Evidence-Based Hormone Therapies

Cortisol

Glucocorticoids is the family name for a group of hormones, natural or synthetic derivatives, that have the capacity to increase serum glucose and thereby to prevent hypoglycaemia. The natural ones are made by the adrenal cortex. Cortisol, hydrocortisone and compound F are synonyms for the same molecule: the human body’s most potent glucocorticoid.  Hydrocortisone is the name most often used for medication containing (exogeneous) cortisol. Cortisol is the term used in general to designate the (endogenous) hormone in blood. Cortisone is the natural precursor of cortisol and has approximately 80% of cortisol’s activity. Prednisone, prednisolone (the active form of prednisone), methylprednisolone (Medrol®), beta-and dexamethasone, and so many other glucocorticoids on the market are synthetic derivatives of natural cortisol. Their structure is a modified version of cortisol to increase some of cortisol’s properties.

Cortisol keeps us alive thanks to three essential and powerful properties. It increases both blood sugar (and thus energy levels) and blood pressure and neutralizes inflammation. The beneficial effects of cortisol such as mood enhancement, dynamism,  work capacity, stress resistance, stimulation of the immune defenses, anti-rheumatic action, anti-pain action, and many others, rely on these fundamental functions. Another action of cortisol is to calm down any excessive activity of the sympathetic nervous system that produces adrenaline, the stimulating neurotransmitter. This explains why persons lacking cortisol often have high levels of adrenaline. As they miss the energy and mood calming action brought about by cortisol, they tend to compensate by making more adrenaline, regularly exploding in emotional outbursts.

Healthy adults
Healthy adults: studies of the effects of cortisol treatment on the hypothalamopituitary- adrenal axis and other physiological processes (3 references)
  1. Roelfsema F, Aoun P, Veldhuis JD. Pulsatile Cortisol Feedback on ACTH Secretion Is Mediated by the Glucocorticoid Receptor and Modulated by Gender. J Clin Endocrinol Metab. 2016 Nov;101(11):4094-4102
  2. Kellner M, Salzwedel C, Wortmann V, Urbanowicz T, Boelmans K, Yassouridis A, Stalla GK, Wiedemann K. No acute suppression of cerebrospinal fluid corticotropin-releasing hormone in man by cortisol administration. Psychiatry Res. 2013 Dec 15;210(2):662-4
  3. Posener JA, Schildkraut JJ, Williams GH, Schatzberg AF. Cortisol feedback effects on plasma corticotropin levels in healthy subjects. Psychoneuroendocrinology. 1997 Apr;22(3):169-76
Healthy adults: pharmacocinetics of cortisol and fludrocortisone treatments (1 reference)
  1. Hamitouche N, Comets E, Ribot M, Alvarez JC, Bellissant E, Laviolle B. Population pharmacokinetic-pharmacodynamic model of oral fludrocortisone and intravenous hydrocortisone in healthy volunteers. AAPS J. 2017 May;19(3):727-735.
Healthy older adults: effects of cortisol treatment on the hypothalamopituitary- adrenal axis (1 reference)
  1. Wilkinson CW, Peskind ER, Raskind MA. Decreased hypothalamic-pituitary-adrenal axis sensitivity to cortisol feedback inhibition in human aging. Neuroendocrinology. 1997 Jan;65(1):79-90
Healthy adults: effects of cortisol treatment on other hormone secretions (14 references)
  1. Nass R, Liu J, Patrie J, Pezzoli SS, Farhy LS, Gaylinn BD, Thorner MO. Four-hour infusion of hydrocortisone does not suppress the nocturnal increase of circulating acyl- or desacyl-ghrelin concentrations in healthy young adults. J Clin Endocrinol Metab. 2014 Sep;99(9):E1696-700
  2. Tops M, Buisman-Pijlman FT, Boksem MA, Wijers AA, Korf J. Cortisol-induced increases of plasma oxytocin levels predict decreased immediate free recall of unpleasant words. Front Psychiatry. 2012 May 16;3:43.
  3. Tops M, van Peer JM, Korf J. Individual differences in emotional expressivity predict oxytocin responses to cortisol administration: relevance to breast cancer? Biol Psychol. 2007 May;75(2):119-23
  4. Porter RJ, Gallagher P, Watson S, Lunn BS, Young AH. The effects of sub-chronic administration of hydrocortisone on hormonal and psychological responses to L-tryptophan in normal male volunteers. Psychopharmacology (Berl). 2002 Aug;163(1):68-75
  5. Kasckow JW, Lupien SJ, Behan DP, Welge J, Hauger RJ. Circulating human corticotropin-releasing factor-binding protein levels following cortisol infusions. Life Sci. 2001 Jun 1;69(2):133-42.
  6. Askari H, Liu J, Dagogo-Jack S. Hormonal regulation of human leptin in vivo: effects of hydrocortisone and insulin. Int J Obes Relat Metab Disord. 2000 Oct;24(10):1254-9.
  7. Watson S, Porter RJ, Young AH. Effect of hydrocortisone on the pituitary response to growth-hormone-releasing hormone. Psychopharmacology (Berl). 2000 Sep;152(1):40-6.
  8. Porter RJ, McAllister-Williams RH, Lunn BS, Young AH. 5-Hydroxytryptamine receptor function in humans is reduced by acute administration of hydrocortisone. Psychopharmacology (Berl). 1998 Oct;139(3):243-50
  9. Newcomer JW, Selke G, Melson AK, Gross J, Vogler GP, Dagogo-Jack S. Dose-dependent cortisol-induced increases in plasma leptin concentration in healthy humans. Arch Gen Psychiatry. 1998 Nov;55(11):995-1000
  10. Young AH, Rue J, Odontiadis J, Cowen PJ. Lack of effect of hydrocortisone treatment on d-fenfluramine-mediated prolactin release. Psychopharmacology (Berl). 1998 Mar;136(2):198-200.
  11. Dinan TG, Scott LV. The influence of cortisol on spontaneous and 5HT stimulated prolactin release in man. J Basic Clin Physiol Pharmacol. 1996;7(1):45-56
  12. Friess E, V Bardeleben U, Wiedemann K, Lauer CJ, Holsboer F. Effects of pulsatile cortisol infusion on sleep-EEG and nocturnal growth hormone release in healthy men. J Sleep Res. 1994 Jun;3(2):73-79
  13. Lal S, Nair NP, Isaac I, Guyda H, Quirion R. Effect of hydrocortisone on basal and apomorphine-induced growth hormone secretion in normal subjects. Clin Invest Med. 1988 Jun;11(3):218-23.
  14. Clerc D, Wick H, Keller U. Acute cortisol excess results in unimpaired insulin action on lipolysis and branched chain amino acids, but not on glucose kinetics and C-peptide concentrations in man. Metabolism. 1986 May;35(5):404-10
Healthy adults: effects of cortisol treatment on memory and other brain processes (30 references)
  1. Merz CJ, Hamacher-Dang TC, Stark R, Wolf OT, Hermann A. Neural Underpinnings of Cortisol Effects on Fear Extinction. Neuropsychopharmacology. 2017 Sep 26.
  2. Graebener AH, Michael T, Holz E, Lass-Hennemann J. Repeated cortisol administration does not reduce intrusive memories – A double blind placebo
  3. Controlled experimental study. Eur Neuropsychopharmacol. 2017 Sep 18. pii: S0924-977X(17)30903-3
  4. Dinse HR, Kattenstroth JC, Lenz M, Tegenthoff M, Wolf OT. The stress hormone cortisol blocks perceptual learning in humans. Psychoneuroendocrinology. 2017 Mar;77:63-67
  5. Fleischer J, Weber J, Hellmann-Regen J, Düsenberg M, Wolf OT, Otte C, Wingenfeld K. The effect of cortisol on autobiographical memory retrieval depends on remoteness and valence of memories. Biol Psychol. 2017 Feb;123:136-140
  6. Duesenberg M, Weber J, Schaeuffele C, Fleischer J, Hellmann-Regen J, Roepke S,M oritz S, Otte C, Wingenfeld K. Effects of Hydrocortisone on false memory recognition in healthy men and women. Behav Neurosci. 2016 Dec;130(6):635-642.
  7. Rombold F, Wingenfeld K, Renneberg B, Schwarzkopf F, Hellmann-Regen J, Otte C, Roepke S. Impact of exogenous cortisol on the formation of intrusive memories in healthy women. J Psychiatr Res. 2016 Dec;83:71-78.
  8. Kinner VL, Merz CJ, Lissek S, Wolf OT. Cortisol disrupts the neural correlates of extinction recall. Neuroimage. 2016 Jun;133:233-43.
  9. Margittai Z, Nave G, Strombach T, van Wingerden M, Schwabe L, Kalenscher T. Exogenous cortisol causes a shift from deliberative to intuitive thinking. Psychoneuroendocrinology. 2016 Feb;64:131-5.
  10. Miller R, Weckesser LJ, Smolka MN, Kirschbaum C, Plessow F. Hydrocortisone accelerates the decay of iconic memory traces: on the modulation of executive and stimulus-driven constituents of sensory information maintenance. Psychoneuroendocrinology. 2015 Mar;53:148-58
  11. Wiemers US, Wolf OT. Cortisol broadens memory of a non-stressful social interaction. Psychopharmacology (Berl). 2015 May;232(10):1727-33
  12. Peifer C, Schächinger H, Engeser S, Antoni CH. Cortisol effects on flow-experience. Psychopharmacology (Berl). 2015 Mar;232(6):1165-73.
  13. Cioncoloni D, Galli G, Mazzocchio R, Feurra M, Giovannelli F, Santarnecchi E, Bonifazi M, Rossi A, Rossi S. Differential effects of acute cortisol administration on deep and shallow episodic memory traces: a study on healthy males. Neurobiol Learn Mem. 2014 Oct;114:186-92
  14. Kandasamy N, Hardy B, Page L, Schaffner M, Graggaber J, Powlson AS, Fletcher PC, Gurnell M, Coates J. Cortisol shifts financial risk preferences. Proc Natl Acad Sci U S A. 2014 Mar 4;111(9):3608-13.
  15. Koessler S, Steidle L, Engler H, Kissler J. Stress eliminates retrieval-induced forgetting–does the oral application of cortisol? Psychoneuroendocrinology. 2013 Jan;38(1):94-106
  16. Tops M, Buisman-Pijlman FT, Boksem MA, Wijers AA, Korf J. Cortisol-induced increases of plasma oxytocin levels predict decreased immediate free recall of unpleasant words. Front Psychiatry. 2012 May 16;3:43.
  17. Young K, Drevets WC, Schulkin J, Erickson K. Dose-dependent effects of hydrocortisone infusion on autobiographical memory recall. Behav Neurosci. 2011 Oct;125(5):735-41
  18. Wilhelm I, Wagner U, Born J. Opposite effects of cortisol on consolidation of temporal sequence memory during waking and sleep. J Cogn Neurosci. 2011 Dec;23(12):3703-12.
  19. Putman P, Berling S. Cortisol acutely reduces selective attention for erotic words in healthy young men. Psychoneuroendocrinology. 2011 Oct;36(9):1407-17.
  20. Wingenfeld K, Wolf S, Krieg JC, Lautenbacher S. Working memory performance and cognitive flexibility after dexamethasone or hydrocortisone administration in healthy volunteers. Psychopharmacology (Berl). 2011 Oct;217(3):323-9
  21. Römer S, Schulz A, Richter S, Lass-Hennemann J, Schächinger H. Oral cortisol impairs implicit sequence learning. Psychopharmacology (Berl). 2011 May;215(1):33-40
  22. Kuehl LK, Lass-Hennemann J, Richter S, Blumenthal TD, Oitzl M, Schachinger H. Accelerated trace eyeblink conditioning after cortisol IV-infusion. Neurobiol Learn Mem. 2010 Nov;94(4):547-53
  23. Richter S, Schulz A, Zech CM, Oitzl MS, Daskalakis NP, Blumenthal TD, Schächinger H. Cortisol rapidly disrupts prepulse inhibition in healthy men. Psychoneuroendocrinology. 2011 Jan;36(1):109-14
  24. Tops M, van der Pompe G, Baas D, Mulder LJ, Den Boer JA, Meijman TF, Korf J. Acute cortisol effects on immediate free recall and recognition of nouns depend on stimulus valence. Psychophysiology. 2003 Mar;40(2):167-73
  25. Hsu FC, Garside MJ, Massey AE, McAllister-Williams RH. Effects of a single dose of cortisol on the neural correlates of episodic memory and error processing in healthy volunteers. Psychopharmacology (Berl). 2003 Jun;167(4):431-42
  26. McAllister-Williams RH, Rugg MD. Effects of repeated cortisol administration on brain potential correlates of episodic memory retrieval. Psychopharmacology (Berl). 2002 Feb;160(1):74-83
  27. Buchanan TW, Brechtel A, Sollers JJ, Lovallo WR. Exogenous cortisol exerts effects on the startle reflex independent of emotional modulation. Pharmacol Biochem Behav. 2001 Feb;68(2):203-10
  28. Kirschbaum C, Wolf OT, May M, Wippich W, Hellhammer DH. Stress- and treatment-induced elevations of cortisol levels associated with impaired declarative memory in healthy adults. Life Sci. 1996;58(17):1475-83.
  29. Young AH, Sahakian BJ, Robbins TW, Cowen PJ. The effects of chronic administration of hydrocortisone on cognitive function in normal male volunteers. Psychopharmacology (Berl). 1999 Aug;145(3):260-6
  30. Newcomer JW, Selke G, Melson AK, Hershey T, Craft S, Richards K, Alderson AL. Decreased memory performance in healthy humans induced by stress-level cortisol treatment. Arch Gen Psychiatry. 1999 Jun;56(6):527-33µ
Healthy older adults: effects of cortisol treatment on memory and other brain processes (16 references)
  1. Schwegler K, Ettlin D, Buser I, Klaghofer R, Goetzmann L, Buddeberg C, Alon E, Brügger M, de Quervain DJ. Cortisol reduces recall of explicit contextual pain memory in healthy young men. Psychoneuroendocrinology. 2010 Sep;35(8):1270-3.

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Quality of life and fatigue: the association with lower cortisol levels (35 references)
  1. Roerink ME, Roerink SHPP, Skoluda N, van der Schaaf ME, Hermus ARMM, van der Meer JWM, Knoop H, Nater UM. Hair and salivary cortisol in a cohort of women with chronic fatigue syndrome. Horm Behav. 2018 Jul;103:1-6.
  2. Fuchs A, Jaite C, Neukel C, Dittrich K, Bertsch K, Kluczniok D, Möhler E, Attar CH, Brunner R, Bödeker K, Resch F, Bermpohl F, Kaess M. Link between children’s hair cortisol and psychopathology or quality of life moderated by childhood adversity risk. 2018 Apr;90:52-60.
  3. van Aken M, Oosterman J, van Rijn T, Ferdek M, Ruigt G, Kozicz T, Braat D, Peeters A, Nap A. Hair cortisol and the relationship with chronic pain and quality of life in endometriosis patients. 2018 Mar;89:216-222
  4. Kumari M, Badrick E, Chandola T, Adam EK, Stafford M, Marmot MG, Kirschbaum C, Kivimaki M. Cortisol secretion and fatigue: associations in a community-based cohort. Psychoneuroendocrinology. 2009 Nov;34(10):1476-85
  5. Roberts AD, Papadopoulos AS, Wessely S, Chalder T, Cleare AJ. Salivary cortisol output before and after cognitive behavioral therapy for chronic fatigue syndrome. J Affect Disord. 2009 May;115(1-2):280-6

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Low quality of life, fatigue: the association with low cortisol levels and the improvement with cortisol/glucocorticoid therapy (4 references)
  1. Nagasaka M, Abdallah N, Samantray J, Sukari A. Is this really just “fatigue”? a case series of immune-related central adrenal insufficiency secondary to immune checkpoint inhibitors. Clin Case Rep. 2018 May 24;6(7):1278-1281
  2. Ntyonga-Pono MP.Chronic adrenal insufficiency: an underestimated cause of chronic fatigue. Pan Afr Med J. 2018 Jan 30;29:93
  3. Nater UM, Youngblood LS, Jones JF, Unger ER, Miller AH, Reeves WC, Heim C. Alterations in diurnal salivary cortisol rhythm in a population-based sample of cases with chronic fatigue syndrome. Psychosom Med. 2008 Apr;70(3):298-305
  4. Bouwer C, Claassen J, Dinans TG, Nemeroff CB. Prednisone augmentation in treatment-resistant depression with fatigue and hypocortisolaemia: a case series. Depress Anxiety. 2000;12(1):44-50
Low quality of life, fatigue: the improvement with cortisol or other glucocorticoid treatments (7 references)
  1. Colombo C, De Leo S, Di Stefano M, Vannucchi G, Persani L, Fugazzola L. Primary adrenal insufficiency during lenvatanib or vandetanib and improvement of fatigue after cortisone acetate therapy. J Clin Endocrinol Metab. 2019 Mar 1;104(3):779-784.
  2. Sorgdrager FJH, Werumeus Buning J, Bos EH, Van Beek AP, Kema IP. Hydrocortisone affects fatigue and physical functioning through metabolism of tryptophan: a randomized controlled trial. J Clin Endocrinol Metab. 2018 Sep 1;103(9):3411-3419.
  3. Tops M, van Peer JM, Wijers AA, Korf J. Acute cortisol administration reduces subjective fatigue in healthy women. Psychophysiology. 2006 Nov;43(6):653-6
  4. Whitcomb JE, Findling JW, Raff H, Harnsher K. Randomized trial of oral hydrocortisone and its effect on emergency physicians during night duty. WMJ. 2000 Oct;99(7):37-41
  5. Bruera E, Roca E, Cedaro L, Carraro S, Chacon R. Action of oral methylprednisolone in terminal cancer patients: a prospective randomized double-blind study. Cancer Treat Rep. 1985 Jul-Aug;69(7-8):751-4

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Burnout: the association with lower cortisol levels (9 references)
  1. Parent-Lamarche A, Marchand A. Work stress, personality traits, and cortisol secretion: testing a model for job burnout. Work. 2018;60(3):485-497.
  2. Osterberg K, Karlson B, Hansen AM. Cognitive performance in patients with burnout, in relation to diurnal salivary cortisol. 2009;12(1):70-81
  3. Sonnenschein M, Mommersteeg PM, Houtveen JH, Sorbi MJ, Schaufeli WB, van Doornen LJ. Exhaustion and endocrine functioning in clinical burnout: an in-depth study using the experience sampling method. Biol Psychol. 2007 May;75(2):176-84.
  4. Moch SL, Panz VR, Joffe BI, Havlik I, Moch JD. Longitudinal changes in pituitary-adrenal hormones in South African women with burnout. Endocrine. 2003 Aug;21(3):267-72.
  5. Nicolson NA, van Diest R. Salivary cortisol patterns in vital exhaustion. J Psychosom Res. 2000 Nov;49(5):335-42

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Burnout: the association with higher salivary cortisol levels (2 references)
  1. Pilger A, Haslacher H, Meyer BM, Lackner A, Nassan-Agha S, Nistler S, Stangelmaier C, Endler G, Mikulits A, Priemer I, Ratzinger F, Ponocny-Seliger E, Wohlschläger-Krenn E, Teufelhart M, Täuber H2, Scherzer TM, Perkmann T, Jordakieva G, Pezawas L, Winker R. Midday and nadir salivary cortisol appear superior to cortisol awakening response in burnout assessment and monitoring. Sci Rep. 2018 Jun 14;8(1):9151.
  2. Penz M, Stalder T, Miller R, Ludwig VM, Kanthak MK, Kirschbaum C. Hair cortisol as a biological marker for burnout symptomatology. 2018 Jan;87:218-221.
Depression: the association with lower cortisol levels (43 references)
  1. Scharlau F, Pietzner D, Vogel M, Gaudl A, Ceglarek U, Thiery J, Kratzsch J, Hiemisch A, Kiess W. Evaluation of hair cortisol and cortisone change during pregnancy and the association with self-reported depression, somatization, and stress symptoms. Stress. 2018 Jan;21(1):43-50.
  2. Schuler KL, Ruggero CJ, Goldstein BL, Perlman G, Klein DN, Kotov R, Schuler KL, Ruggero CJ, Goldstein BL, Perlman G, Klein DN, Kotov R. Diurnal cortisol interacts with stressful events to prospectively predict depressive symptoms in adolescent girls. J Adolesc Health. 2017 Dec;61(6):767-772 J Adolesc Health. 2017 Dec;61(6):767-772.
  3. Huang MC, Chuang SC, Tseng MM, Chien YL, Liao SC, Chen HC, Kuo PH. Cortisol awakening response in patients with bipolar disorder during acute episodes and partial remission: A pilot study. Psychiatry Res. 2017 Dec;258:594-597.
  4. Williams ME, Frey BN. Salivary cortisol during memory encoding in pregnancy predicts postpartum depressive symptoms: a longitudinal study. Trends Psychiatry Psychother. 2017 Oct-Dec;39(4):280-284.
  5. Steudte-Schmiedgen S, Wichmann S, Stalder T, Hilbert K, Muehlhan M, Lueken U, Beesdo-Baum K. Hair cortisol concentrations and cortisol stress reactivity in generalized anxiety disorder, major depression and their comorbidity. J Psychiatr Res. 2017 Jan;84:184-190.

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Depression: lower glucocorticoid receptor levels and a circadian rhythm with lower fluctuations of serum cortisol (3 references)
  1. Scott LV, Dinan TG. Urinary free cortisol excretion in chronic fatigue syndrome, major depression and in healthy volunteers. J Affect Disord; 1998 Jan;47(1-3):49-54
  2. Yerevanian BI, Woolf PD, Iker HP. Plasma ACTH levels in depression before and after recovery: relationship to the dexamethasone suppression test. Psychiatry Res. 1983 Nov;10(3):175-81
  3. Yehuda R, Boisoneau D, Mason JW, Giller EL. Glucocorticoid receptor number and cortisol excretion in mood, anxiety, and psychotic disorders. Biol Psychiatry. 1993 Jul 1-15;34(1-2):18-25
Depression: no association with cortisol awakening response (1 reference)
  1. LeMoult J, Ordaz SJ, Kircanski K, Singh MK, Gotlib IH. Predicting first onset of depression in young girls: interaction of diurnal cortisol and negative life events. J Abnorm Psychol. 2015 Nov;124(4):850-9.
Depression: the association with higher cortisol levels (2 references)
  1. Milrad SF1, Hall DL2, Jutagir DR1, Lattie EG3, Czaja SJ4, Perdomo DM4, Fletcher MA5, Klimas N5, Antoni MH6. Depression, evening salivary cortisol and inflammation in chronic fatigue syndrome: a psychoneuroendocrinological structural regression model. Int J Psychophysiol. 2018 Sep;131:124-130.
  2. Chang WP, Lin CC. Relationships of salivary cortisol and melatonin rhythms to sleep quality, emotion, and fatigue levels in patients with newly diagnosed lung cancer. Eur J Oncol Nurs. 2017 Aug;29:79-84.
Depression: the improvement with cortisol or other glucocorticoid treatments (4 references)
  1. Werumeus Buning J, Brummelman P, Koerts J, Dullaart RP, van den Berg G, van der Klauw MM, Sluiter WJ, Tucha O, Wolffenbuttel BH, van Beek AP. Hydrocortisone dose influences pain, depressive symptoms and perceived health in adrenal insufficiency: a randomized controlled trial. Neuroendocrinology. 2016;103(6):771-8.
  2. Goodwin GM, Muir WJ, Seckl JR, Bennie J, Carroll S, Dick H, Fink G. The effects of cortisol infusion upon hormone secretion from the anterior pituitary and subjective mood in depressive illness and in controls. J Affect Disord. 1992 Oct;26(2):73-83
  3. O’Dwyer AM, Lightman SL, Marks MN, Checkley SA. Treatment of major depression with metyrapone and hydrocortisone. J Affect Disord. 1995 Feb 21;33(2):123-8
  4. Adunsky A, Berkowitz M, Waller A. Corticosteroids in terminal cancer. 1995 Mar 1;128(5):278-80, 335
Anxiety: the association with lower cortisol levels or a flatter cortisol circadian rhythm (18 references)
  1. Wichmann S, Kirschbaum C, Böhme C, Petrowski K. Cortisol stress response in post-traumatic stress disorder, panic disorder, and major depressive disorder patients. Psychoneuroendocrinology. 2017 Sep;83:135-141.
  2. van den Bos E, Tops M, Westenberg PM. Social anxiety and the cortisol response to social evaluation in children and adolescents. 2017 Apr;78:159-167.
  3. Assari S, Moghani Lankarani M, Caldwell CH, Zimmerman M. Anxiety symptoms during adolescence predicts salivary cortisol in early adulthood among blacks; sex differences. Int J Endocrinol Metab. 2015 Oct 26;13(4):e18041.
  4. Zaig I, Azem F, Schreiber S, Amit A, Litvin YG, Bloch M. Psychological response and cortisol reactivity to in vitro fertilization treatment in women with a lifetime anxiety or unipolar mood disorder diagnosis. J Clin Psychiatry. 2013 Apr;74(4):386-92.
  5. Doane LD, Mineka S, Zinbarg RE, Craske M, Griffith JW, Adam EK. Are flatter diurnal cortisol rhythms associated with major depression and anxiety disorders in late adolescence? The role of life stress and daily negative emotion. Dev Psychopathol. 2013 Aug;25(3):629-42.

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Anxiety: the improvement with cortisol or other glucocorticoid treatment (9 references)
  1. Soravia LM, Schwab S, Weber N, Nakataki M, Wiest R, Strik W, Heinrichs M, de Quervain D, Federspiel A. Glucocorticoid administration restores salience network activity in patients with spider phobia. Depress Anxiety. 2018 Oct;35(10):925-934.
  2. Ito S, Masuda M, Tanaka S, Takagi M, Tanaka C, Yamada N, Nakajima K, Akashi T, Hirano T, Utsumi H. Low-dose glucocorticoid therapy complements the pituitary-adrenocortical system and reduces anxiety and insomnia in myasthenia gravis patients. Clin Neuropharmacol. 2012 Jan-Feb;35(1):30-6.
  3. Demiralay C, Jahn H, Kellner M, Yassouridis A, Wiedemann K. Differential effects to CCK-4-induced panic by dexamethasone and hydrocortisone. World J Biol Psychiatry. 2012 Oct;13(7):526-34.
  4. de Quervain DJ, Aerni A, Schelling G, Roozendaal B. Glucocorticoids and the regulation of memory in health and disease. Front Neuroendocrinol. 2009 Aug;30(3):358-70
  5. Putman P, Hermans EJ, Koppeschaar H, van Schijndel A, van Honk J. A single administration of cortisol acutely reduces preconscious attention for fear in anxious young men. 2007 Aug;32(7):793-802

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Stress: the association with lower cortisol levels or a flatter cortisol circadian rhythm (3 references)
  1. Brooks KP, Robles TF. Recent depressive and anxious symptoms predict cortisol responses to stress in men. Psychoneuroendocrinology. 2009 Aug;34(7):1041-9
  2. Petrelluzzi KF, Garcia MC, Petta CA, Grassi-Kassisse DM, Spadari-Bratfisch RC. Salivary cortisol concentrations, stress and quality of life in women with endometriosis and chronic pelvic pain. Stress. 2008;11(5):390-7
  3. Van den Bergh BR, Van Calster B, Pinna Puissant S, Van Huffel S. Self-reported symptoms of depressed mood, trait anxiety and aggressive behaviour in post-pubertal adolescents: Associations with diurnal cortisol profiles. Horm Behav. 2008 Aug;54(2):253-7
Psychological distress (perceived stress): the association with high and then low cortisol during the day (1 reference)
  1. Marchand A, Durand P, Juster RP, Lupien SJ. Workers’ psychological distress, depression, and burnout symptoms: associations with diurnal cortisol profiles. Scand J Work Environ Health. 2014 May 1;40(3):305-14.
Posttraumatic stress disorder: the association with lower cortisol levels (7 references)
  1. Straub J, Klaubert LM, Schmiedgen S, Kirschbaum C, Goldbeck L. Hair cortisol in relation to acute and post-traumatic stress symptoms in children and adolescents. Anxiety Stress Coping. 2017 Nov;30(6):661-670.
  2. Yehuda R, Bierer LM, Pratchett LC, Lehrner A, Koch EC, Van Manen JA, Flory JD, Makotkine I, Hildebrandt T. Cortisol augmentation of a psychological treatment for warfighters with posttraumatic stress disorder: Randomized trial showing improved treatment retention and outcome. Psychoneuroendocrinology. 2015 Jan;51:589-97.
  3. Steudte S, Kirschbaum C, Gao W, Alexander N, Schönfeld S, Hoyer J, Stalder T. Hair cortisol as a biomarker of traumatization in healthy individuals and posttraumatic stress disorder patients. Biol Psychiatry. 2013 Nov 1;74(9):639-46.
  4. Thomas KS, Bower JE, Williamson TJ, Hoyt MA, Wellisch D, Stanton AL, Irwin M. Post-traumatic disorder symptoms and blunted diurnal cortisol production in partners of prostate cancer patients. Psychoneuroendocrinology. 2012 Aug;37(8):1181-90.
  5. Vythilingam M, Gill JM, Luckenbaugh DA, Gold PW, Collin C, Bonne O, Plumb K, Polignano E, West K, Charney D. Low early morning plasma cortisol in posttraumatic stress disorder is associated with co-morbid depression but not with enhanced glucocorticoid feedback inhibition. Psychoneuroendocrinology. 2010 Apr;35(3):442-50.

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Attention deficit disorder: the association with lower cortisol levels (5 references)
  1. Schloß S, Ruhl I, Müller V, Becker K, Skoluda N, Nater UM, Pauli-Pott U. Low hair cortisol concentration and emerging attention-deficit/hyperactivity symptoms in preschool age. Dev Psychobiol. 2018 Sep;60(6):722-729.
  2. Pauli-Pott U, Schloß S, Ruhl I, Skoluda N, Nater UM, Becker K. Hair cortisol concentration in preschoolers with attention-deficit/hyperactivity symptoms-Roles of gender and family adversity. Psychoneuroendocrinology. 2017 Dec;86:25-33.
  3. Northover C, Thapar A, Langley K, Fairchild G, van Goozen SHM. Cortisol levels at baseline and under stress in adolescent males with attention-deficit hyperactivity disorder, with or without comorbid conduct disorder. Psychiatry Res. 2016 Aug 30;242:130-136.
  4. Isaksson J, Nilsson KW, Lindblad F. Early psychosocial adversity and cortisol levels in children with attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry. 2013 Jul;22(7):425-32.
  5. Isaksson J, Nilsson KW, Nyberg F, Hogmark A, Lindblad F. Cortisol levels in children with attention-deficit/hyperactivity disorder. J Psychiatr Res. 2012 Nov;46(11):1398-405.
Better memory, less risk of cognitive impairment: the association with higher cortisol levels and/or cortisol awakening levels  (20 references)
  1. Korten NCM, Penninx BWJH, Rhebergen D, Deeg DJH, Comijs HC. Hypothalamus-Pituitary-Adrenal-axis activity and cognitive functioning in older adults. 2018 May;91:50-54.
  2. Bäumler D, Voigt B, Miller R, Stalder T, Kirschbaum C, Kliegel M. The relation of the cortisol awakening response and prospective memory functioning in young children. Biol Psychol. 2014 May;99:41-6.
  3. Stawski RS, Almeida DM, Lachman ME, Tun PA, Rosnick CB, Seeman T. Associations between cognitive function and naturally occurring daily cortisol during middle adulthood: timing is everything. J Gerontol B Psychol Sci Soc Sci. 2011 Jul;66 Suppl 1:i71-81.
  4. Souza-Talarico JN, Chaves EC, Lupien SJ, Nitrini R, Caramelli P. Relationship between cortisol levels and memory performance may be modulated by the presence or absence of cognitive impairment: evidence from healthy elderly, mild cognitive impairment and Alzheimer’s disease subjects. J Alzheimers Dis. 2010;19(3):839-48.
  5. Hampson E, Duff-Canning SJ. Salivary cortisol and explicit memory in postmenopausal women using hormone replacement therapy. Psychoneuroendocrinology. 2016 Feb;64:99-107.

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Cognitive function: the association with greater daytime fluctuations in cortisol levels (1 reference)
  1. Dijckmans B, Tortosa-Martínez J, Caus N, González-Caballero G, Martínez-Pelegrin B, Manchado-Lopez C, Cortell-Tormo JM, Chulvi-Medrano I, Clow A. Does the diurnal cycle of cortisol explain the relationship between physical performance and cognitive function in older adults? Eur Rev Aging Phys Act. 2017 May 15;14:6.
Memory: the improvement for memory of stressful events with hydrocortisone and glucocorticoid treatments (13 references)
  1. Cioncoloni D, Galli G, Mazzocchio R, Feurra M, Giovannelli F, Santarnecchi E, Bonifazi M, Rossi A, Rossi S. Differential effects of acute cortisol administration on deep and shallow episodic memory traces: a study on healthy males. Neurobiol Learn Mem. 2014 Oct;114:186-92
  2. Rubin LH, Phan KL, Keating SM, Maki PM. A single low dose of hydrocortisone enhances cognitive functioning in HIV-infected women. AIDS. 2018 Sep 10;32(14):1983-1993.
  3. Kuehl LK, Wolf OT, Driessen M, Schlosser N, Fernando SC, Wingenfeld K. Effects of cortisol on the memory bias for emotional words? A study in patients with depression and healthy participants using the Directed Forgetting task. Psychiatr Res. 2017 Sep;92:191-198.
  4. Wingenfeld K, Driessen M, Terfehr K, Schlosser N, Fernando SC, Otte C, Beblo T, Spitzer C, Löwe B, Wolf OT. Effects of cortisol on memory in women with borderline personality disorder: role of co-morbid post-traumatic stress disorder and major depression. Psychol Med. 2013 Mar;43(3):495-505.
  5. Wingenfeld K, Driessen M, Terfehr K, Schlosser N, Fernando SC, Otte C, Beblo T, Spitzer C, Löwe B, Wolf OT. Cortisol has enhancing, rather than impairing effects on memory retrieval in PTSD. 2012 Jul;37(7):1048-56.

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Alzheimer’s disease: the association with lower glucocorticoid receptor levels (1 reference)
  1. Armanini D, Vecchio F, Basso A, Milone FF, Simoncini M, Fiore C, Mattarello MJ, Sartorato P, Karbowiak I. Alzheimer’s disease: pathophysiological implications of measurement of plasma cortisol, plasma dehydroepiandrosterone sulfate, and lymphocytic corticosteroid receptors. Endocrine. 2003 Nov;22(2):113-8
Behavioral problems in dementia: the association with lower cortisol levels (1 reference)
  1. Woods DL, Kim H, Yefimova M. Morning cortisol in relation to behavioral symptoms of nursing home residents with dementia. Biol Res Nurs. 2011 Apr;13(2):196-203.
Anecdotal report on dementia reversed with glucocorticoid treatment (1 reference)
  1. Basavaraju N, Phillips SL. Cortisol deficient state. A cause of reversible cognitive impairment and delirium in the elderly. J Am Geriatr Soc. 1989 Jan;37(1):49-51
Schizophrenia, more negative symptoms (deficit in behavior): the association with lower cortisol levels (3 references)
  1.  White RG, Lysaker P, Gumley AI, McLeod H, McCleery M, O’Neill D, MacBeth A, Giurgi-Oncu C, Mulholland CC. Plasma cortisol levels and illness appraisal in deficit syndrome schizophrenia. Psychiatry Res. 2014 Dec 30;220(3):765-71.
  2. Day FL, Valmaggia LR, Mondelli V, Papadopoulos A, Papadopoulos I, Pariante CM, McGuire P. Blunted cortisol awakening response in people at ultra-high risk of developing psychosis. Schizophr Res. 2014 Sep;158(1-3):25-31.
  3. Hempel RJ, Tulen JH, van Beveren NJ, Röder CH, de Jong FH, Hengeveld MW. Diurnal cortisol patterns of young male patients with schizophrenia. Psychiatry Clin Neurosci. 2010 Oct;64(5):548-54.
Cocaine craving: the association with lower cortisol levels (1 reference)
  1. Walter M, Bentz D, Schicktanz N, Milnik A, Aerni A, Gerhards C, Schwegler K,  Vogel M, Blum J, Schmid O, Roozendaal B, Lang UE, Borgwardt S, de Quervain D. Effects of cortisol administration on craving in heroin addicts. Transl Psychiatry. 2015 Jul 28;5:e610.
Sleep disorders, insomnia: the association with low cortisol levels and/or a low cortisol awakening response (15 references)
  1. Henry M, Ross IL, Thomas KGF. Reduced slow-wave sleep and altered diurnal cortisol rhythms in patients with Addison’s disease. Eur J Endocrinol. 2018 Oct 16;179(5):319-330.
  2. Chang WP. Influence of shift type on sleep quality of female nurses working monthly rotating shifts with cortisol awakening response as mediating variable. Chronobiol Int. 2018 Oct;35(11):1503-1512.
  3. Hernández LM, Markwald RR, Kviatkovsky SA, Perry LN, Taylor MK. Morning cortisol is associated with stress and sleep in elite military men: a brief report. Mil Med. 2018 Sep 1;183(9-10):e255-e259.
  4. Fekedulegn D, Innes K, Andrew ME, Tinney-Zara C, Charles LE, Allison P, Violanti JM, Knox SS. Sleep quality and the cortisol awakening response (car) among law enforcement officers: the moderating role of leisure-time physical activity. 2018 Sep;95:158-169.
  5. Drake CL, Cheng P, Almeida DM, Roth T. Familial risk for insomnia is associated with abnormal cortisol response to stress. Sleep. 2017 Oct 1;40(10).

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Sleep disorders, insomnia: the association with high cortisol levels (review) (1 reference)
  1. Vargas I, Vgontzas AN, Abelson JL, Faghih RT, Morales KH, Perlis ML. Altered ultradian cortisol rhythmicity as a potential neurobiological substrate for chronic insomnia. Sleep Med Rev. 2018 Oct;41:234-243.
Sleep disorders, insomnia: the improvement with glucocorticoid treatment (1 reference)
  1. Ito S, Masuda M, Tanaka S, Takagi M, Tanaka C, Yamada N, Nakajima K, Akashi T, Hirano T, Utsumi H. Low-dose glucocorticoid therapy complements the pituitary-adrenocortical system and reduces anxiety and insomnia in myasthenia gravis patients. Clin Neuropharmacol. 2012 Jan-Feb;35(1):30-6.
Sleep apnea: the association with low cortisol levels (3 references)
  1. Bozic J, Galic T, Supe-Domic D, Ivkovic N, Ticinovic Kurir T, Valic Z, Lesko J, Dogas Z. Morning cortisol levels and glucose metabolism parameters in moderate and severe obstructive sleep apnea patients. 2016 Sep;53(3):730-9.
  2. Jeong JH, Guilleminault C, Park CS, Son HL, Lee HK, Hwang SH, Choi YS. Changes in salivary cortisol levels in pediatric patients with obstructive sleep apnea syndrome after adenotonsillectomy. Sleep Med. 2014 Jun;15(6):672-6.
  3. Edwards KM, Kamat R, Tomfohr LM, Ancoli-Israel S, Dimsdale JE. Obstructive sleep apnea and neurocognitive performance: the role of cortisol. Sleep Med. 2014 Jan;15(1):27-32.
Sleep apnea: no association with high diurnal cortisol levels (1 reference)
  1. Haba-Rubio J, Ouanes S, Franc Y, Marques-Vidal P, Waeber G, Vollenweider P, von Gunten A, Preisig M, Kuehner C, Castelao E, Heinzer R, Popp J. Do diurnal cortisol levels mediate the association between sleep disturbances and cognitive impairment?. Neurobiol Aging. 2018 Sep;69:65-67.
Higher sexual desire and interest: the association with high cortisol levels (3 references)
  1. Harris A, Endresen Reme S, Tangen T, Hansen ÅM, Helene Garde A, Eriksen HR. Diurnal cortisol rhythm: Associated with anxiety and depression, or just an indication of lack of energy? Psychiatry Res. 2015 Aug 15;228(2):209-15.
  2. Cerda-Molina AL, Hernández-López L, de la O CE, Chavira-Ramírez R, Mondragón-Ceballos R. changes in men’s salivary testosterone and cortisol levels, and in sexual desire after smelling female axillary and vulvar scents. Front Endocrinol (Lausanne). 2013 Oct 28;4:159.
  3. Basson R, O’Loughlin JI, Weinberg J, Young AH, Bodnar T, Brotto LA. Dehydroepiandrosterone and cortisol as markers of HPA axis dysregulation in women with low sexual desire. 2019 Mar 8;104:259-268.
Sexual well-being: the association with higher cortisol levels in men (1 reference)
  1. Hoyt MA, Gaffey AE, Wang AW, Litwin MS, Lawsin CJ. Sexual well-being and diurnal cortisol after prostate cancer treatment. J Health Psychol. 2018 Apr 1:1359105318772655.
Skin pigmentation, darkening of the skin, the association with lower cortisol levels (9 references)
  1. Badri T, Zeglaoui F, Khiari K, El Fekih N, Fourati M, Fazaa B, Kamoun MR. Isolated cutaneous pigmentation: adrenal insufficiency may be the cause. Presse Med. 2007 Apr;36(4 Pt 1):615-8
  2. Jones D, Kay M, Craigen W, McCabe E, Hawkins H, Dominey A. Coal-black hyperpigmentation at birth in a child with congenital adrenal hypoplasia. J Am Acad Dermatol. 1995 Aug;33(2 Pt 2):323-6.
  3. Schürer N, Zumdick M, Goerz G. Hyperpigmentation in primary adrenal cortex insufficiency: Addison disease. Hautarzt. 1993 May;44(5):300-5.
  4. Mor F, Green P, Wysenbeek AJ. Myopathy in Addison’s disease. Ann Rheum Dis. 1987 Jan;46(1):81-3
  5. Shapiro MS, Trebich C, Shilo L, Shenkman L. Myalgias and muscle contractures as the presenting signs of Addison’s disease. Postgrad Med J. 1988 Mar;64(749):222-3

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Pigmented face, neck and back of hands: the association with lower cortisol levels (1 reference)
  1. Orth DN, Kovacs WJ. Chapter 12: The adrenal cortex. Major manifestations in patients with primary adrenal insufficiency, p. 550. Williams Textbook of Endocrinology, 9th edition, Wilson, Foster, Kronenberg & Larsen editors, WB Saunders Company, 1998
Mucosal pigmentation: the association with lower cortisol levels (2 references)
  1.  Zargar AH, Laway BA, Masoodi SR, Bashir MI, Wani AI, Salahuddin M. A critical evaluation of signs and symptoms in the diagnosis of Addison’s diseases. J Assoc Physicians India. 2001 May;49:523-6
  2. Orth DN, Kovacs WJ. Chapter 12: The adrenal cortex. Major manifestations in patients with primary adrenal insufficiency, p. 550. Williams Textbook of Endocrinology, 9th edition, Wilson, Foster, Kronenberg & Larsen editors, WB Saunders Company, 1998
Pigmented tongue: the association with lower cortisol levels (1 reference)
  1. Orth DN, Kovacs WJ. Chapter 12: The adrenal cortex. Major manifestations in patients with primary adrenal insufficiency, p. 550. Williams Textbook of Endocrinology, 9th edition, Wilson, Foster, Kronenberg & Larsen editors, WB Saunders Company, 1998
Pigmented elbows, knees, knuckles, waist, midriff and shoulders: the association with lower cortisol levels (1 reference)
  1. Orth DN, Kovacs WJ. Chapter 12: The adrenal cortex. Major manifestations in patients with primary adrenal insufficiency, p. 550. Williams Textbook of Endocrinology, 9th edition, Wilson, Foster, Kronenberg & Larsen editors, WB Saunders Company, 1998
Pigmented palmar creases: the association with lower cortisol levels (1 reference)
  1. Orth DN, Kovacs WJ. Chapter 12: The adrenal cortex. Major manifestations in patients with primary adrenal insufficiency, p. 550. Williams Textbook of Endocrinology, 9th edition, Wilson, Foster, Kronenberg & Larsen editors, WB Saunders Company, 1998
Pigmentation of nails: the association with lower cortisol levels (2 references)
  1. Bissell GW, Surakomol K, Greenslit F. Longitudinal banded pigmentation of nails in primary adrenal insufficiency. JAMA. 1971 Mar 8;215(10):1666-7
  2. Orth DN, Kovacs WJ. Chapter 12: The adrenal cortex. Major manifestations in patients with primary adrenal insufficiency, p. 550. Williams Textbook of Endocrinology, 9th edition, Wilson, Foster, Kronenberg & Larsen editors, WB Saunders Company, 1998
Hyperpigmented freckles, old and new ones: the association with lower cortisol levels (1 reference)
  1. Orth DN, Kovacs WJ. Chapter 12: The adrenal cortex. Major manifestations in patients with primary adrenal insufficiency, p. 550. Williams Textbook of Endocrinology, 9th edition, Wilson, Foster, Kronenberg & Larsen editors, WB Saunders Company, 1998
Pigmented scars: the association with lower cortisol levels (1 reference)
  1. Orth DN, Kovacs WJ. Chapter 12: The adrenal cortex. Major manifestations in patients with primary adrenal insufficiency, p. 550. Williams Textbook of Endocrinology, 9th edition, Wilson, Foster, Kronenberg & Larsen editors, WB Saunders Company, 1998
Vitiligo: the association with lower cortisol levels (2 references)
  1. Sassi F, Cazzaniga S, Tessari G, Chatenoud L, Reseghetti A, Marchesi L, Girolomoni G, Naldi L. Randomized controlled trial comparing the effectiveness of 308-nm excimer laser alone or in combination with topical hydrocortisone 17-butyrate cream in the treatment of vitiligo of the face and neck. Br J Dermatol. 2008 Nov;159(5):1186-91
  2. Orth DN, Kovacs WJ. Chapter 12: The adrenal cortex. Major manifestations in patients with primary adrenal insufficiency, p. 550. Williams Textbook of Endocrinology, 9th edition, Wilson, Foster, Kronenberg & Larsen editors, WB Saunders Company, 1998
Acne: the improvement with glucocorticoid treatment (1 reference)
  1. Nader S, Rodriguez-Rigau LJ, Smith KD, Steinberger E. Acne and hyperandrogenism: impact of lowering androgen levels with glucocorticoid treatment. J Am Acad Dermatol. 1984 Aug;11(2 Pt 1):256-9
Hirsutism, body hair overgrowth (due to excessive levels of adrenal androgens): the improvement with glucocorticoid (9 references)
  1. Rittmaster RS, Givner ML. Effect of daily and alternate day low dose prednisone on serum cortisol and adrenal androgens in hirsute women. J Clin Endocrinol Metab. 1988 Aug;67(2):400-3
  2. Rittmaster RS, Loriaux DL, Cutler GB Jr. Sensitivity of cortisol and adrenal androgens to dexamethasone suppression in hirsute women. J Clin Endocrinol Metab. 1985 Sep;61(3):462-6
  3. Wieland RG, Zorn E. Effect of chronic combined glucocorticoid and estrogen on serum androgens and androgen binding in hirsutism. Cutis. 1979 Apr;23(4):458-60.
  4. Ho Yuen B, Mincey EK. Role of androgens in menstrual disorders of non-hirsute and hirsute women, and the effect of glucocorticoid therapy on androgen levels in hirsute hyperandrogenic women. Am J Obstet Gynecol. 1983 Jan 15;145(2):152-7
  5. Carmina E, Lobo RA. Peripheral androgen blockade versus glandular androgen suppression in the treatment of hirsutism. Obstet Gynecol. 1991 Nov;78(5 Pt 1):845-9

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Eczema, dermatitis: the association with lower cortisol levels (3 references)
  1. Fukuda H, Suzuki T, Saotome A, Sode E, Mukai H. Efficacy of inpatient treatment for atopic dermatitis evaluated by changes in serum cortisol levels. J Dermatol. 2013 Jan;40(1):43-7.
  2. Buske-Kirschbaum A, Jobst S, Wustmans A, Kirschbaum C, Rauh W, Hellhammer D.  Attenuated free cortisol response to psychosocial stress in children with atopic dermatitis. Psychosom Med. 1997 Jul-Aug;59(4):419-26. PubMed PMID: 9251162.
  3. Rupprecht M, Hornstein OP, Schlüter D, Schäfers HJ, Koch HU, Beck G, Rupprecht R. Cortisol, corticotropin, and beta-endorphin responses to corticotropin-releasing hormone in patients with atopic eczema. Psychoneuroendocrinology. 1995;20(5):543-51
Eczema, dermatitis: the improvement with cortisol or other glucocorticoid treatments (4 references)
  1. Haeck IM, Timmer-de Mik L, Lentjes EG, Buskens E, Hijnen DJ, Guikers C, Bruijnzeel-Koomen CA, de Bruin-Weller MS. Low basal serum cortisol in patients with severe atopic dermatitis: potent topical corticosteroids wrongfully accused. Br J Dermatol. 2007 May;156(5):979-85
  2. Lebrun-Vignes B, Legrain V, Amoric J, Taïeb A. Comparative study of efficacy and effect on plasma cortisol levels of micronized desonide cream 0.1 p. 100 versus betamethasone di-propionate cream 0.05 p. 100 In the treatment of childhood atopic dermatitis. Ann Dermatol Venereol. 2000 Jun-Jul;127(6-7):590-5
  3. Wozniak KD. Use of glucocorticoids in dermatitis. Z Arztl Fortbild (Jena). 1987;81(15):789-91. German. PubMed PMID: 3687094
  4. Niedner R, Schöpf E. Clinical efficacy of topical glucocorticoid preparations and other types of dermatics in inflammatory diseases, particularly in atopic dermatitis. Curr Probl Dermatol. 1993;21:157-69
Dyslipidemia: the association with higher basal cortisol levels (1 reference)
  1. Veen G, Giltay EJ, DeRijk RH, van Vliet IM, van Pelt J, Zitman FG. Salivary cortisol, serum lipids, and adiposity in patients with depressive and anxiety disorders. Metabolism. 2009 Jun;58(6):821-7.
Hypercholesterolemia: the improvement of atherogenic index (increase or no increase in total cholesterol, but greater increase in HDL cholesterol) with glucocorticoid treatment (2 references)
  1. Boers M, Nurmohamed MT, Doelman CJ, Lard LR, Verhoeven AC, Voskuyl AE, Huizinga TW, van de Stadt RJ, Dijkmans BA, van der Linden S.Influence of glucocorticoids and disease activity on total and high-density lipoprotein cholesterol in patients with rheumatoid arthritis. Ann Rheum Dis. 2003 Sep;62(9):842-5
  2. Schroeder LL, Tang X, Wasko MC, Bili A. Glucocorticoid use is associated with increase in HDL and no change in other lipids in rheumatoid arthritis patients. Rheumatol Int. 2015 Jun;35(6):1059-67.
HyperhomocystInemia: the improvement with glucocorticoid treatment (2 references)
  1. Lazzerini PE, Capecchi PL, Bisogno S, Galeazzi M, Marcolongo R, Pasini FL.Reduction in plasma homocysteine level in patients with rheumatoid arthritis given pulsed glucocorticoid treatment. Ann Rheum Dis. 2003 Jul;62(7):694-5
  2. Kim MH, Kim E, Passen EL, Meyer J, Kang SS. Cortisol and estradiol: nongenetic factors for hyperhomocyst(e)inemia. Metabolism. 1997 Mar;46(3):247-9
Atherosclerosis (increased carotid intima-media thickness): the association with lower cortisol levels (2 references)
  1. Soriano-Rodríguez P, Osiniri I, Grau-Cabrera P, Riera-Pérez E, Prats-Puig A, Carbonell-Alferez M, Schneider S, Mora-Maruny C, De Zegher F, Ibánez L, Bassols J, López-Bermejo A. Physiological concentrations of serum cortisol are related to vascular risk markers in prepubertal children. Pediatr Res. 2010 Nov;68(5):452-5.
  2. Toledo-Corral CM, Myers SJ, Li Y, Hodis HN, Goran MI, Weigensberg MJ. Blunted nocturnal cortisol rise is associated with higher carotid artery intima-media thickness (CIMT) in overweight African American and Latino youth. 2013 Sep;38(9):1658-67.
Atherosclerosis (increased carotid intima-media thickness): the improvement (slower progression) at higher doses of prednisolone treatment (1 reference)
  1. Tanaka N, Masuoka S, Kusunoki N, Nanki T, Kawai S. Serum resistin level and progression of atherosclerosis during glucocorticoid therapy for systemic autoimmune diseases. Metabolites. 2016 Sep 16;6(3).
Arterial hypotension, orthostatic hypotension: the association with low cortisol levels (7 references)
  1. Kemp WL, Koponen MA, Meyers SE. Addison Disease: The first presentation of the condition may be at autopsy. Acad Forensic Pathol. 2016 Jun;6(2):249-257.
  2. Michels A, Michels N. Addison disease: early detection and treatment principles. Am Fam Physician. 2014 Apr 1;89(7):563-8.
  3. Syriou V, Moisidis A, Tamouridis N, Alexandraki KI, Anapliotou M.Isolated adrenocorticotropin deficiency and flexion contractures syndrome. Hormones (Athens). 2008 Oct-Dec;7(4):320-4
  4. Mor F, Green P, Wysenbeek AJ. Myopathy in Addison’s disease. Ann Rheum Dis. 1987 Jan;46(1):81-3
  5. Nieman LK, Chanco Turner ML. Addison’s disease. Clin Dermatol. 2006 Jul-Aug;24(4):276-80

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Systolic and diastolic blood pressure: inverse correlation with serum cortisol awakening response (1 reference)
  1. Kuehl LK, Hinkelmann K, Muhtz C, Dettenborn L, Wingenfeld K, Spitzer C, Kirschbaum C, Wiedemann K, Otte C. Hair cortisol and cortisol awakening response are associated with criteria of the metabolic syndrome in opposite directions. Psychoneuroendocrinology. 2015 Jan;51:365-70.
Arterial hypotension: the improvement with hydrocortisone treatment in adults (1 reference)
  1. Jeske W, Gawrychowski K, Smiertka W. Supplementation with hydrocortisone on the 3rd-5th day following dexamethasone premedicated chemotherapy eliminated severe dizziness and postural hypotension. Kardiol Pol. 2012;70(3):273-4.
Arterial hypotension: the improvement with hydrocortisone treatment in newborns (10 references)
  1. Kovacs K, Szakmar E, Meder U, Szakacs L, Cseko A, Vatai B, Szabo AJ, McNamara PJ, Szabo M, Jermendy A. A randomized controlled study of low-dose hydrocortisone versus placebo in dopamine-treated hypotensive neonates undergoing hypothermia treatment for hypoxic-ischemic encephalopathy. J Pediatr. 2019 Aug;211:13-19.e3.
  2. Salas G, avaglianti M, Leone A, Couceiro C, Rodríguez S, Fariña D. Hydrocortisone for the treatment of refractory hypotension: a randomized controlled trial]. An Pediatr (Barc). 2014 Jun;80(6):387-93
  3. Mizobuchi M, Yoshimoto S, Nakao H. Time-course effect of a single dose of hydrocortisone for refractory hypotension in preterm infants. Pediatr Int. 2011 Dec;53(6):881-6.
  4. Baker CF, Barks JD, Engmann C, Vazquez DM, Neal CR Jr, Schumacher RE, Bhatt-Mehta V. Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns. J Perinatol. 2008 Jun;28(6):412-9.
  5. Ng PC, Lee CH, Bnur FL, Chan IH, Lee AW, Wong E, Chan HB, Lam CW, Lee BS, Fok TF. A double-blind, randomized, controlled study of a “stress dose” of hydrocortisone for rescue treatment of refractory hypotension in preterm infants. Pediatrics. 2006 Feb;117(2):367-75.

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Coronary heart disease: the association with lower cortisol levels (4 references)
  1. Malan L, Schutte CE, Alkerwi A, Stranges S, Malan NT. Hypothalamic-pituitary-adrenal-axis dysregulation and double product increases potentiate ischemic heart disease risk in a Black male cohort: the SABPA study. Hypertens Res. 2017 Jun;40(6):590-597.
  2. Ronaldson A, Kidd T, Poole L, Leigh E, Jahangiri M, Steptoe A. Diurnal cortisol rhythm is associated with adverse cardiac events and mortality in coronary artery bypass patients. J Clin Endocrinol Metab. 2015 Oct;100(10):3676-82.
  3. Nikkheslat N, Zunszain PA, Horowitz MA, Barbosa IG, Parker JA, Myint AM, Schwarz MJ, Tylee AT, Carvalho LA, Pariante CM. Insufficient glucocorticoid signaling and elevated inflammation in coronary heart disease patients with comorbid depression. Brain Behav Immun. 2015 Aug;48:8-18.
  4. Reynolds RM, Walker BR, Haw S, Newby DE, Mackay DF, Cobbe SM, Pell AC, Fischbacher C, Pringle S, Murdoch D, Dunn F, Oldroyd K, Macintyre P, O’Rourke B, Pell JP. Low serum cortisol predicts early death after acute myocardial infarction. Crit Care Med. 2010 Mar;38(3):973-5.
Coronary heart disease: the improvement with glucocorticoid treatment (2 references)
  1. Bagheri B, Sohrabi B, Movassaghpour AA, Mashayekhi S, Garjani A, Shokri M, Pezeshkian M, Garjani A. Hydrocortisone reduces Toll-like receptor 4 expression on peripheral CD14+ monocytes in patients undergoing percutaneous coronary intervention. Iran Biomed J. 2014;18(2):76-81.
  2. Morrison J, Maley T, Reduto L, Victa C, Pyros I, Brandon J, Gulotta S. Effect of methylprednisolone on predicted myocardial infarction size in man. Crit Care Med. 1975 May-Jun;3(3):94-102.
Thinness, low body weight, weight loss, cachexia: the association with lower cortisol levels (8 references)
  1. Syriou V, Moisidis A, Tamouridis N, Alexandraki KI, Anapliotou M. Isolated adrenocorticotropin deficiency and flexion contractures syndrome. Hormones (Athens). 2008 Oct-Dec;7(4):320-4
  2. Nieman LK, Chanco Turner ML. Addison’s disease. Clin Dermatol. 2006 Jul-Aug;24(4):276-80
  3. Zargar AH, Laway BA, Masoodi SR, Bashir MI, Wani AI, Salahuddin M. A critical evaluation of signs and symptoms in the diagnosis of Addison’s diseases. J Assoc Physicians India. 2001 May;49:523-6.
  4. Adams R, Hinkebein MK, McQuillen M, Sutherland S, El Asyouty S, Lippmann S. Prompt differentiation of Addison’s disease from anorexia nervosa during weight loss and vomiting. South Med J. 1998 Feb;91(2):208-11
  5. Orth DN, Kovacs WJ. Chapter 12: The adrenal cortex. Major manifestations in patients with primary adrenal insufficiency, p. 549-50. Williams Textbook of Endocrinology, 9th edition, Wilson, Foster, Kronenberg & Larsen editors, WB Saunders Company, 1998

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Binge eating: the association with lower cortisol levels (1 reference)
  1. Lavagnino L, Amianto F, Parasiliti Caprino M, Maccario M, Arvat E, Ghigo E, Abbate Daga G, Fassino S. Urinary cortisol and psychopathology in obese binge-eating subjects. Appetite. 2014 Dec;83:112-6.
Obesity: the association with lower cortisol levels (9 references)
  1. Pervanidou P, Bastaki D, Chouliaras G, Papanikolaou K, Kanaka-Gantenbein C, Chrousos G. Internalizing and externalizing problems in obese children and adolescents: associations with daily salivary cortisol concentrations. Hormones (Athens). 2015 Oct-Dec;14(4):623-31.
  2. Kjölhede EA, Gustafsson PE, Gustafsson PA, Nelson N. Overweight and obese children have lower cortisol levels than normal-weight children. Acta Paediatr. 2014 Mar;103(3):295-9.
  3. Lumeng JC, Miller A, Peterson KE, Kaciroti N, Sturza J, Rosenblum K, Vazquez Diurnal cortisol pattern, eating behaviors and overweight in low-income preschool-aged children. Appetite. 2014 Feb;73:65-72.
  4. Shabir I, Ganie MA, Praveen EP, Khurana ML, John J, Gupta N, Kumar G, Ammini Morning plasma cortisol is low among obese women with polycystic ovary syndrome. Gynecol Endocrinol. 2013 Dec;29(12):1045-7.
  5. Ursache A, Wedin W, Tirsi A, Convit A. Preliminary evidence for obesity and elevations in fasting insulin mediating associations between cortisol awakening response and hippocampal volumes and frontal atrophy. Psychoneuroendocrinology. 2012 Aug;37(8):1270-6.

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Abdominal obesity: the association with lower cortisol levels (2 references)
  1. Duclos M, Marquez Pereira P, Barat P, Gatta B, Roger P. Increased cortisol bioavailability, abdominal obesity, and the metabolic syndrome in obese women. Obes Res. 2005 Jul;13(7):1157-66
  2. Duclos M, Corcuff JB, Etcheverry N, Rashedi M, Tabarin A, Roger P. Abdominal obesity increases overnight cortisol excretion. J Endocrinol Invest. 1999 Jun;22(6):465-71
Metabolic syndrome: the association with lower cortisol levels (4 references)
  1. Baughman P, Andrew ME, Burchfiel CM, Fekedulegn D, Hartley TA, Violanti JM, Miller DB. High-protein meal challenge reveals the association between the salivary cortisol response and metabolic syndrome in police officers. Am J Hum Biol. 2016 Jan-Feb;28(1):138-44.
  2. Langerak T, van den Dries LW, Wester VL, Staufenbiel SM, Manenschijn L, van Rossum EF, van Gorp EC. The relation between long-term cortisol levels and metabolic syndrome in HIV-infected patients. Clin Endocrinol (Oxf). 2015 Aug;83(2):167-72.
  3. Constantinopoulos P, Michalaki M, Kottorou A, Habeos I, Psyrogiannis A, Kalfarentzos F, Kyriazopoulou V. Cortisol in tissue and systemic level as a contributing factor to the development of metabolic syndrome in severely obese patients. Eur J Endocrinol. 2015 Jan;172(1):69-78.
  4. DeSantis AS, DiezRoux AV, Hajat A, Golden SH, Jenny NS, Sanchez BN, Shea S, Seeman TE. Associations of salivary cortisol levels with metabolic syndrome and its components: the multi-ethnic study of atherosclerosis. J Clin Endocrinol Metab. 2011 Nov;96(11):3483-92.
Fibromyalgia: the association with lower cortisol levels (13 references)
  1. Riva R, Mork PJ, Westgaard RH, Rø M, Lundberg U. Fibromyalgia syndrome is associated with hypocortisolism. Int J Behav Med. 2010 Sep;17(3):223-33.
  2. Izquierdo Alvarez S, Bancalero Flores JL, García Pérez MC, Serrano Ostariz E, Alegre de Miquel C, Bocos Terraz JP. Evaluation of urinary cortisol levels in women with fibromyalgia. Med Clin (Barc). 2009 Jul 18;133(7):255-7.
  3. Izquierdo-Alvarez S, Bocos-Terraz JP, Bancalero-Flores JL, Pavón-Romero L, Serrano-Ostariz E, de Miquel CA. Is there an association between fibromyalgia and below-normal levels of urinary cortisol? BMC Res Notes. 2008 Dec 22;1:134.
  4. Macedo JA, Hesse J, Turner JD, Meyer J, Hellhammer DH, Muller CP. Glucocorticoid sensitivity in fibromyalgia patients: decreased expression of corticosteroid receptors and glucocorticoid-induced leucine zipper. Psychoneuroendocrinology. 2008 Jul;33(6):799-809.
  5. Wingenfeld K, Wagner D, Schmidt I, Meinlschmidt G, Hellhammer DH, Heim C. The low-dose dexamethasone suppression test in fibromyalgia. J Psychosom Res. 2007 Jan;62(1):85-91

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