosed) but i never heard of my cortisol being too high again?

[Broken_Shell]

At my last neurology visit, she wrote me out a slip to get some labs done, my lyme titer came back positive, and mythyroid came back low. She referred me to an endocrinologist. He said that he seen from a lab a while back that my cardiologist had wrote, that my cortisol was high. That was my first time hearing about it, I never knew my cardiologist wrote out a lab for cortisol, and was never told it was high, and I am assuming it must not be to important if it's the endocrinologist that had to tell me about it, if my cardiologist knew a few years ago. What is cortisol? And what causes it to be high? Anyway, this endocrinologist wrote out a lab slip, and told me to have my labs done right away, several tubes were drawn. He said to call him in 3 weeks if I haven't heard from him...

Hi NorthernDarlene,

One thing I wanted to mention is that certain medications can cause "false" elevations in cortisol during lab tests. One of the most common is birth control pills, but there are others. Do you mind if I ask which medications you are taking?

If you repeat the test and it shows that it is still high this is something that you might want to rule out with your doctor before you begin an extensive work-up for elevated cortisol.

~ Broken_Shell

[Darlene]

Broken Shell

The medications I take are Lexapro, Lopressor, Loratadine, Ibuprofen as needed, Klonopin as needed, and Ranitidine as needed.

Do any of these medications cause your cortisol levels to be high?

I looked up symptoms of cushings, I bolded the symptoms I have.

Signs and symptoms of Cushing?s syndrome vary, but most people with the disorder have upper body obesity, a rounded face, increased fat around the neck, and relatively slender arms and legs. Children tend to be obese with slowed growth rates.

Other signs appear in the skin, which becomes fragile and thin, bruises easily, and heals poorly. Purple or pink stretch marks may appear on the abdomen, thighs, buttocks, arms, and breasts. The bones are weakened, and routine activities such as bending, lifting, or rising from a chair may lead to backaches and rib or spinal column fractures.

Women with Cushing?s syndrome usually have excess hair growth on their face, neck, chest, abdomen, and thighs. Their menstrual periods may become irregular or stop. Men may have decreased fertility with diminished or absent desire for sex and, sometimes, erectile dysfunction.

Other common signs and symptoms include

severe fatigue

weak muscles

high blood pressure mine is low

high blood glucose mine is low at times

increased thirst and urination

irritability, anxiety, or depression

a fatty hump between the shoulders

Sometimes other conditions have many of the same signs as Cushing?s syndrome, even though people with these disorders do not have abnormally elevated cortisol levels. For example, polycystic ovary syndrome can cause menstrual disturbances, weight gain beginning in adolescence, excess hair growth, and impaired insulin action and diabetes. Metabolic syndrome?a combination of problems that includes excess weight around the waist, high blood pressure, abnormal levels of cholesterol and triglycerides in the blood, and insulin resistance?also mimics the symptoms of Cushing?s syndrome.

[Broken_Shell]

Broken Shell

The medications I take are Lexapro, Lopressor, Loratadine, Ibuprofen as needed, Klonopin as needed, and Ranitidine as needed.

Do any of these medications cause your cortisol levels to be high?

I looked up symptoms of cushings, I bolded the symptoms I have.

Signs and symptoms of Cushing?s syndrome vary, but most people with the disorder have upper body obesity, a rounded face, increased fat around the neck, and relatively slender arms and legs. Children tend to be obese with slowed growth rates.

Other signs appear in the skin, which becomes fragile and thin, bruises easily, and heals poorly. Purple or pink stretch marks may appear on the abdomen, thighs, buttocks, arms, and breasts. The bones are weakened, and routine activities such as bending, lifting, or rising from a chair may lead to backaches and rib or spinal column fractures.

Women with Cushing?s syndrome usually have excess hair growth on their face, neck, chest, abdomen, and thighs. Their menstrual periods may become irregular or stop. Men may have decreased fertility with diminished or absent desire for sex and, sometimes, erectile dysfunction.

Other common signs and symptoms include

severe fatigue

weak muscles

high blood pressure mine is low

high blood glucose mine is low at times

increased thirst and urination

irritability, anxiety, or depression

a fatty hump between the shoulders

Sometimes other conditions have many of the same signs as Cushing?s syndrome, even though people with these disorders do not have abnormally elevated cortisol levels. For example, polycystic ovary syndrome can cause menstrual disturbances, weight gain beginning in adolescence, excess hair growth, and impaired insulin action and diabetes. Metabolic syndrome?a combination of problems that includes excess weight around the waist, high blood pressure, abnormal levels of cholesterol and triglycerides in the blood, and insulin resistance?also mimics the symptoms of Cushing?s syndrome.

Hello NorthernDarlene,

I wanted to clarify what I wrote earlier about elevated cortisol and medications. What I was referring to were medications that bind circulating cortisol. Since the test that measures cortisol levels in the blood measures total cortisol (that which is free and active plus that which is bound and inactive), it can appear falsely elevated in people who are taking these medications. (I went through several doctors before one of them was knowledgable enough to recognize that this was happening with my lab values). However, the medications do NOT actually cause elevations in cortisol, so there would not be symptoms of elevated cortisol. When I wrote that, I did not know that you indeed had symptoms of elevated cortisol. Also, none of the medications you are taking are known to bind cortisol. (My formal education is in pharmacy practice). I would definitely follow up with the endocrinologist to determine whether or not you are experiencing cortisol abnormalities. Like someone wrote earlier, there are many things that can cause transient elevations in cortisol, so the endocrinologist would be the correct doctor to evaluate this. Best wishes and keep us updated on what you find out.

~ Broken_Shell