From the Guidelines
Elevated cortisol levels should be managed with a combination of lifestyle changes and medical interventions, prioritizing rapid normalization of cortisol in severe cases with medications such as osilodrostat, metyrapone, or etomidate, as recommended by the most recent guidelines 1. To manage elevated cortisol levels, it's essential to focus on stress management techniques, regular moderate exercise, prioritizing sleep, and adopting a balanced diet.
- Stress management techniques like meditation, deep breathing, yoga, or progressive muscle relaxation for 15-20 minutes daily can help reduce cortisol levels.
- Regular moderate exercise such as walking, swimming, or cycling for 30 minutes most days helps normalize cortisol patterns.
- Prioritizing sleep by maintaining a consistent schedule and aiming for 7-9 hours nightly is crucial.
- Adopting a balanced diet rich in whole foods, vegetables, lean proteins, and omega-3 fatty acids while limiting caffeine, alcohol, and processed foods can also help regulate cortisol. For medical management, the selection of therapy should be based on factors such as the need for rapid normalization of cortisol, the presence of residual tumor, and the potential for tumor shrinkage, as well as considerations of drug intolerance, side effects, and concomitant comorbidities 1. In cases of diagnosed conditions like Cushing's syndrome, medications such as osilodrostat, metyrapone, or ketoconazole might be prescribed under medical supervision to directly inhibit cortisol production in the adrenal glands. The choice of medication should be guided by the severity of the disease, the need for rapid action, and the presence of specific comorbidities or conditions, such as pregnancy or a history of bipolar or impulse control disorder 1. It's crucial to monitor treatment response and adjust the medication regimen as needed to avoid worsening outcomes and minimize the risk of serious health issues associated with chronic elevated cortisol, including weight gain, hypertension, and immune suppression.
From the Research
Managing Elevated Cortisol Levels
Elevated cortisol levels can be managed through various methods, including:
- Surgery to remove the source of excess endogenous cortisol production, as seen in Cushing syndrome 2
- Medication, such as adrenal steroidogenesis inhibitors, pituitary-targeted drugs, or glucocorticoid receptor blockers 2
- Ketoconazole treatment, which has been shown to decrease urinary cortisol levels and improve clinical symptoms in patients with Cushing's syndrome 3
- Meditation interventions, which have been found to efficiently reduce cortisol levels in at-risk samples, such as patients with somatic illnesses 4
- Stress management interventions, including mind-body therapies, mindfulness, relaxation, and talking therapies, which have been shown to positively influence cortisol levels 5
Evaluation and Treatment
The evaluation and treatment of patients with hypercortisolism is crucial to prevent severe adverse effects, such as increased risk of mortality 6. The treatment of hypercortisolism should be individualized and may involve a combination of surgery, medication, and lifestyle modifications.
Lifestyle Modifications
Lifestyle modifications, such as stress management and relaxation techniques, can help reduce cortisol levels and improve overall health. Mindfulness and meditation interventions have been found to be particularly effective in reducing cortisol levels in at-risk populations 4, 5. Additionally, relaxation techniques, such as deep breathing and yoga, can help reduce stress and anxiety, which can contribute to elevated cortisol levels.
Monitoring and Follow-up
Regular monitoring and follow-up are essential to ensure that cortisol levels are within a healthy range. This can be done through blood or saliva tests, and may involve regular check-ups with a healthcare provider to adjust treatment as needed 2, 3, 6.