Symptoms of chronically low cortisol can appear throughout the body and include fatigue, decreased appetite, low blood pressure and, less often, life-threatening shock.
The hormone cortisol is known as the “stress hormone” because it fluctuates in response to physical and mental stress, helping you deal with whatever crisis (or exciting challenge) is at hand. But cortisol plays many other roles in the body as well.
“It helps with controlling blood-sugar levels, regulating metabolism and reducing inflammation,” says Vijay Shivaswamy, MBBS, associate professor of internal medicine in the division of diabetes, endocrine and metabolism at the University of Nebraska Medical Center 1. “It’s involved in memory and helps develop the baby during pregnancy. It has many, many different functions crucial to well-being.”
While cortisol levels normally fluctuate throughout the day, chronically low levels could be a sign something’s wrong, according to the Society for Endocrinology 3. And since cortisol is multifunctional, the symptoms of low cortisol can surface throughout the body, notes Dr. Shivaswamy. Generally, problems originate in the adrenal glands (which actually produce the cortisol) or in the pituitary gland or hypothalamus sections of the brain, both of which tell the adrenal glands when they need to make more cortisol.
Primary vs. Secondary Adrenal Insufficiency
Primary adrenal insufficiency (also called Addison’s Disease) is when the adrenal glands shut down completely, often the result of an autoimmune disorder 2511. Although relatively rare, the sudden drop-off in hormones that results can cause very striking symptoms.
“Primary adrenal insufficiency symptoms tend to be more dramatic [than those of secondary adrenal insufficiency],” says Dr. Shivaswamy. “The reason is, when your adrenal glands are destroyed, it’s not just cortisol [that's affected], it’s another hormone — aldosterone — as well. You lose both.”
Per the National Adrenal Diseases Foundation (NADF), aldosterone levels aren't usually affected in secondary adrenal insufficiency 4. Rather, the adrenal cortex isn't stimulated normally, resulting in a cortisol deficiency. Because secondary adrenal insufficiency usually results in a more gradual depletion of cortisol levels, its symptoms tend to be more subtle.
Secondary adrenal insufficiency is more common than primary 511. According to the National Institute of Diabetes and Digestive and Kidney Diseases, it affects 150 to 280 people per million, whereas primary adrenal insufficiency affects 100 to 140 people per million 45. Secondary adrenal insufficiency can happen after coming off steroid medications, although tumors, inflammation and injury to or removal of the pituitary gland can also contribute, per the Mayo Clinic 2511.
The symptoms of low cortisol vary from person to person. In rare cases, they can be life-threatening and require immediate medical attention. Only your doctor can tell for sure if you have low cortisol and why, but here are some of the more common signs of this condition.
Feeling Tired All the Time
One of the most common symptoms of low cortisol is long-lasting fatigue. Keep in mind that low cortisol levels are only one reason you may feel tired. If you feel fatigued for a long time, visit a doctor to suss out the reason.
Little or No Appetite
Along with leptin and ghrelin, cortisol is an appetite-related hormone, according to an article in the journal Obesity. A common effect of low cortisol is a decreased appetite, often accompanied by unintended weight loss, says Dr. Shivaswamy. Decreased cortisol can also produce nausea, vomiting, diarrhea and abdominal pain, according to the Mayo Clinic (and those symptoms can obviously affect appetite) 2. But many other factors can affect weight and appetite as well, so don't immediately assume that changes in those areas are due to cortisol fluctuations.
Weak Muscles and Joint Pain
Low cortisol levels sometimes lead to muscle weakness. It’s not entirely clear why this happens, but it may have to do with cortisol’s effect on glucose metabolism, according to the National Institutes of Health 9. Cortisol helps regulate glucose metabolism in various cells of the body, including muscles. Glucose provides energy for the body to operate. If cortisol interferes with that process, muscle weakness may result.
Some people also have joint pain when cortisol levels are down, says Dr. Shivaswamy, although it's not clear exactly why.
Low Blood Pressure
“Cortisol is involved in maintaining the balance of salt and water in your body,” says Dr. Shivaswamy. “That’s why you see some of the symptoms of low blood pressure [when you have low cortisol].”
Low blood pressure from too little cortisol may make you feel dizzy, especially when you stand up. Some people even faint. Dr. Shivaswamy says that low blood pressure tends to be worse in people with Addison’s disease, who have also lost aldosterone 2.
Mood and Reproductive Effects
Some people with low cortisol report irritability, anxiety and/or depression. Women may have irregular or missed periods, and both men and women may experience a lower sex drive. That’s because without cortisol, your body has trouble making androgens such as testosterone, which contribute to libido, says Dr. Shivaswamy.
When the adrenal glands stop working, levels of pigment-producing hormones go up, Dr. Shivaswamy explains.
“[The pituitary] is trying its best to crank up the adrenal gland, but it doesn’t know there’s no cortisol, so it goes crazy and affects the pigment-producing cells of the skin,” he says.
Because cortisol is involved in maintaining the body's salt-water balance, salt cravings can be another symptom of cortisol deficiency. But this symptom is more profound in people with low aldosterone levels, according to Dr. Shivaswamy.
When to Seek Help
People who have primary or secondary adrenal insufficiency can go into Addisonian crisis, per the NADF. That's a potentially life-threatening condition and needs immediate medical attention. If you have any of these symptoms, head to an emergency room right away.
And since cortisol is multifunctional, the symptoms of low cortisol can surface throughout the body, notes Dr. Shivaswamy. Some people also have joint pain when cortisol levels are down, says Dr. Shivaswamy, although it's not clear exactly why. A common effect of low cortisol is a decreased appetite, often accompanied by unintended weight loss, says Dr. Shivaswamy.
- Vijay Shivaswamy, MBBS, associate professor of internal medicine, division of diabetes, endocrine and metabolism, University of Nebraska Medical Center, Omaha
- Mayo Clinic: “Addison’s Disease.”
- Society for Endocrinology: “Cortisol.”
- National Institute for Diabetes and Digestive and Kidney Diseases: “Adrenal Insufficiency and Addison’s Disease.”
- Johns Hopkins Medicine: “Adrenal Insufficiency (Addison's Disease).”
- BMC Endocrine Disorders: “Adrenal fatigue does not exist: a systematic review.”
- Harvard Medical School: “Is adrenal fatigue ‘real’?”
- Obesity: “Stress, cortisol, and other appetite-related hormones: Prospective prediction of 6-month changes in food cravings and weight.”
- National Institutes of Health: “Physiology, Cortisol.”
- Journal of the Royal Society of Medicine: “Endocrine evaluation for muscle pain.”
- Pituitary Network Association: “Adrenal Insufficiency (Addison's Disease).”
- National Organization for Rare Disorders: “Addison’s Disease.”
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