HomeAnswersEndocrinologyhigh cortisolIs my cortisol levels considerably high for stress?

Can hypercortisolism lead to depression, stress, and obesity?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. Preetha. J

Published At November 26, 2021
Reviewed AtJune 14, 2023

Patient's Query

Hi doctor,

I am wondering about my cortisol levels because my last 2 AM cortisol levels were 399 ng/mL and 335 ng/mL (reference range is 50 to 536 ng/mL), and PM (Post meridiem) cortisol level was 146 ng/mL (reference range 20 to 120 ng/mL). My 24-hour urine-free cortisol was in the normal range at 27 ng/mL (reference range 3.2 to 47.6 ng/mL) because my urine test was normal. My doctor says that the high AM results are due to chronic stress and does not want to investigate further. My question is, are not these levels considerably high for stress? I am stressed but not to the point where it makes me sick. Should I pursue any more tests? In addition to my blood work, I have gained a lot of weight in the last couple of years. I have cognitive and memory difficulties and mood issues, but I have also dealt with episodic depression for the past 12 years. My cortisol level was high four years back and was associated with birth control, but I have not been on birth control for more than four years now. I also have PCOS (polycystic ovarian syndrome). I am currently taking Rexulti (Brexpiprazole), Lamotrigine, Wellbutrin (Bupropion), and Viibryd (Vilazodone).

Hi,

Welcome to icliniq.com.

Some of the symptoms of hypercortisolism can overlap with neuropsychiatric conditions, including depression, stress, and obesity. The laboratories can also be misleading. Having said that, if you have symptoms and strong clinical suspicion, we should proceed with more tests. Since you have a few symptoms and are concerned, you can do additional tests like:

1. Midnight salivary cortisol test.

2. Dexamethasone suppression test - Take 1 mg Dexamethasone (glucocorticoid) at 11 PM and check Cortisol at 7 AM.

But I recommend seeing an endocrinologist at a local academic institution and having a complete history and physical examination before proceeding. You do not have high BP (blood pressure) or diabetes. Do you have wide purple striae? Do you bruise easily? Do you have a fullness or hump in the back of your neck or above your collar bones? Answers to these questions will help decide if we need to proceed with further testing. It is a matter of balancing the benefits of finding something you may have versus the risks of creating more anxiety for something you may not have.

I hope this helps.

Patient's Query

Hi doctor,

Thank you for your reply.

I had an abnormal Dexamethasone suppression test and an abnormal late night saliva test. Because my UFC is normal, my doctor is still is unsure if he wants to send me to an endocrinologist. I attached my results. While I do not have the physical hallmarks of Cushing's syndrome, I wonder if it is possible that I have mild case or incipient case of Cushing's. I feel my mental health has been under control with medication for some time and that being the cause does not sit right with me.

Hi,

Welcome back to icliniq.com.

The Dexamtheasone suppression test is abnormal. The night salivary cortisol is borderline. It does not rule in or out if you have Cushing's. And like you mentioned you may have a mild case (I mean you cannot rule out the possibility) I recommend that you repeat the 24 hour urine free cortisol. Some times we do check this once every few months to 'catch it' if it is cyclical. See a local endocrinologist. Take photographs of you taken over the last several years.

I hope this helps.

Patient's Query

Hi doctor,

I got my 24 hour UFC results back and they are pretty elevated. I am feeling anxious. I have to wait months to see a local doctor, so I am just wondering what your thoughts are. My results are 449 ng/mL (reference range 3.2 to 47.6 ng/mL). Is this number diagnostic of Cushing's or could a number this high still be attributed to stress?

Hi,

Welcome back to icliniq.com.

Yes the 24 hours urinary free cortisol is more than 4 times the upper limit of normal. It is definitely abnormal. It is hard to say that depression or stress caused it. With saying all of the above, there is no number diagnostic of Cushing's there is no single best test for Cushing's. We have to make a strong case for it with different abnormal tests. But now you have abnormal UFC (urinary free cortisol excretion), DST (Dexamethasone suppressing test) and slightly abnormal midnight salivary cortisol. So there is a strong suspicion for Cushing's now and Cushing's is best managed in a referral center. So, I recommend going to an academic hospital attached to a university to get further care.

Patient's Query

Help doctor,

Thank you for your reply.

Unfortunately there are no teaching hospitals where I live. I am told the wait list to see a specialist will be long, so I guess I just have to wait. I live in a place where there is no private healthcare which is great but also means long wait times. Thank you for answering all my questions. I have just a couple more. If not Cushings, what else could it be, and is this serious enough for me to consider traveling to be seen sooner? Finally, is there anything I should be doing while I wait like avoid certain foods or anything? Other than that, I will try to just relax and trust in my healthcare system.

Hi,

Welcome back to icliniq.com.

The main confounder here is your depression and the various ication you take, other things like obesity and alcohol abuse can also give similar results. since clinically you do not seem to progress very fast, it is fine to wait. There are no food restrictions as such. But eat healthy and exercise regularly. Discuss with your mental health provider and have your mood disorder well controlled, see if you can come off some of your medicines. Collect photos of yourself over the last 10 years or more at various times and keep it ready. Finally, the chances are still more towards you not having Cushing's but since we have a few abnormal tests, we should evaluate further.

I hope this helps.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Thiyagarajan. T
Dr. Thiyagarajan. T

Diabetology

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