Imagine yourself finishing up a 12 hour work day during which time you drank coffee for breakfast, fired someone before you ate a bag of potato chips for lunch, and sat down only when you got into your car to drive home. You are exhausted and probably ready for a hot shower and a glass of wine. Much to your dismay, your spouse has something else in mind because you forgot to pick up the dry cleaning again and you missed your child’s piano recital. From where your spouse is standing, you may appear to be quite a formidable opponent. However, internally your stress response system is holding up the white flag of defeat because the captain of your army, cortisol, is nowhere to be found. Among other things, your job stress, chronic caffeine consumption, and less than optimal diet have driven it into hiding.


Cortisol is your primary defense hormone against stress. It is responsible for allowing you to mount a ‘fight or flight’ response to ensure your survival. Its key roles are to provide your body with the fuel necessary to fight or flee. When a stress induced rise in cortisol occurs, your blood sugar and blood pressure rise, and the cells of your bones, muscles, and other tissues are sacrificed for the greater good. These physiological changes are essential in the short term. However, if your life hasn’t allowed your cortisol levels to come down, your body begins to ‘turn to the dark side’ and slowly deteriorate…something we refer to as ‘life’ in the 21st century.


Chronic stress in its many forms can ultimately lead to a decline in cortisol levels for reasons not attributable to ‘adrenal fatigue’. Under normal circumstances, cortisol peaks in the morning and is at its lowest level the first several hours of sleep. Insomniacs often suffer from a reversal in this pattern of cortisol release. Regardless of cause, the end result is called hypocortisolism. Once this occurs, daytime cortisol remains abnormally flattened during the day and/or the body is unable to produce optimal amounts of cortisol in the face of ongoing stress. For example, your daytime cortisol levels may be low if the amount of caffeing you consume throughout the day could harm a small animal. If you also cannot mount an appropriate cortisol response to additional stress then you may decompensate when you find the vending machine is out of diet soda.


The symptom triad most often seen in patients with hypocortisolism is sensitivity to stress, chronic pain, and chronic fatigue. However, other signs and symptoms can also be seen which resemble those of Addison’s disease albeit not as severe. It is for this reason that some in the medical community have nicknamed hypocortisolism “subclinical Addison’s Disease.” When we take a closer look at a host of common stress-related diseases and disorders, we find that low cortisol frequently comes into play. In fact, hypocortisolism has been found in 20 to 25 percent of patient with these stress-related bodily disorders: chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, PTSD, burnout, atypical depression, and chronic pain (pelvic, back, headache).


Table 1:  Signs and Symptoms of Hypocortisolism
General:  fatigue, fever, weakness, muscle pain , joint pain , sore throat, headaches, dizziness upon standing, chronic pain
Gastrointestinal:  Lack of appetite , nausea, vomiting, diarrhea, abdominal or flank pain
Psychiatric:  Depression, apathy, irritability, sleep disturbances, difficulty concentrating, difficulty with memory, confusion, stress sensitivity
Cardiovascular:  Increased heart rate, abnormal regulation of blood pressure and heart rate with changes in body position., hypovolemia, depressed myocardial contractility
Laboratory:  Low blood sugar, low sodium, high potassium, high calcium, increased numbers of white blood cells, neutropenia, eosinophilia, hyperprolactinemia, hypothyroidism, , lymphocytosis[1]

The signs and symptoms of hypocortisolism may include any of the following:


The symptoms and disease states associated with low cortisol CAN be treated once the underlying cause is identified and properly addressed. The key is to work with a health care provider who is properly trained and insightful enough to know that the statistically derived laboratory reference ranges will often miss patients with hypocortisolism. Simply stand firm in reminding your health care provider that you do not have an anti-depressant deficiency!

Chart by Dr. Edwards