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Too much cortisol over a long time — the commonest cause is cortisone treatment itself.
Also known as: Cushing’s syndrome · hypercortisolism · cortisol excess
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Too much cortisol over a long time. The most common cause is treatment with cortisone (steroids) for another illness; less often a tumour producing cortisol or the control hormone ACTH. Typical signs: weight gain on the trunk, a round “moon” face, easy bruising, reddish-purple stretch marks, high blood pressure and blood sugar, muscle weakness and mood swings. It must be distinguished from ordinary weight gain — targeted tests are needed. If the cause is treated (adjust cortisone medically or treat the tumour), much of it reverses. Never stop cortisone abruptly.
First clarify: is it a cortisone treatment or a hormone-producing tumour? That decides everything else.
After longer use, cortisone must be tapered slowly and only under medical guidance.
If a tumour is present, its targeted treatment (often surgical) is the decisive step.
Blood pressure, blood sugar and bone density are managed alongside.
The drugs (metyrapone, ketoconazole, osilodrostat) slow cortisol production — they are usually a bridge to surgery, or a route when surgery is not possible. They do not remove the cause. After successful surgery comes a period of too little cortisol, which can last six to eighteen months and is bridged with hydrocortisone — that phase feels worse than the illness and is still the way back.
Two to three people per million develop it each year — which is why two to six years often pass between the first signs and the diagnosis. Far more common than the illness is the form caused by cortisone medicines. After successful surgery comes a phase of too little cortisol, which can last six to eighteen months. Skin, muscle and bone recover over one to two years; high blood pressure stays in some.
Gain on the belly and neck with rather slim arms and legs.
Thin skin, easy bruising and wide reddish-purple stretch marks.
High blood pressure and sugar, plus muscle weakness especially in the thighs.
Irritability, low mood or sleep problems may be added.
A single morning value settles nothing — cortisol swings across the day. What counts is the dexamethasone suppression test, late-evening salivary cortisol and the 24-hour urine output.
Separates the causes: high points to a source making ACTH — in the pituitary or elsewhere. Low points to the adrenal itself or to steroids taken from outside.
Can be low, because a lot of cortisol also acts on salt balance. A normal potassium rules nothing out.
Cortisol raises blood sugar. A newly appearing diabetes alongside the other signs is a clue, never on its own.
Without vitamin D only a fraction of the calcium from food is taken up. It is the value that is most often too low with bone and joint complaints.
The building material itself. Better from food than from a tin: hard cheese, yoghurt, calcium-rich mineral water, almonds, broccoli and fortified plant drinks.
Involved in the action of insulin inside the cell. With poorly controlled sugar it is lost through the urine — a circle that can be closed.
Activates the proteins that build calcium into bone. Green leafy vegetables and fermented foods cover it — under coumarin blood thinning the amount stays steady rather than swinging.
Metformin lowers the uptake measurably over years. With tingling in the feet under this treatment B12 belongs checked before it is put down to nerve damage from the sugar.
Too much cortisol breaks down bone, and quickly. 1000 mg a day from food and supplement together is the accompaniment as long as the situation lasts.
For the same reason and in the same move: 20–50 µg (800–2000 IU) a day. Cortisol additionally reduces calcium uptake in the gut — together the two explain why bone gives way so fast.
Too much cortisol drives potassium out through the kidney. Muscle weakness and cramps are often the first signs — the value belongs measured, not guessed.
Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.
Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.
The controlling hormone above it. With steroids given from outside it is suppressed — hence a low level while the body is in excess.
Too much cortisol holds water, drives blood sugar and pulls calcium from bone. Salt below 5 g a day, slow carbohydrates and 1000 mg calcium with vitamin D is the usual approach while the cause is treated.
Cortisol breaks down muscle protein, mainly in thighs and upper arms. 1.2–1.5 g per kg body weight a day across three meals is the usual target.
Strength training counters the muscle loss cortisol causes in thighs and upper arms. The exercises are adapted to the reduced bone density.
Steroids pull calcium from bone. Vitamin D and calcium belong from the start, not only once the bone density scan raises a flag.