Cortisol is a steroid hormone, which is produced by two small adrenal glands in the body. These glands are located just above the kidneys and are also part of the body's endocrine system (a network of organs that produces hormones).
Problems with the endocrine system can lead to low levels of adrenal or cortisol insufficiency . Knowing this is important as it is a reason to be vigilant.
Discover 3 reasons to have low your cortisol levels , so you can solve this problem without mishaps.
What is cortisol?
Cortisol is known as the " stress hormone " because it fluctuates in response to different types of stress, but it also has other important roles.
On the one hand, it participates in metabolism, supporting glucose production in the liver, counteracting inflammation, and helping to regulate both blood pressure and heart rate.
Cortisol is also related to the "internal clock." When you wake up in the morning (assuming you have a normal sleep cycle), your cortisol levels are normally high , because they have to "get you going." Instead, at the end of the day, cortisol levels are quite low, as they are ready to put you to sleep.
Notably, the adrenal glands work in conjunction with the pituitary gland and the hypothalamus region of the brain. When the cortisol level is low in the blood , the hypothalamus tells the pituitary gland to make the adrenal glands release more cortisol. This process occurs naturally over the course of a day, but low cortisol levels sometimes occur for reasons other than stress or normal daily activity.
The causes of adrenal insufficiency are divided into 3 categories, depending on where in the body they occur:
- Primary: The adrenal glands are affected.
- Secondary: when the pituitary gland is the culprit.
- Tertiary: when the problem originates in the hypothalamus.
Causes of low cortisol levels
Primary causes
When the problem that causes low cortisol levels in the blood develops in the adrenal gland, it is called "primary adrenal insufficiency" or "Addison's disease ."
Between 80 and 90% of Addison's cases are related to autoimmunity. The immune system mistakenly produces substances called autoantibodies, which attack the adrenal gland.
Causes of non-autoimmune primary adrenal insufficiency include problems such as: tuberculosis, HIV infection, a fungal infection called histoplasmosis , cancer, surgical removal of the adrenal glands, certain genetic disorders, and the use of a general anesthetic called Etomidate.
According to one study, primary adrenal insufficiency is relatively rare, affecting only 100 to 140 out of every million Americans (Bornstein et al., 2016).
People with Addison's disease must take a replacement hormone for the rest of their lives, but other than this, their lives can be normal and active.
2.2 Secondary causes
These causes occur when the cause of low blood cortisol is in the pituitary, a small gland located at the base of the brain. This is the most common of the three categories of adrenal insufficiency.
Normally, the pituitary gland produces adrenocorticotropic hormone (ACTH). This is what is responsible for directing the adrenal glands to produce cortisol. If the pituitary gland cannot make and send ACTH, the adrenal glands never get the message to make cortisol.
One of the most common causes of secondary adrenal insufficiency is taking a steroid medication. For example, it suppresses ACTH and reduces cortisol production. That's one of the reasons doctors don't abruptly stop steroids, but rather taper them gradually and judiciously. This way, the pituitary gland has time to start making ACTH again.
However, secondary adrenal insufficiency can also occur for other reasons related to the pituitary gland, such as tumors, inflammation, injury, or removal of the gland.
2.3 Tertiary causes
These causes originate in the hypothalamus of the brain. One of the functions of the hypothalamus is to send messages, in the form of corticotropin-releasing hormone (also known as CRH), to the pituitary, which is then in charge of alerting the pituitary gland, which subsequently alerts the adrenal glands through ACTH . If the CRH is not released properly, ACTH will not release either.
Tertiary causes are usually caused by the use of opioids or narcotics. The good news is that the high is usually short-lived, and cortisol levels return to normal shortly after opioids are stopped.
Less common causes of tertiary adrenal insufficiency include long-term steroid use, use of certain antipsychotics, tumors related to the hypothalamus, injury or surgery, and Cushing's syndrome (when the body produces cortisol for long periods of time) .
When to watch for low cortisol levels
Daily fluctuations in blood cortisol levels are normal, but persistent low levels are not.
Adrenal insufficiency is related to low levels of other adrenal hormones, which play many important roles in the body. So if you experience a loss of muscle strength, a gradually worsening feeling of fatigue, or a lack of appetite accompanied by weight loss, you may have low cortisol levels in your blood.
Warnings to take into account regarding your cortisol levels
If you are a person who has Addison's disease, and therefore you experience "Addison's crisis," then you should go to the emergency room immediately. The reason is that an Addisonian crisis, also called acute adrenal insufficiency , is a life-threatening condition, which normally occurs in response to a physical stressor, such as injury or illness.
Basically, your body can't keep up with the immediate demand for more hormones, so your blood pressure and blood sugar levels drop rapidly. You may have symptoms like vomiting and diarrhea, feel weak, or even have sudden pain in your lower back, legs, or abdomen.
conclusion
Cortisol is a hormone that reacts to certain types of stress. The problems derived from having low levels of this can range from certain discomforts to pain in some parts of the body; so it is recommended to stay aware of some unusual reactions that may be taking place in your body.
References
- Bornstein, S., Allolio, B., Arlt, W., Barthel, A., Don-Wauchope, A., Hammer, G., Husebye, E… Merke, D. (2016). Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism . doi: 10.1210 / jc.2015-1710
- Adam, P. 3 Causes of Low Cortisol Levels – and When to Talk to a Doctor. For Healthfully [Revised December 2019].
