Episode 1: Understanding the Role and Impact of Cortisol
An expert discusses how cortisol, a vital hormone regulating stress, metabolism, and the sleep-wake cycle, can lead to a complex range of symptoms when elevated—beyond classic Cushing syndrome—highlighting the importance of recognizing subtle signs such as resistant hypertension, fatigue, and poorly controlled diabetes for early diagnosis and treatment.
By
Pamela Kushner, MD
| Published on May 28, 2025
2 min read
The following is an AI-generated summary based on the video content above:
A board-certified family physician introduces cortisol as a critical steroid hormone, commonly referred to as the “stress hormone,” produced by the adrenal glands. Cortisol is essential for regulating the body’s stress response, but it also plays a vital role in managing blood pressure, inflammation, glucose metabolism, and the sleep-wake cycle, also known as the circadian rhythm. Its levels naturally fluctuate throughout the day, rising in the early morning to prepare the body for waking and gradually declining in the evening. This daily rhythm, along with cortisol’s role in the “fight or flight” response, highlights its importance in maintaining overall health and homeostasis.
The speaker explains that an excess of cortisol, or hypercortisolism, can present in many ways. Historically linked only to classic Cushing syndrome—marked by central obesity, excess hair growth, and a fatty hump on the back—the condition is now understood to have a broader range of presentations. Subtle signs such as central obesity with poorly controlled diabetes, proximal muscle weakness, fatigue, emotional instability, and particularly resistant hypertension are now recognized as possible indicators. These symptoms suggest that hypercortisolism is a complex, multisystemic disorder not always confined to dramatic physical changes.
Attention is drawn to specific red flags that may suggest cortisol imbalance, including resistant hypertension requiring multiple medications, osteoporosis in younger individuals, and diabetes that is difficult to manage despite lifestyle adherence. Although simple obesity alone is not considered a strong indicator, the presence of unexplained weight gain in combination with other symptoms may warrant further investigation. Recognizing these more nuanced patterns is essential for identifying individuals who may be experiencing cortisol-related disorders, allowing for earlier intervention and more effective treatment planning.
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