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Reasons for Low Cortisol Levels

Cortisol is a hormone your body releases in response to stress. It activates your body to perform its daily activities. It is produced by the adrenal glands, and its release is triggered by ACTH, or adenocorticotropic hormone. It is kept in balance by the hormone DHEA. Persons with low cortisol levels may have symptoms that mimic hyper or hypothyroid, but their thyroid levels are normal. Cortisol counteracts insulin production and helps in the breakdown of lipids and proteins.

  1. Adrenal Insufficiency

    • Adrenal insufficiency occurs when the adrenal glands do not produce the level of cortisol needed by the body. This condition can be acquired, meaning it's caused by damage or destruction of the adrenal gland, and congenital, meaning it is hereditary. It is usually caused by Addison's disease and is more common in females than in males. Treatment is usually done with replacement hormones.

    Hypothalamus Failure

    • In some cases, adrenal insufficiency is caused when the hypothalamus fails to respond to the low cortisol levels and does not release CRH or corticotrophin releasing hormone. This too can be treated with hormone replacement therapy.

    Nelson's Syndrome

    • Caused by the surgical removal of the both of the adrenal glands, the remnants of the adrenal glands can grow unchecked and produce large amounts of ACTH. These high levels of ACTH will suppress any cortisol production. It is uncommon, as it is not the usual practice to remove both of the adrenal glands unless cancer is present. Treatment for it is usually removal of the pituitary gland.

    Hemorrhage

    • Hemorrhage that leads to shock can produce low levels of cortisol. Especially noted with low levels of cortisol is hemorrhage during and after childbirth, because this greatly affects the pituitary gland, which in turn decreases ACTH production and decreases cortisol production. Treatment is blood transfusions to increase blood volume and decrease shock. It may take several weeks for cortisol levels to regain their normal level after such an event. Blood tests will need to be done frequently to monitor cortisol levels, as well as other blood enzyme levels after blood replacement is done.

    Testing

    • Your physician may order a test to measure your cortisol levels. It is done with a simple blood test in which blood is taken from a vein in your arm. Your physician may also test your urine for cortisol. It is common for both tests to be ordered together. There is also a test that measures the amount of salivary cortisol.

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