Cortisol Deficiency – What It Is and How to Handle It

If you’ve ever felt inexplicably tired, weak, or dizzy, low cortisol might be the hidden cause. Cortisol is the hormone that helps your body respond to stress, keep blood sugar steady, and maintain blood pressure. When the adrenal glands can’t make enough of it, you end up with cortisol deficiency, also called adrenal insufficiency.

People often mistake the symptoms for a bad flu or chronic fatigue. The reality is that the body is struggling to keep the basic balance it needs to run smoothly. Spotting the problem early can prevent serious complications like an adrenal crisis, which is a medical emergency.

Causes and Risk Factors

Most cases of cortisol deficiency are either primary or secondary. Primary adrenal insufficiency (Addison’s disease) happens when the adrenal glands themselves are damaged – autoimmune attacks, infections like tuberculosis, or bleeding are common culprits. Secondary deficiency occurs when the pituitary gland doesn’t signal the adrenals properly, often because of long‑term steroid use or a tumor.

Other risk factors include sudden withdrawal from high‑dose steroids, genetic disorders, and rare cancers that affect the glandular system. Even a stressful illness or major surgery can tip the scales if your body’s cortisol reserves are already low.

How Doctors Diagnose It

The first step is a detailed medical history and a physical exam. Doctors will look for classic signs: darkening of the skin, low blood pressure, salt cravings, and weight loss. Blood tests are the backbone of diagnosis – a morning cortisol level below 5 µg/dL strongly points to deficiency.

To confirm, doctors often perform an ACTH stimulation test. You’ll get an injection of synthetic ACTH, and blood samples are taken before and after to see how much cortisol your adrenals can produce. A blunted response confirms the problem.

Imaging tests like CT or MRI may be ordered if a tumor or structural abnormality is suspected.

Managing Low Cortisol

Treatment revolves around replacing the missing hormone. Hydrocortisone tablets taken twice a day mimic the body’s natural rhythm. Some people use longer‑acting steroids like prednisone if dosing convenience is a priority. The goal is to keep you feeling stable without over‑replacing, which can cause weight gain and high blood pressure.

During illness, injury, or surgery, the body needs extra cortisol. Doctors call this “stress dosing” – you’ll temporarily increase your steroid dose to prevent an adrenal crisis. Keep an emergency injection kit on hand and wear a medical ID bracelet that says you have cortisol deficiency.

Lifestyle tweaks also help. Eat regular meals with a good mix of protein, healthy fats, and complex carbs to keep blood sugar steady. Stay hydrated, especially if you’re prone to low blood pressure. Moderate exercise is fine, but avoid extreme endurance workouts until your hormone levels are stable.

Finally, keep regular follow‑up appointments. Blood tests every 3‑6 months let your doctor fine‑tune the dose. If you notice new symptoms – severe dizziness, vomiting, or confusion – seek medical help right away.Living with cortisol deficiency isn’t a death sentence. With the right diagnosis, medication, and a few everyday habits, you can get back to feeling like yourself again.