Cortisol and Cortisone: What Are They and What Do They Do?

Cortisol and cortisone are two frequently confused steroid hormones with important roles in the body. Cortisol is the naturally produced “stress hormone” , while cortisone is its synthetic form used for treatment. This article discusses their definitions, functions, effects when levels are high or low, links with weight gain, and possible connections with cancer. We also explore medical uses, adverse effects, and frequently asked questions about cortisone.

What Is Cortisol?

Cortisolis a vital steroid hormone produced in the adrenal glands above the kidneys. Because it plays a critical role in regulating the body's stress response, it is often called the “stress hormone” . Secretion fluctuates during the day: it peaks around waking in the morning to prepare the body for the day, then falls in the evening and at night to support rest.

Cortisol release is controlled by the hypothalamus and pituitary in the brain. The pituitary releases a hormone called ACTH , which stimulates the adrenal glands to increase or decrease cortisol production. Levels are thus adjusted to immediate needs. For example, cortisol rises rapidly during sudden fear, excitement, or stress, supporting the body's “fight-or-flight” response by increasing heart rate, energy, and alertness. It helps prepare the body for danger.

What Is Cortisone?

Cortisoneis a synthetic (artificial) formof the body's natural hormone cortisol: the name given to cortisol produced in a laboratory. Cortisone medicines mimic cortisol's effects and are valuable in treating many diseases. The difference between cortisol and cortisoneis that one is produced naturally by the body while the other is taken externally as medication. Their mechanisms are similar; taking cortisone produces responses resembling those of cortisol.

Cortisone is generally used medically as injections, tablets, creams or ointments . Externally administered cortisone reduces inflammation, suppresses excessive immune responses, and helps control various conditions when needed. Injections may reduce pain and swelling in inflamed joints; in asthma attacks, reducing airway inflammation makes breathing easier. In short, when used at an appropriate dose and duration, cortisone provides therapeutic benefits as a powerful anti-inflammatory and immunosuppressive agent.

In Summary: Cortisol is the natural hormone produced by the body, while cortisone is its medicinal form. Both technically belong to the steroid hormone class called glucocorticoids and affect similar systems.

What Does Cortisol Do?

Cortisol acts as a regulator with diverse effects throughout the body. What does cortisol do? Its main functions can be summarized as follows:

• Regulating the Stress Response: Cortisol prepares the body for physical or psychological stress. In danger, it raises heart rate and blood pressure to deliver more blood to muscles and the brain. This provides the energy and alertness needed to cope with the stressor.

• Controlling Metabolism: Cortisol helps regulate the body's fat, protein, and carbohydrate balance. Acting on the liver, muscles, and fatty tissue, it raises blood glucose and helps ensure an adequate supply to the brain. During fasting, it helps maintain energy production; under prolonged stress, it is known to affect appetite and increase food intake.

• Reducing Inflammation: Cortisol controls inflammatory immune responses. It suppresses swelling, redness, and pain arising from injury or infection, helping prevent an excessive immune response from damaging tissue.

• Regulating the Immune System: High cortisol partly reduces immune activity. This can benefit autoimmune diseases, in which the body attacks its own tissues; however, immune suppression during chronic stress may increase susceptibility to infection. Cortisol helps maintain this balance.

• Blood Pressure and Circulation: By constricting blood vessels, cortisol helps maintain blood pressure . Deficiency can therefore cause dangerously low pressure. Normal cortisol contributes to healthy cardiovascular function.

• Regulating Sleep: Cortisol secretion follows a daily rhythm. Rising in the morning and falling at night influences the sleep-wake cycle. Its effects on daytime energy also diminish near bedtime, supporting the transition to rest.

Cortisol is therefore a vital regulator affecting metabolism, the nervous system, immunity, and circulation as well as almost every other body system. Normal levels are necessary for health. What happens when levels are high or low ? We examine these situations below.

What Does High Cortisol (Hypercortisolism) Mean? What Are Its Symptoms?

High cortisolmeans an abnormally elevated level in the blood. Persistently excessive levels can have unwanted effects. Excessive production can cause a rare condition called Cushing's syndrome . It may result from an adrenal tumor, excessive ACTH secretion by the pituitary, or prolonged use of high-dose cortisone medication.

Symptoms of high cortisol usually develop gradually and may resemble other conditions. The main signs specialists can diagnose include:

• Weight Gain: Prominent fat accumulation occurs particularly in the face, producing a rounded “moon face” , and abdomen. Weight gain is one of the most common signs of high cortisol. Fat accumulation at the base of the neck can also create a “buffalo hump” fat pad.

• Skin Changes: The skin may thin and bruise easily, with broad purple stretch marks (striae), particularly over the abdomen, hips, and thighs. High cortisol weakens skin collagen, causing these changes.

• High Blood Pressure: Excess cortisol can chronically raise blood pressure. Resistant hypertension may develop, causing symptoms such as headaches and dizziness.

• Raised Blood Glucose: Because cortisol raises blood glucose, it can eventually cause hyperglycemia and insulin resistance. Some patients may even develop type 2 diabetes despite no previous history.

• Muscle and Bone Weakness: Excess cortisol breaks down muscle proteins, causing muscle weakness and thinning, particularly in the arms and legs. It also accelerates calcium loss from bones, so osteoporosis (bone loss) may develop, increasing fracture risk.

• Psychological Changes: Excess cortisol can cause mood changes, depression, anxiety, and sleep disturbances. Marked irritability or emotional fluctuations may occur.

• Immune Problems: Because high cortisol suppresses immunity, frequent infections and slow wound healing may also be signs.

• Other Symptoms: Women may experience irregular periods and excess hair growth (hirsutism); children may have delayed growth, and abnormal fat distribution may occur in certain body regions.

Not all symptoms occur together, and the pattern varies between individuals. Some seek medical advice only for weight gain and high blood pressure, while skin changes predominate in others. Remember: Abnormally high cortisol is generally rare. Weight gain or high blood pressure does not automatically mean cortisol excess. Endocrinologists evaluate levels at different times using specific blood, urine, and saliva tests. If true hypercortisolism is found, treatment addresses the underlying cause.

What Does Low Cortisol (Hypocortisolism) Mean? What Are Its Symptoms?

Low cortisolmeans that the adrenal glands do not produce enough. Persistently abnormally low levels are called Adrenal Insufficiency . The best-known example is primary adrenal insufficiency, or Addison's disease. In Addison's disease, the immune system attacks the adrenal glands, impairing hormone production. Pituitary problems (secondary adrenal insufficiency) or abruptly stopping prolonged high-dose cortisone can also cause low cortisol.

Insufficient cortisol disrupts the body's vital response to stress. Symptoms of low cortisol may include:

• Severe Weakness and Fatigue: Persistent exhaustion and low energy are prominent. With advanced deficiency, patients may struggle to stand or be too weak to get out of bed.

• Loss of Appetite and Weight Loss: Appetite may decline and weight decrease over time without an obvious cause. Without sufficient cortisol, the body cannot use nutrients efficiently and becomes prone to weight loss.

• Low Blood Pressure (Hypotension): Cortisol deficiency can lower blood pressure dangerously, causing dizziness, lightheadedness, or fainting, particularly on standing. Persistently low pressure is typical in Addison's disease.

• Salt Cravings: Because the body struggles to retain sodium, patients may crave very salty foods. Intense salt cravings or increased salt consumption may indicate cortisol/aldosterone deficiency.

• Digestive Problems: Nausea, vomiting, and abdominal pain may occur. These become more pronounced during acute adrenal insufficiency (Addisonian crisis) and may require urgent treatment.

• Generalized Body Pain: Low cortisol may cause muscle and joint pain. The person may also feel generally unwell.

Although low cortisol is rare, it can be life-threatening . Particularly in Addison's disease, stress such as infection or an accident may overwhelm the body's response and cause an adrenal crisis . Once diagnosed, replacing the missing hormone, for example with cortisone tablets, is therefore lifesaving. Fortunately, adrenal insufficiency causes signs such as persistent weakness and weight loss and can be diagnosed with appropriate tests.

The table below summarizes normal, high, and low cortisol levels, the main systems affected, and general treatment approaches:

Cortisol Ranges and Effects on the Body (Table)

Note: These ranges represent typical morning and evening serum levels. Normal laboratory ranges may vary. Doctors assess results alongside symptoms and specific tests to diagnose abnormalities.

Medical Uses of Cortisone

Cortisone is used for treating many diseases and is widely prescribed by doctors. Its strong anti-inflammatory and immunosuppressive effects mean that cortisone treatment may be used in the following areas:

• Rheumatic and Autoimmune Diseases: In diseases in which immunity attacks the body, such as rheumatoid arthritis, lupus (SLE), ankylosing spondylitis, and vasculitis, cortisone reduces inflammation and harmful immune effects. This relieves joint pain and controls organ involvement.

• Allergic Diseases and Asthma: Cortisone can be lifesaving in allergic asthma attacks, severe allergic reactions (anaphylaxis), chronic allergic rhinitis, or skin allergies such as urticaria. It eases breathing by reducing airway swelling and inflammation and calms excessive immune responses in allergy.

• Skin Diseases: Cortisone creams or tablets rapidly relieve symptoms in conditions with severe skin inflammation and itching, such as severe eczema, psoriasis, and contact dermatitis. They reduce redness, swelling, and itching, providing relief.

• Organ Transplantation: Immunity must be suppressed in transplant recipients to prevent rejection. Cortisone medicines are combined with other immunosuppressants for this purpose. High doses are particularly used early after transplantation and gradually reduced.

• Brain and Nervous System Conditions: In conditions such as brain tumors or MS (multiple sclerosis) relapses, cortisone reduces brain swelling and pressure. High doses during acute MS relapses promote faster neurological recovery.

• Support During Cancer Treatment: Cortisone derivatives are used in some cancer treatments, particularly as part of treatment for hematological cancers such as lymphoma and leukemia. They are also widely used to reduce chemotherapy-induced nausea and vomiting. Dexamethasone, for example, given before chemotherapy, both reduces allergic reaction risk and controls nausea.

• Adrenal Insufficiency (Addison's Disease): In people unable to produce cortisol, such as those with Addison's disease, cortisone medicines provide hormone replacement therapy . This corrects a natural deficiency. Regular low doses allow these patients to lead normal lives.

These are the main uses. Doctors may also prescribe cortisone in intensive-care situations such as severe COVID-19 pneumonia, eye diseases, and certain inflammatory ear, nose, and throat conditions when appropriate. The important pointis that cortisone must be used under medical supervision according to a defined plan. Indiscriminate or prolonged high-dose use can cause serious adverse effects, which we discuss next.

What Are the Adverse Effects of Cortisone?

Because cortisone is potent, its adverse effects vary with dose, duration, and individual factors. Short-term (temporary) effects generally occur with high doses or after injections. Long-term effects may appear after months of treatment or repeated high doses.

Possible Short-Term Effects:

• Increased Appetite and Weight Gain: Cortisone may increase appetite and food intake. Water and salt retention can also raise weight within a few days. Facial rounding, a temporary “moon face,” can develop quickly.

• Mood Changes: Some patients notice sudden mood changes after taking cortisone. Euphoria, restlessness, or irritability may occur. Sleep disturbances and nighttime awakenings are also common.

• Stomach and Digestion: High doses may increase stomach acid, heartburn, burning sensations, or ulcer risk. Doctors therefore often prescribe a stomach-protective drug alongside cortisone.

• Blood Glucose and Blood Pressure: Blood glucose can rise even in the short term, requiring particular caution in people with diabetes. Blood pressure may also rise temporarily.

Long-Term (Chronic Use) Adverse Effects:

• Weight Gain and Fat Distribution: Prolonged cortisone use almost always causes weight gain through increased appetite and metabolic changes. Fat accumulation is particularly prominent around the abdomen, neck, and face.

• Bone Loss (Osteoporosis): Cortisone weakens bones by reducing calcium absorption and accelerating calcium withdrawal from bone. Treatment over months may reduce bone density and increase fracture risk.

• Muscle Weakness: Increased protein breakdown reduces muscle mass and causes weakness. Muscle wasting may particularly affect the arms and legs.

• Diabetes and Metabolic Problems: Persistently raised blood glucose can promote diabetes and complicate glucose control in existing diabetes.

• Hypertension: Long-term use may raise blood pressure persistently and require antihypertensive treatment.

• Skin and Cosmetic Changes: Thinner skin, easy bruising, and slow wound healing accompany prolonged use. Acne, facial redness, and increased body hair may also occur.

• Infection Risk: Immune suppression reduces resistance. People using cortisone long term may acquire infections more readily, and infections may be more severe, such as pneumonia.

• Growth Delay: In children, prolonged treatment can affect growth plates and slow height gain. Long-term high doses are therefore avoided unless necessary.

• Adrenal Suppression: When cortisone is continually supplied externally, the body reduces cortisol production by its own adrenal glands. Abrupt withdrawal may then leave it without sufficient cortisol, causing adrenal crisis. Doses are therefore reduced gradually when stopping prolonged treatment.

This list may seem alarming, but cortisone adverse effects can be minimized by managing dose and duration. Doctors aim for the lowest effective dose for the shortest period. Strategies such as alternate-day dosing or local administration may reduce risk when appropriate. For example, after an injection into a particular joint, most of the drug remains there and systemic effects are fewer. Patients should nevertheless eat a balanced diet, particularly restricting salt and increasing protein, exercise gently and regularly, and attend follow-up appointments.

The table below summarizes major uses and adverse effects that may occur:

Cortisone Uses and Adverse Effects (Table)

Note: Each patient responds differently. The table lists common effects. Doctors monitor patients closely and manage adverse effects, using calcium/vitamin D supplementation, glucose-control measures, or infection prophylaxis when necessary.

Cortisol, Cortisone, and Weight Gain

An aspect attracting particular interest is the effect of cortisol and cortisone on weight gain . People under chronic stress or taking cortisone may notice increased weight. So what is cortisol's relationship with weight gain ?

High cortisol levelsmay stimulate appetite and increase eating. Cortisol released under stress signals as though the body needs energy, making people particularly inclined toward carbohydrates and sugary foods. Research supports increased appetite and, particularly, abdominal fat accumulation in people experiencing chronic stress. One explanation is that abdominal fat cells have more cortisol-sensitive receptors, making the abdomen more prone to storing fat when cortisol is high. Stressful living conditions may therefore cause persistent weight gain and a larger waist.

Cortisone treatment is another potent contributor to weight gain. These medicines artificially produce high-cortisol effects. Increased appetite is particularly common with medium- to long-term use; patients may feel constantly hungry and consume more calories. Cortisone also causes edema , or fluid retention, which raises scale weight. Facial swelling (moon face) and abdominal bloating are common complaints. As discussed under cortisone adverse effects , redistribution of body fat also changes the appearance of weight gain.

How Can Weight Gain Be Prevented? If you take cortisone, follow your doctor's dietary advice. Restricting salt, avoiding excessively calorie-dense and sugary foods, and obtaining enough protein may help. Even when hungry, choose healthy snacks where possible, such as vegetables, yogurt, or moderate portions of walnuts and almonds. Regular exercisehelps balance cortisol by reducing stress and aids weight management by burning calories. Movement acts as a balancing mechanism for a body exposed to high cortisol.

Stress-coping techniques such as meditation, breathing exercises, and yoga also reduce chronic stress and indirectly help return cortisol to normal ranges. Adequate sleep is critical because sleep deprivation itself can raise cortisol and appetite.

Weight gain related to cortisol or cortisone can be largely managed through careful lifestyle and dietary choices . If you use cortisone for cancer treatment or another reason, your doctor and dietitian can provide individualized advice and intervene early when needed. Do not let weight gain discourage you; when treatment ends and stress resolves, the body begins rebalancing, and appropriate efforts can help shed excess weight.

Cortisol and Cancer

Whether high levels of the stress hormone cortisol are connected with cancer interests both patients and scientists. The cortisol-cancer relationshipis investigated through indirect rather than direct pathways. Although there is no conclusive evidence that high cortisol alone causes cancer, chronic stress's negative effects are thought potentially to increase cancer risk.

During prolonged stress, cortisol and similar stress hormones remain elevated, potentially weakening immunity over time. The immune systemnormally plays an important role in recognizing and eliminating abnormal cells, including potentially cancerous cells. Stress-related immune suppression may facilitate uncontrolled cancer cell growth. Some research has suggested that certain cancers, such as breast cancer, might occur more often in people under intense stress.

Indirect effects also matter. High cortisol --> contributes to metabolic problems such as high blood glucose, hypertension, and obesity. These are known long-term risk factors for various cancers; obesity, for example, increases certain cancer risks. A chronically high-cortisol environment may therefore make the body more conducive to cancer development.

However, it is important to emphasize that the relationship between stress and cancer is complex, and cortisol is only one factor. Not everyone under stress develops cancer. Some patients already have high cortisol at diagnosis or during treatment as a stress response to illness. Physicians also prioritize reducing psychological stress during cancer care because general well-being may affect treatment success.

In Conclusion: A definite, direct causal relationship between cortisol and cancer has not been scientifically established. Reducing stress where possible benefits physical and mental health and is also recommended for cancer prevention. Managing stress through balanced habits, regular exercise, adequate sleep, and psychological support when needed helps maintain healthy cortisol levels and promotes stronger long-term immunity and resilience to illness.

Frequently Asked Questions

What Should Cortisol Levels Be?

In healthy people, cortisol varies by time of day. It begins rising toward morning and peaks around 6-8 in the morning , generally at approximately ~10-20 µg/dL. It declines during the day, reaching lower levels around 4-5 in the afternoon , approximately 3-10 µg/dL. Near midnight, it reaches its lowest level, between 1-5 µg/dL. This fluctuation is part of the biological clock. Laboratory reports provide a normal range, but stress, sleep, and health can affect results. Instead of relying on a single measurement, doctors may use cortisol stimulation/suppression tests or a 24-hour urinary cortisol test to assess whether levels are normal.

Does Cortisone Cause Weight Gain?

Yes, cortisone treatment can cause weight gain. Increased appetite may lead to eating more, while salt and water retention cause edema and extra scale weight. Fat accumulation in the face and trunk becomes particularly prominent with prolonged use. The extent varies: some experience mild gain, others more. Dietary and lifestyle measures are important for limiting this effect. Your doctor may refer you to a nutrition professional to help manage it.

Is Long-Term Cortisone Use Harmful?

When necessary and supervised, cortisone generally provides benefits and is indispensable in many serious diseases. However, taking it at high doses for a prolonged period can cause unwanted effects. Months of use may cause or worsen osteoporosis, hypertension, and diabetes. External cortisone also reduces the body's own cortisol production, making abrupt withdrawal dangerous; the dose must be tapered gradually. Doctors aim for the shortest duration and lowest dose. When prolonged use is essential, they monitor adverse effects and take precautions such as bone-protective medication, glucose control, and regular checkups. Long-term treatment is therefore undertaken only when essential and under medical supervision to minimize possible harms.

Can Cortisol Be Lowered Naturally?

Partly, yes. If elevation is caused by stress rather than a tumor or disease, lifestyle changes can help balance levels. Reducing stressis the most important step. Regular exercise, relaxation techniques such as meditation or yoga, hobbies, and psychological support when needed help lower stress hormones. Regular, adequate sleep also restores the natural rhythm; aim for 7-8 hours of quality sleep each night. Healthy eating has indirect effects too. A balanced diet of vegetables, fruit, whole grains, and protein instead of high-sugar or caffeinated foods may stabilize blood glucose and reduce cortisol fluctuations. Some research suggests that fish oil (omega-3) supplements and vitamin Cmay help control stress hormones, but consult your doctor before taking supplements. These approaches do not treat a medical disorder; they only support returning stress-related elevation toward a healthy range. Seek medical assessment if significant cortisol excess is suspected.

How Is High Cortisol Treated?

Treatment of high cortisol depends on its cause. Doctors first perform detailed tests to identify the source. If the underlying cause is Cushing's syndrome , meaning excessive production by the body, treatment generally involves removing the responsible tumor. A pituitary tumor may require neurosurgery, while an adrenal tumor may require abdominal surgery. If surgery is impossible, radiotherapy or specific cortisol-suppressing drugs may be used. If the elevation results from prolonged cortisone medication , the doctor gradually reduces the dose to a safe level or stops it completely, never abruptly because this may be dangerous. Alternative treatments are introduced when needed. During treatment, diet and lifestyle also provide support: restricting salt and carbohydrates, exercising regularly, and reducing stress contribute to recovery. Treatment is individualized and should be planned by an endocrinologist; patients support it by following instructions and maintaining healthy habits.

Conclusion

Cortisol is essential, and balanced levels throughout life are key to health. Cortisone, the manufactured form of this hormone, helps treat many diseases. Both are beneficial in appropriate amounts but can cause effects requiring attention when excessive. If you suspect a cortisol- or cortisone-related health problem, consult a specialist and obtain the necessary tests. Remember that an informed approach under medical supervision can manage or treat most hormone-related problems.