What is the function of cortisol in the body?

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From the Guidelines

Cortisol is a vital steroid hormone produced by the adrenal glands that plays a central role in regulating metabolism, stress response, inflammation, blood pressure, and sleep-wake cycles. The function of cortisol in the body is multifaceted, and its importance is underscored by the potential health consequences of both excessive and insufficient cortisol levels, as seen in conditions like Cushing's syndrome and Addison's disease, respectively 1.

Key Functions of Cortisol

  • Regulates metabolism by controlling the use of carbohydrates, fats, and proteins
  • Essential for the stress response, helping the body to respond appropriately to physical or emotional stress
  • Reduces inflammation by suppressing the immune system, which is why synthetic cortisol is used to treat inflammatory conditions
  • Helps maintain blood pressure
  • Regulates sleep-wake cycles following a diurnal rhythm
  • Affects memory formation

Clinical Implications

The careful control of cortisol levels is crucial for maintaining overall bodily function and homeostasis. As highlighted in the consensus statement on the diagnosis, treatment, and follow-up of patients with primary adrenal insufficiency, the diagnosis and management of cortisol-related disorders require a comprehensive approach, including the measurement of serum cortisol and plasma ACTH levels, and appropriate replacement therapy with hydrocortisone and fludrocortisone 1.

Importance of Balanced Cortisol Levels

Both excessive and insufficient cortisol levels can lead to serious health problems. The importance of maintaining balanced cortisol levels is emphasized by the potential complications of glucocorticoid therapy, which include effects on bone mineral density, highlighting the need for regular monitoring and assessment of patients with cortisol-related disorders 1.

From the FDA Drug Label

ACTIONS Naturally occurring glucocorticoids (hydrocortisone and cortisone), which also have salt-retaining properties, are used as replacement therapy in adrenocortical deficiency states. Their synthetic analogs are primarily used for their potent anti-inflammatory effects in disorders of many organ systems. Glucocorticoids cause profound and varied metabolic effects. In addition, they modify the body's immune responses to diverse stimuli.

The function of cortisol in the body includes:

  • Metabolic effects: causing profound and varied metabolic effects
  • Immune response modification: modifying the body's immune responses to diverse stimuli
  • Salt-retaining properties: having salt-retaining properties 2

From the Research

Function of Cortisol in the Body

The provided studies do not directly address the function of cortisol in the body. However, they do discuss the effects of excess cortisol and the diagnosis and treatment of Cushing's syndrome, a condition caused by excessive exposure to cortisol.

Effects of Excess Cortisol

  • Excess cortisol can lead to severe multisystem morbidity, including impaired cardiovascular and metabolic function, infections, and neuropsychiatric disorders 3
  • It can also cause symptoms such as diabetes mellitus, hypertension, hypokalaemia, and gynaecomastia 4
  • The control loop of the hypothalamic-pituitary-adrenal (HPA) axis is closed by negative feedback of cortisol on the hypothalamus and pituitary 5

Regulation of Cortisol Synthesis

  • The physiological control of cortisol synthesis in the adrenal cortex involves stimulation of adrenocorticotrophic hormone (ACTH) by hypothalamic corticotrophin-releasing hormone (CRH) and then stimulation of the adrenal by ACTH 5
  • The HPA axis is regulated by a negative feedback loop, where cortisol inhibits the production of ACTH and CRH 5

Diagnosis and Treatment of Cushing's Syndrome

  • The diagnosis of Cushing's syndrome exploits three physiological principles: failure to achieve the normal nadir in the cortisol diurnal rhythm, loss of sensitivity of ACTH-secreting tumours to cortisol negative feedback, and increased excretion of free cortisol in the urine 5
  • Treatment options include surgical removal of ACTH or cortisol-secreting tumours, medical therapy targeted to the anatomical location of the dysregulated component of the HPA axis, and steroidogenesis inhibitors 6, 4, 7, 3

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

Cushing syndrome.

Nature reviews. Disease primers, 2025

7
Research

Current strategies for the treatment of severe Cushing's syndrome.

Expert review of endocrinology & metabolism, 2016

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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