Excessive levels of cortisol inhibit the proliferation of fibroblasts and the formation of collagen, leading to thinning and vulnerability of the skin. Capillary injury or bruising is also heightened due to impaired connective tissue support. In the kidney, cortisol acts as an antagonist to antidiuretic hormone (ADH), inhibiting its secretion and action. In the absence of cortisol, the potency of ADH increases, making it difficult to eliminate excess water and increasing the risk of water intoxication. While cortisol has a high affinity for the mineralocorticoid receptor, its activity is typically blocked by the enzyme 11βHSD2, which converts cortisol to cortisone. However, the extent of mineralocorticoid activity depends on the relative amount of cortisol and the activity of 11β-HSD2. Certain substances, like those found in black licorice, inhibit 11βHSD2, thereby intensifying the mineralocorticoid activity of cortisol. Cortisol enhances the glomerular filtration rate by increasing cardiac output and directly impacting the kidneys. Excessive levels of cortisol often lead to muscle weakness and pain, partly due to increased proteolysis caused by cortisol. Furthermore, hypokalemia can occur, resulting in muscle weakness due to mineralocorticoid actions that hyperpolarize and stabilize muscle cell membranes. The gastrointestinal tract experiences a trophic effect from cortisol, with its absence leading to decreased motility, degeneration of the GI mucosa, and reduced production of gastric acid and enzymes. Hypercortisolism is commonly associated with weight gain due to the stimulation of appetite. Additionally, cortisol-induced stimulation of gastric acid and pepsin secretion increases the risk of developing ulcers. Psychiatric disturbances can arise from excessive or deficient levels of corticosteroids. Initially, excessive corticosteroids may induce a sense of well-being, but prolonged exposure can lead to emotional instability and depression. Both excessive and deficient hormone levels can result in psychosis. Cortisol increases the likelihood of insomnia and reduces REM sleep. Individuals with corticosteroid deficiencies often experience depression, apathy, and irritability. Cortisol plays a crucial role in the development of the central nervous system, retina, skin, gastrointestinal tract, and lungs during fetal development. The lungs, in particular, undergo differentiation and maturation of type II alveolar cells under the influence of cortisol. These cells produce surfactant in late gestation, reducing surface tension in the lungs and facilitating breathing at birth. The production of cortisol is regulated by various mechanisms.
Cortisol inhibits fibroblast proliferation and collagen formation. In the presence of excessive amounts of cortisol, the skin thins and is more readily damaged. The connective tissue support of capillaries is impaired, and capillary injury, or bruising, is increased.
Actions of Cortisol on the Kidney
Cortisol inhibits the secretion and action of antidiuretic hormone (ADH), and thus it is an ADH antagonist. In the absence of cortisol, the action of ADH is potentiated, which makes it difficult to increase free water clearance in response to a water load and increases the likelihood of water intoxication. Although cortisol binds to the mineralocorticoid receptor with high affinity, this action is normally blocked by inactivation of cortisol to cortisone by the enzyme 11βHSD2. However, the mineralocorticoid activity (i.e., renal Na+ and H2O retention, K+ and H+ excretion) of cortisol depends on the relative amount of cortisol (or synthetic glucocorticoids) and the activity of 11β-HSD2. Certain agents (e.g., compounds in black licorice) inhibit 11βHSD2 and thereby increase the mineralocorticoid activity of cortisol. Cortisol increases the glomerular filtration rate by both increasing cardiac output and acting directly on the kidney.
Actions of Cortisol on Muscle
When cortisol levels are excessive, muscle weakness and pain are common symptoms. The weakness has multiple origins. In part it is a result of the excessive proteolysis cortisol produces. High cortisol levels can result in hypokalemia (via mineralocorticoid actions), which can produce muscle weakness because it hyperpolarizes and stabilizes the muscle cell membrane and thus makes stimulation more difficult.
Actions of Cortisol on the Gastrointestinal Tract
Cortisol exerts a trophic effect on the GI mucosa. In the absence of cortisol, GI motility decreases, GI mucosa degenerates, and GI acid and enzyme production decreases. Because cortisol stimulates appetite, hypercortisolism is frequently associated with weight gain. The cortisol-mediated stimulation of gastric acid and pepsin secretion increases the risk for development of ulcers.
Psychological Effects of Cortisol
Psychiatric disturbances are associated with either excessive or deficient levels of corticosteroids. Excessive corticosteroids can initially produce a feeling of well-being, but continued excessive exposure eventually leads to emotional lability and depression. Frank psychosis can occur with either excessive or deficient hormone. Cortisol increases the tendency for insomnia and decreases rapid eye movement (REM) sleep. People who are deficient in corticosteroids tend to be depressed, apathetic, and irritable.
Effects of Cortisol During Fetal Development
Cortisol is required for normal development of the CNS, retina, skin, GI tract, and lungs. The best studied system is the lungs, in which cortisol induces differentiation and maturation of type II alveolar cells. During late gestation these cells produce surfactant, which reduces surface tension in the lungs and thus allows the onset of breathing at birth.
Regulation of Cortisol Production