Adrenal and cortisol-related disorders

The adrenal glands produce several hormones that are essential for daily function, including cortisol and aldosterone. These hormones help regulate energy levels, blood pressure, immune response and how the body responds to physical or psychological stress.

True adrenal or cortisol disorders are uncommon, but they are important to recognise. This page explains how GPs assess possible adrenal problems, when testing is appropriate, and how results are interpreted safely in primary care.

These articles are intended as educational sources, not diagnostic nor taking place of a proper medical assessment. If you need help, please book an appointment with one of our GP’s.

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What cortisol does in the body

Cortisol is often described as a “stress hormone”, but it has a broader role. It helps to:

Maintain blood pressure and circulation
Regulate blood glucose between meals
Support immune and inflammatory responses
Help the body respond to illness, injury or stress

Cortisol levels naturally rise and fall during the day, typically highest in the morning and lowest overnight.

When GPs consider adrenal or cortisol problems

Most people with fatigue, low mood or stress do not have an adrenal disorder. GPs consider cortisol-related conditions only when symptoms, examination findings or blood results suggest something more specific.

Situations where adrenal causes may be considered include:

Persistent unexplained low blood pressure
Recurrent low sodium or high potassium on blood tests
Unexplained weight loss or gain with other concerning features
Skin changes such as unusual pigmentation
Severe fatigue with systemic symptoms
Use or withdrawal of long-term steroid medication

Conditions linked to cortisol deficiency

Adrenal insufficiency (Addison’s disease)

This is a rare condition where the adrenal glands do not produce enough cortisol and aldosterone.

Possible features include:

Persistent fatigue and weakness
Weight loss and loss of appetite
Dizziness on standing
Low blood pressure
Salt craving
Darkening of the skin in some cases

Because symptoms can be non-specific, diagnosis relies on careful blood testing and specialist assessment.

Conditions linked to cortisol excess

Cushing’s syndrome

This is an uncommon condition caused by prolonged exposure to high cortisol levels. It may be due to adrenal disease, pituitary causes or long-term steroid medication.

Possible features include:

Progressive weight gain, particularly around the abdomen and face
Easy bruising and thin skin
Muscle weakness
High blood pressure
Raised blood glucose or diabetes
Mood or sleep changes

Cushing’s syndrome is rare, and most people with weight gain or stress symptoms do not have this condition.

Cortisol and stress: an important distinction

Everyday stress, poor sleep and illness can temporarily affect cortisol levels. This is a normal physiological response, not a disease.

For this reason:

Random cortisol tests can be misleading
Isolated borderline results are often rechecked
Results are always interpreted alongside symptoms, timing of the test and other blood results

GPs aim to avoid unnecessary testing that may cause anxiety without improving outcomes.

How cortisol is tested in primary care

If testing is appropriate, a GP may arrange:

Morning cortisol blood test, taken at a specific time
Repeat testing if results are borderline
Additional blood tests to assess electrolytes and glucose

Specialist tests, such as dynamic stimulation tests or imaging, are usually arranged only after endocrinology review.

When referral to endocrinology is needed

Referral may be recommended if:

Cortisol levels are clearly abnormal on repeat testing
There are clinical features strongly suggestive of adrenal disease
Blood tests show associated electrolyte abnormalities
There is concern about pituitary or adrenal gland function

When to seek urgent medical help

Urgent assessment is needed if someone with known or suspected adrenal insufficiency develops:

Severe vomiting or diarrhoea
Collapse or fainting
Confusion
Severe infection or injury

These situations require same-day medical attention.

AccessGP work with blood tests to help you

When to speak to a GP

You should seek GP review if:

You have ongoing symptoms such as persistent fatigue, dizziness on standing, unexplained weight change, or low blood pressure
Blood tests have shown abnormal sodium, potassium, or cortisol results that need interpretation
You are taking, or have recently stopped, long-term steroid medication and feel unwell
Symptoms are persistent, worsening, or not explained by stress, sleep or mental health alone
You have multiple abnormal blood results affecting hormones or electrolytes
You are unsure whether further testing or specialist referral is neededed

A GP can assess symptoms in context, review medications, decide whether repeat or timed testing is appropriate, and determine whether referral to endocrinology is required.

How various conditions are managed by GPs at AccessGP

GP insight

In general practice, the priority is to identify the small number of people who need specialist investigation, while reassuring the majority where symptoms are more likely related to stress, sleep, mental health or other common medical conditions.

A structured, evidence-based approach helps avoid missed diagnoses without over-investigation.