Cortisol or Hydrocortisone

Cortisol is the anti-stress hormone. In alarm situations, its secretion increases. However, under normal conditions it follows a circadian rhythm, its release being highest at noon. Learn more in this article.

Written and verified by Farmacéutica Clara Sebastin.

Last update: 31 July, 2021

Cortisol, or hydrocortisone, is known as the anti-stress hormone. It’s produced in an area just above the kidneys: the adrenal cortex. It belongs to the group of glucocorticoids, and is related to metabolism and inflammation processes. Among other things, they’re powerful anti-inflammatories.

Synthesis of cortisol

Cortisol is synthesized in the adrenal cortex of the kidneys. Androgens are also produced in this adrenal gland – these are male sex hormones, and are created from cholesterol.

Cortisol synthesis occurs in response to ACTH. ACTH is corticotropin, a pituitary hormone that can be influenced to either decrease or increase cortisol synthesis.

For example, some factors that increase its synthesis are :

• Stress
• Physical effort
• Hyperthermia
• Exposure to cold
• Burns
• Radiation

However, under normal conditions, cortisol release follows a circadian rhythm. In this way, cortisol levels are minimal at night and increase throughout the day. At noon, the release is maximum.

Cortisol characteristics

Hydrocortisone is a natural steroid that doesn’t have a very long-lasting effect. However, longer-acting and higher potency synthetic derivatives such as betamethasone have been created.

Actions of cortisol in the body

Cortisol, along with the rest of glucocorticoids, activates our bodies in situations of stress and alarm. That’s why, among other things, it has actions at different levels:

• Increases blood glucose: This has the opposite effect to insulin. Thus, it allows us to maintain a high level of energy to respond to stressful situations.
• Releases fatty acids: It destroys fat stores. In this way, body fat is redistributed and energy levels in the blood also increase.
• Decreases proteins: It reduces their synthesis and favors their destruction.
• Anti-inflammatory effect: it reduces inflammation regardless of the origin.
• Anti-allergic effect: It suppresses the immune system. In allergies, the immune system becomes over-active and produces very bothersome symptoms. Cortisol reduces these symptoms and the activation of the immune system, thus saving energy.
• Destroys bones: This can lead to osteoporosis when used in therapy.

Indications of cortisol as therapy

The use of glucocorticoids, such as cortisol, has been the subject of controversy in recent years. Because of this, a series of precautions must be taken. For example, it’s important not to stop treatment abruptly.

They have many uses, and these are the main ones. 

• Asthma
• Allergies
• Acute adrenal insufficiency
• Arthritis
• Malignant processes, such as leukemias or lymphomas
• Skin diseases, such as contact dermatitis
• Other illnesses, such as lupus

Cortisol is not the most potent of its group and, therefore, its synthetic derivatives are often used. They’re very effective and safe drugs, which are widely used.

Adverse reactions

Despite their effectiveness, it’s advisable to use them as little time as possible. Side effects occur more often when we use them chronically and at high doses.

Among the most common adverse reactions, the following stand out:

• Hypertension
• Osteoporosis
• Diabetes
• Stunted growth
• Psychological disorders

Many of these symptoms can be prevented with proper and controlled use. If symptoms like these are experienced, you should consult a doctor. If they consider it appropriate, they may prescribe treatment.

Cortisol-related pathologies

Two situations can occur here:

• Abnormally low cortisol levels
• A high hormone level in our bodies – the so-called Cushing syndrome stands out.

These problems can arise from an external cause, such as glucocorticoid treatment, or because something in our body isn’t functioning correctly. Likewise, the doctor must make a diagnosis and, if appropriate, prescribe some suitable treatment.

Cushing’s syndrome

Cushing syndrome causes levels of cortisol in the blood to rise. This increase is due, most of the time, to a tumor in the pituitary. However, it’s very typical for it to also appear after prolonged treatment with glucocorticoids.

Symptoms vary greatly from person to person. Many are common to those that come from glucocorticoid treatment. Thus, it’s common to find:

• The characteristic ‘ full moon face‘: red, round face
• Central obesity: thin arms and legs, but a prominent abdomen
• Arterial hypertension
• Hirsutism: excess facial hair in women
• Acne
• General weakness and pain
• Changes in behavior, anxiety, or depression

If Cushing syndrome isn’t treated, it’s life-threatening. Fortunately, most people receive proper treatment and are cured, with no sequelae.

If the cause of the syndrome is a tumor, it’s usually removed with surgery. After removal, symptoms subside in most cases. Sometimes radiation therapy or certain medications are necessary. However, if this syndrome comes from the treatment itself, then these symptoms usually disappear after stopping the glucocorticoids that caused it.