High Cortisol Symptoms: How to Know if Your Cortisol Levels are High

Cortisol is a hormone your body releases during stress. Often called the body's "stress hormone," cortisol helps regulate blood pressure, blood sugar and energy levels. Short-term increases in cortisol are a normal, necessary function. However, chronically high cortisol levels can lead to noticeable physical and emotional symptoms and may signal an underlying medical condition.

Chitravathi Reddy, MD, endocrinologist at UnityPoint Health, explains what high cortisol looks like, how it's diagnosed and what can help. Losty Torres Potter, MD, UnityPoint Health, adds more detail on what actually causes high cortisol and how doctors sort out one cause from another.

Signs and Symptoms: How to Know if You Have High Cortisol Levels

"The big one is rapid weight gain, especially around the abdomen or midsection. If someone reports gaining 20 pounds in a month without any lifestyle changes, that's a significant indicator," Dr. Reddy says.

Other symptoms you might feel when cortisol is high include:

• Fatigue
• High blood pressure
• High blood sugar
• Mood changes
• Muscle weakness, especially in the thighs and shoulders (making it difficult to get out of a chair or climb stairs)
• Sleep disturbances

When cortisol levels are high, men and women may also develop a "buffalo hump" - a buildup of fatty tissue at the base of the neck from rapid fat accumulation.

Signs of High Cortisol Levels in Women

"In younger, menstruating women, irregular cycles and difficulty getting pregnant are also symptoms of high cortisol" Dr. Reddy says. "There may be excess facial and body hair and acne, too."

Is Stress-Related High Cortisol Different from Cushing's Syndrome?

While chronic stress can contribute to elevated cortisol, Cushing's syndrome is a medical condition caused by prolonged exposure to excess cortisol in the body. Understanding the difference is important because treatment depends on the underlying cause.

• Bruising without an obvious injury
• Developing osteoporosis, diabetes, or high blood pressure at an unusually young age
• Reddish-purple stretch marks wider than a finger
• Round, reddened face
• Thinning skin

What Causes High Cortisol? Common Causes of Elevated Cortisol Levels

Prescription Steroid Medications (Most Common)

"The most common cause of excess cortisol is actually medications," Dr. Torres Potter says. Glucocorticoid drugs - steroids like prednisone and dexamethasone - produce excess cortisol effects when used over time.

Steroids in less obvious forms are frequently overlooked because they can still be absorbed into the body depending on the dose and duration. These include:

• Inhaled steroids and nasal sprays
• Joint or cortisone injections
• Skin creams and eye drops

If you're concerned about your cortisol level, don't stop taking a prescription medication on your own. Stopping steroids suddenly can be dangerous. Always talk with your doctor first.

Naturally Occurring Cushing's Syndrome (Tumors)

When the body makes too much cortisol on its own, it's known as naturally occurring Cushing's syndrome. It's uncommon, but the usual causes include:

• A pituitary tumor: A benign tumor on the pituitary gland in the brain that produces too much adrenocorticotropic hormone (ACTH), the signal that tells the adrenal glands to make cortisol.
• An adrenal tumor: A tumor on an adrenal gland (near the kidneys) that's rarely cancerous and makes cortisol on its own.
• An ectopic tumor: A tumor elsewhere in the body, most often in the lungs, that produces ACTH outside the pituitary gland.

Lifestyle Factors and Secondary Health Conditions

Several common health conditions and lifestyle factors can contribute to elevated cortisol levels without a tumor being involved. Doctors sometimes call this pseudo-Cushing's syndrome because the symptoms can resemble true Cushing's syndrome.

• Depression and other psychiatric conditions
• Eating disorders, such as anorexia
• Heavy alcohol use
• Major physical stress, such as serious illness, pain or surgery
• Polyendocrine metabolic ovarian syndrome (PMOS), formerly polycystic ovary syndrome (PCOS)
• Poorly controlled diabetes
• Pregnancy
• Obesity
• Real licorice root (found in certain candies, teas and supplements), which can increase cortisol's effects in the body and raise blood pressure.
• Sleep apnea or chronically disrupted sleep (including night-shift work)

The cortisol elevation in these cases is milder and typically improves once the underlying condition is addressed.

Can Certain Foods Cause High Cortisol?

No specific food causes Cushing's syndrome or long-term high cortisol. Here's what actually happens when you eat:

• Temporary rises are normal: Cortisol naturally spikes slightly after meals to help your body process food.
• Carbs and fats cause larger bumps: High-fat or carb-heavy meals may trigger a slightly higher short-term cortisol rise than protein.
• These spikes aren't dangerous: Brief post-meal fluctuations are a normal part of your daily hormone rhythm - not a cause of Cushing's syndrome.

How Doctors Test for High Cortisol Levels

"You can't tell which type of high cortisol you're dealing with from symptoms alone, and one blood test usually won't settle it either," Dr. Torres Potter says. Diagnosing high cortisol levels typically requires specialized hormone testing and evaluation by an endocrinologist.

When Cushing's is suspected, doctors rely on specific primary tests:

• A 24-hour urine cortisol collection
• A late-night saliva cortisol sample
• An overnight dexamethasone suppression test: As Dr. Reddy explains, "You take a pill, and the next morning your blood is tested. If the pill doesn't lower your cortisol like it should, it can be a sign your body is producing too much." This test often needs to be repeated.

If tests confirm high cortisol, the next step involves specialized imaging, like CT or MRI scan, to determine if the source is the adrenal or pituitary gland.

Medications That Can Distort Cortisol Test Results

Certain non-steroid medications don't necessarily raise actual cortisol, but they can interfere with the accuracy of the lab tests:

• Estrogen & birth control: Estrogen found in birth control pills or hormone therapy increases a blood protein that carries cortisol. Blood cortisol levels can look falsely high even when active hormone levels are normal.
• Other medications: Seizure drugs, antibiotics, antifungals and antidepressants can throw off lab results, making your cortisol levels appear higher or lower than they are.

High Cortisol Treatment: How Elevated Cortisol Is Managed

High cortisol treatment depends entirely on finding the root cause. That may mean adjusting a steroid prescription under medical supervision, treating an underlying condition like sleep apnea or surgically removing a tumor.

How to Lower Cortisol Naturally

While medical Cushing's syndrome requires clinical treatment, lifestyle changes and certain supplements may help lower stress-related cortisol levels and improve symptoms associated with chronic stress.

• Natural stress relief: Meditation and deep breathing are effective, evidence-based approaches to help naturally lower stress-induced cortisol.
• Supplements: "For chronic stress, if a thorough workup doesn't show a specific medical condition, supplements like omega-3 fatty acids, ashwagandha, or magnesium may help with symptoms," Dr. Reddy says. "In particular, a mix of magnesium glycinate, citrate and malate shows early promise for stress, anxiety and sleep, though medical evidence is still developing."

When to See a Doctor About High Cortisol Symptoms

While stress management can help day-to-day, it's important to see a healthcare provider if you feel constantly worn down by stress or notice rapid, unexplained physical changes. Left unmanaged, chronically high cortisol levels can increase the risk of serious health problems, including high blood pressure, weight gain, diabetes, osteoporosis and heart disease. If you're experiencing symptoms of high cortisol or unexplained physical changes, early evaluation can help identify the cause and guide appropriate treatment.