Cortisol Stress Load Assessment

Cortisol is the body’s primary stress hormone, produced by the adrenal glands in response to stress and low blood glucose. It is essential for survival, regulating metabolism, inflammation, blood sugar and the sleep-wake cycle.

No questionnaire can tell you your cortisol level, and this one does not try. What it scores is the load your habits put on the system: the things known to push cortisol up or keep it from falling at night. Your actual level takes a test, and the right test depends on which way a doctor thinks it is off.

The cortisol rhythm

In a healthy person, cortisol follows a predictable daily curve:

• It jumps by about half in the 30 to 45 minutes after you wake (the “cortisol awakening response”), whatever the clock says
• Gradually declines through the day
• Reaches its lowest point around midnight, in the first hours of sleep

Shift work, irregular sleep and late nights flatten that curve, and a flat curve (high in the evening, blunted in the morning) is the pattern linked to poorer health in long-running studies.

What raises cortisol

• Physical stress (intense exercise, illness, injury)
• Psychological stress (work pressure, anxiety, relationship conflict)
• Short sleep. In Leproult’s 1997 study, one night of sleep loss left cortisol 37 to 45% higher the following evening, when it should be falling
• Caffeine, especially in people who rarely drink it. Habitual drinkers build partial tolerance, which is why the effect is smaller than many websites claim
• Skipping meals or extreme calorie restriction
• Heavy alcohol use
• Screens late at night, less through cortisol itself than by holding off the sleep that lets it fall

“Adrenal fatigue” is not a diagnosis

You will see the idea everywhere that years of stress wear the adrenal glands out until they cannot make enough cortisol. The Endocrine Society says there is no evidence for it, and a 2016 systematic review of 58 studies (Cadegiani and Kater) found none either. Stressed, tired people usually have normal or high cortisol. The saliva panels sold to diagnose adrenal fatigue do not diagnose anything.

Real low cortisol exists. It is called adrenal insufficiency, and it is a medical condition rather than a lifestyle one.

The signs that do need a test

Too much cortisol for a long time is Cushing’s syndrome. The features that best separate it from ordinary weight gain and stress, according to the Endocrine Society’s guideline, are easy bruising, a red rounded face, weakness in the thighs and shoulders (struggling to get out of a low chair), and reddish-purple stretch marks wider than 1 cm. The commonest cause by far is steroid medicine such as prednisone, not a tumour. Testing is a late-night saliva cortisol, a 24-hour urine collection, or an overnight dexamethasone suppression test.

Too little is adrenal insufficiency: tiredness, weight loss, dizziness on standing, salt craving, nausea, and in Addison’s disease darkening skin, particularly in creases and scars. It is checked with an early-morning blood cortisol and a stimulation test.

Never stop a steroid medicine suddenly. After about three weeks of prednisone or a similar steroid, your own adrenals stop making cortisol and take weeks to months to restart. Stopping at once can cause an adrenal crisis, which is an emergency. Tapering is something to agree with the prescriber.

This assessment is for information only and does not diagnose anything.