From the Guidelines
Elevated morning cortisol levels can indeed be dangerous if persistent, and it is crucial to investigate the underlying cause to prevent serious health problems. High cortisol, whether in the morning or throughout the day, may indicate conditions like Cushing's syndrome, chronic stress, or adrenal tumors that require medical attention. Chronically elevated cortisol can lead to serious health problems including high blood pressure, diabetes, osteoporosis, impaired immune function, and increased cardiovascular risk 1. If you have elevated morning cortisol, consult with an endocrinologist who may order additional tests such as a 24-hour urinary cortisol test, late-night salivary cortisol test, or dexamethasone suppression test to determine the cause. Some key points to consider include:
- The condition of mild autonomous cortisol secretion (MACS) has been associated with medical comorbidities such as type 2 diabetes, hypertension, cardiovascular events, vertebral fractures, and mortality, even in the absence of overt Cushing's syndrome symptoms 1.
- Treatment depends on the underlying cause and might include stress management techniques, medication adjustments if certain drugs are triggering the elevation, or specific treatments for conditions like Cushing's syndrome.
- Cortisol follows a natural daily rhythm, typically highest in the morning and lowest at night, so context is important when interpreting results.
- A single elevated reading should be confirmed with follow-up testing before making treatment decisions, as the risk of progression to overt Cushing's syndrome is low but still contributes to medical comorbidity 1. Given the potential risks associated with elevated cortisol levels, it is essential to prioritize further evaluation and management to mitigate morbidity, mortality, and impact on quality of life.
From the Research
Elevated Morning Cortisol Levels
- Elevated morning cortisol levels have been associated with various health risks, including cardiovascular disease and metabolic syndrome 2, 3.
- A study found that 20% of overweight or obese children and adolescents had elevated morning serum cortisol levels, which were associated with higher fasting glucose levels 2.
- Another study found that morning plasma cortisol was a causal risk factor for cardiovascular disease and coronary heart disease, with a positive association between morning plasma cortisol and incident cardiovascular disease 3.
Health Risks Associated with Elevated Morning Cortisol
- Elevated morning cortisol levels have been linked to: