Cortisol

Cortisol (cortisol; not to be confused with cortisone (cortisone), the inactivated form of cortisol) is a hormone synthesized in the zona fasciculata of the adrenal cortex and belongs to the glucocorticoid group. It is regulated by higher-level hormones such as ACTH (adrenocorticotropic hormone). It has its function mainly effects on carbohydrate balance (promotion of gluconeogenesis in the liver), lipid metabolism (promotion of lipolytic effect of adrenaline and noradrenaline) and protein turnover (catabolic). It has antiphlogistic (anti-inflammatory) and immunosuppressive effects.

Cortisol is subject to circadian rhythms: it is predominantly secreted in the morning at 8:00 am, and the nadir serum level is midnight.

The process

Material needed

  • Blood serum

Preparation of the patient

  • Blood collection is performed in the morning at eight o’clock fasting

Interfering factors

  • See preparation of the patient

Standard values

Age Normal values (taken at 8 o’clock)
5th day of life 0.6-20 μg/dl
2-12 months of age 2.4-23 μg/dl
2-15 years of age (LY). 2.5-23 μg/dl
16-18 .LJ 2.4-29 μg/dl
> 18. LJ 4-22 μg/dl
Normal values (taken at other times of the day)
> 18. LJ 4-20 μg/dl (blood collection at 12 noon).
0-5 μg/dl (blood collection at 24 h)

Indications

  • Suspicion of adrenal dysfunction.

Interpretation

Interpretation of increased values

False high values

  • Obesity (overweight)
  • Anorexia nervosa (anorexia)
  • Acute psychoses
  • Acute diseases
  • Infections
  • Estrogen therapy/contraceptives (an increase in corticosteroid-binding globulin – e.g., estrogen therapy – can lead to an increase in cortisol)
  • Stress
  • Burns

Interpretation of lowered values

  • Senility (marasmus senilis) – disturbed dynamic regulation of cortisol levels with lowered levels in the morning and increased levels in the evening.
  • Addison’s disease (primary adrenocortical insufficiency) – disease caused by insufficient production of cortisol in the adrenal cortex; the cause is usually an autoimmune disease is caused
  • Secondary hypocortisolism (secondary adrenal insufficiency) – caused by an insufficiency of the pituitary gland (pituitary gland) or the hypothalamus (“regulatory center”) underproduction of cortisol.
  • Adrenogenital syndrome (AGS) with 21-hydroxylase deficiency, or 20,2-desmolase deficiency or 11-β-hydroxylase deficiency – autosomal recessive inherited metabolic disorder characterized by disorders of hormone synthesis in the adrenal cortex. These disorders lead to a deficiency of aldosterone and cortisol.
  • Cortisone therapy

Further notes

  • More advanced adrenal function diagnostics still include:
    • Cortisol daily profile
    • ACTH (Adrenocorticotropic Hormone)
    • Dexamethasone test