Lever
Lifestyle
- Regular physical activity
- Stress management techniques
- Adequate sleep
- Mindfulness meditation
Blutwerte · Marker
Cortisol
Serum Cortisol · Hydrocortisone · Stresshormon
Hormone — StressachseZeitabhängig
- Einheit:
- nmol/L
Cortisol tests measure the level of cortisol, a steroid hormone, in the blood, urine, or saliva.
Reference Ranges
Reference
138–635nmol/L
138
6
18
635
LowNormalHigh
Reference
Optimal
Unit · nmol/LCortisol levels vary by time of day, peaking in the early morning and declining throughout the day.
Overview
Übersicht
Cortisol, also known as serum cortisol or hydrocortisone, is a steroid hormone produced by the adrenal glands in response to stress and low blood-glucose concentration. It plays a crucial role in various physiological processes, including metabolism regulation, immune response modulation, and stress response via the hypothalamus-pituitary-adrenal (HPA) axis. Clinically, cortisol levels are significant in diagnosing conditions such as Cushing's syndrome, characterized by hypercortisolism, and adrenal insufficiency, where cortisol production is inadequate. Researchers found that cortisol levels correlate with thyroid function, particularly in conditions like Cushing's syndrome, where thyroid hormone levels may be impaired. In the context of athletic performance and biohacking, cortisol is often monitored as a stress biomarker, with elevated levels potentially indicating overtraining or chronic stress, which can impact recovery and performance. However, measuring cortisol accurately can be challenging due to its diurnal variation, binding to proteins like cortisol-binding globulin, and the influence of external factors such as stress, illness, and medications. Researchers observed that salivary cortisol provides a non-invasive measure of free cortisol, but its interpretation requires careful consideration of the time of day and individual variability.
Klinische Bedeutung
Elevated cortisol levels may indicate Cushing's syndrome, stress, or adrenal hyperfunction, while reduced levels can suggest adrenal insufficiency or Addison's disease. Cortisol levels are also used to assess the HPA axis function.
Dynamics
Trend Interpretation
Rising Values
Progressively rising cortisol levels may suggest worsening stress or Cushing's syndrome. Re-test in 4 weeks if outside optimal range.
Falling Values
Progressively falling cortisol levels may indicate improving stress management or potential adrenal insufficiency.
Re-test Interval
4 weeks if outside optimal range
Etiology
Causes — High & Low
Cause
Elevated Levels
- Cushing's syndrome
- Chronic stress
- Adrenal tumors
- Excessive ACTH production
- Prolonged corticosteroid use
Cause
Low Levels
- Adrenal insufficiency
- Addison's disease
- Hypopituitarism
- Chronic fatigue syndrome
- Certain medications
Protocol
How to Optimize
Lever
Nutrition
- Balanced diet rich in fruits and vegetables
- Adequate hydration
- Reduced caffeine intake
- Omega-3 fatty acids
Lever
Supplementation
- Ashwagandha
- Rhodiola rosea
Note:
Consult a healthcare provider before making significant lifestyle or dietary changes, especially if managing a health condition.
Testing Guidelines
✓Fasting Not Required
🕐Time-Sensitive
Cortisol peaks at 8am; draw at same time for comparability.
Testing Frequency
Annually for healthy adults, more frequently if monitoring a condition.
Interfering Factors
- Recent intense exercise
- Acute illness
- Corticosteroid medication
Related Peptides & Hormones
Acth
hormoneCorrelated with
Open Research Questions
Current research suggests that reference ranges for salivary cortisol remain poorly standardized, leading to challenges in interpreting results across different assays. Researchers have not yet established optimal cortisol cut-off values for diagnosing conditions like adrenal insufficiency using newer assays. Additionally, clinical questions remain unanswered regarding the physiological implications of cortisol fluctuations in various populations, particularly in those with altered serum protein concentrations or during acute illness.
39 Research Publications
3,378
Total Citations
12
Human/RCT
6.8
Avg. Influence
2025
Latest
Sort
Filter
01Top
#01
Salivary cortisol as a biomarker in stress research.
ReviewInfluence51.0
1905
This study examined the use of salivary cortisol as a biomarker for psychological stress. Researchers found that salivary cortisol measures may not directly correlate with plasma cortisol levels due to various biological factors affecting the hypothalamus-pituitary-adrenal axis. The paper highlights the importance of understanding these variables for accurate stress assessment.
02Top
#02
Measuring cortisol in serum, urine and saliva - are our assays good enough?
ReviewInfluence4.0
325
Researchers reviewed methods for measuring cortisol in serum, urine, and saliva, emphasizing the importance of accurate assays. They found that while serum cortisol assays can be misleading, liquid chromatography-tandem mass spectrometry (LC-MS/MS) offers improved specificity. Salivary cortisol is a reliable alternative for assessing free cortisol levels.
03Top
#03
Effects of forest bathing (shinrin-yoku) on levels of cortisol as a stress biomarker: a systematic review and meta-analysis.
Meta-AnalysisInfluence10.0
238
Researchers conducted a systematic review and meta-analysis to assess the effects of forest bathing on cortisol levels. They found that cortisol levels were significantly lower in forest groups compared to urban groups, indicating that forest bathing may reduce stress. The study suggests further research is needed due to limited data.
04
#04
Cortisol assays and diagnostic laboratory procedures in human biological fluids.
ReviewInfluence5.0
201
This review critiqued various methods for measuring cortisol in biological fluids. Researchers found that each measurement method requires its own reference range and diagnostic cut-off levels to ensure accurate results.
05
#05
Cardiovascular Disease and Hair Cortisol: a Novel Biomarker of Chronic Stress.
ReviewInfluence4.0
168
This review explored hair cortisol as a biomarker for chronic stress related to cardiovascular disease. Researchers found that elevated hair cortisol levels are associated with increased CVD risk and poorer treatment outcomes. The study suggests that hair cortisol could serve as a novel biomarker for chronic stress in CVD.
06
#06
The detection of cortisol in human sweat: implications for measurement of cortisol in hair.
In VitroInfluence2.0
164
Researchers explored the relationship between sweat cortisol and hair cortisol content. They found that intense exercise increased sweat cortisol levels, which may influence hair cortisol measurements, suggesting careful consideration in chronic stress studies.
07
#07
Salivary cortisol and cortisone in the clinical setting.
ReviewInfluence7.0
105
Researchers reviewed the clinical utility of salivary cortisol and cortisone as biomarkers for adrenal function. They found that salivary measurements are advantageous for assessing cortisol levels, particularly in conditions of altered cortisol binding. Salivary cortisone was noted as a superior marker in specific clinical scenarios.
08
#08
Borderline hypertensives produce exaggerated adrenocortical responses to mental stress.
HumanInfluence3.0
88
09
#09
SERS-based immunoassay for monitoring cortisol-related disorders.
In Vitro
47
This study introduced a novel SERS-based immunoassay for measuring cortisol levels, highlighting its advantages over traditional methods. Researchers found that this method could effectively monitor cortisol-related disorders, offering a portable and sensitive alternative for assessing stress.
10
#10
Cortisol is an associated-risk factor of brain dysfunction in patients with severe sepsis and septic shock.
HumanInfluence3.0
42
This study examined the relationship between cortisol levels and brain dysfunction in patients with severe sepsis and septic shock. Researchers observed that higher cortisol levels were associated with increased brain dysfunction and ICU mortality. The findings suggest cortisol as a potential risk factor for brain complications in these patients.
Clinical Trials (23)
23
Total Trials
2,679
Total Enrolled
Cortisol Levels and Mortality in Septic Shock ICU Patients
NCT07582926RECRUITING
Sponsor
Ankara Etlik City Hospital
Enrollment
183
Started
2026
Primary outcome
1.ICU mortality
SepsisSeptic Shock
Hair Biomarkers Study
NCT07011082RECRUITING
Sponsor
Stanford University
Enrollment
600
Started
2024
Primary outcome
Identification of Participants hair cortisol concentrations (HCC) and hair oxytocin concentrations (HOC)
Healthy
A Prospective Observational Study of Changes in Cortisol Levels After Neoadjuvant Immunotherapy and Their Prognostic Value in Patients With NSCLC
NCT07530276ACTIVE_NOT_RECRUITING
Sponsor
Guangdong Provincial People's Hospital
Enrollment
330
Started
2024
Primary outcome
Major Pathological Response (MPR) Rate
NSCLC
Effect of Transcranial Alternative Current Stimulation at Alpha Frequency (α-tACS) on Stressed Healthy Subjects
NCT06229002RECRUITING
Sponsor
Hôpital le Vinatier
Enrollment
40
Started
2024
Primary outcome
Area under the curve (AUC) of the cortisol secretion after the stress task.
Healthy
Post-biotic Intervention for Acute Stress Management
NCT06097182COMPLETED
Sponsor
Institute for Human Development and Potential (IHDP), Singapore
Enrollment
75
Started
2023
Primary outcome
Salivary Cortisol
Stress ResponseMood StateSleepCognition
Investigating the Effects of Osteopathic Manipulative Treatment on Stress Management in Medical Students
NCT06125574COMPLETED
Sponsor
The Touro College and University System
Enrollment
10
Started
2023
Primary outcome
Weekly Cortisol Level
Stress, JobStudent BurnoutStress, PhysiologicalStress, Psychological
danceSing Care Evaluation: Testing the Effectiveness
NCT05601102COMPLETED
Sponsor
University of Stirling
Enrollment
34
Started
2023
Primary outcome
Change From Baseline Salivary Cortisol Levels
Older AdultsHealthy AgingAgingQuality of LifeDepression, AnxietyStress, Physiological
Peri-Implant Sulcus Fluid Stress Markers in Health and Disease
NCT07353515COMPLETED
Sponsor
Inonu University
Enrollment
62
Started
2023
Primary outcome
Peri-implant Sulcular Fluid Cortisol Level
Peri-implantitisPeri-implant MucositisPeri-Implant Health
Enoxolone in Major Depression - Biomarker-outcome Relationship
Sponsor
Philipps University Marburg
Enrollment
80
Started
2022
Primary outcome
Plasma and urine aldosterone/cortisol ratio
Unipolar Depression
Enhancing Emotional and Motivational Development to Support Well-being and Retention in Diverse University Students
NCT05294913COMPLETED
Sponsor
University of Arizona
Enrollment
39
Started
2022
Primary outcome
Salivary diurnal cortisol pattern change (from baseline to end-of-semester)
Healthy
Efficacy and Safety of Topical Hydrocortisone on Signs and Symptoms of Dry Eye Associated to Meibomian Gland Dysfunction
Sponsor
Laboratorios Thea, Spain
Enrollment
54
Started
2021
Primary outcome
Efficacy endpoint: Change from baseline in Meibomian Gland Dysfunction Dry Eye symptom score (MGD-DE) at 14 days
Dry EyeMeibomian Gland Dysfunction
Assessing the Repeatability of a Psychological Stress Test
NCT04714450COMPLETED
Sponsor
Liverpool John Moores University
Enrollment
24
Started
2021
Primary outcome
Change in saliva cortisol (pre-post MMST)
Stress, PhysiologicalStress, Psychological
Self Awakening and Snoozing Effects on the Cortisol Awakening Response
NCT04129593UNKNOWN
Sponsor
University of Notre Dame
Enrollment
100
Started
2021
Primary outcome
Cortisol Awakening Response
Cortisol Awakening Response
Effect of Mindfulness-Based Protocols on Psychological Parameters and Biological Markers in Populations Exposed to Conditions of Persistent Distress
NCT07129057COMPLETED
Sponsor
Azienda Unita Sanitaria Locale di Piacenza
Enrollment
100
Started
2020
Primary outcome
Cortisol level
Distress, Psychological
Stress Hydrocortisone In Pediatric Septic Shock
Sponsor
Jerry Zimmerman
Enrollment
500
Started
2019
Primary outcome
New or progressive multiple organ dysfunction syndrome as assessed utilizing the Pediatric Logistic Organ Dysfunction (PELOD-2) instrument.
Septic Shock
Screening and Stimulation Testing for Residual Secretion of Adrenal Steroid Hormones in Autoimmune Addison's Disease
NCT03793114ACTIVE_NOT_RECRUITING
Sponsor
University of Bergen
Enrollment
200
Started
2018
Primary outcome
The percentage of included patients with residual secretion of cortisol and aldosterone.
Primary Adrenal Insufficiency
Atomoxetine, Diurnal Profiles of Cortisol and α-amylase
NCT03075579UNKNOWN
Sponsor
Praxis für kleine und grosse Leute
Enrollment
50
Started
2016
Primary outcome
saliva cortisol
ADHD
Hormonal and Inflammatory Biomarkers and Response to Cognitive Remediation in Recent-onset Psychosis
NCT04418570COMPLETED
Sponsor
Corporacion Parc Tauli
Enrollment
28
Started
2016
Primary outcome
Plasma cortisol concentrations
Psychotic Disorders
Hair Cortisol and Testosterone Levels in Patients With Sarcoidosis
NCT03108547COMPLETED
Sponsor
Erasmus Medical Center
Enrollment
32
Started
2014
Primary outcome
Scalp hair cortisol differences between sarcoidosis patients with and without fatigue and healthy controls
Sarcoidosis
Treatment of Cushing's Disease With R-roscovitine
Sponsor
Shlomo Melmed, MD
Enrollment
4
Started
2014
Primary outcome
Number of Participants With a Normalized 24 Hour Urinary Free Cortisol After 4 Weeks
Cushings Disease
The Effects of Lactobacillus Plantarum on Cortisol, IgA and Alpha-amylase Levels in Human Saliva During Stress
NCT02974894COMPLETED
Sponsor
Lund University
Enrollment
42
Started
2013
Primary outcome
The impact of Lactobacillus plantarum on the levels of stress-induced cortisol in saliva.
Stress Reaction
CGRP, Estrogen, Cortisol, VIP, α-Amylase, PGE2, PGI2 and ß-Endorphin Levels in Menstrual Migraine Before and After Treximet
Sponsor
Cady, Roger, M.D.
Enrollment
41
Started
2011
Primary outcome
Migraine Recurrence
Menstrual Migraine
Calcitriol in Combination With Ketoconazole and Therapeutic Hydrocortisone in Treating Patients With Prostate Cancer
Sponsor
Roswell Park Cancer Institute
Enrollment
51
Started
2006
Primary outcome
Determine the Maximum Tolerated Dose (MTD)
Prostate AdenocarcinomaRecurrent Prostate CarcinomaStage III Prostate CancerStage IV Prostate Cancer
Publication Trend
Research publications about Cortisol over time
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