An insufficient amount of cortisol disrupts metabolism, resulting in low blood sugar and a lack of glycogen, which is stored in the liver and can be rapidly converted into the glucose required for energy. Lack of cortisol also causes a drop in blood pressure, which decreases cardiac output. A discoloration of the skin called hyperpigmentation can occur as a decrease in cortisol stimulates an increase in other hormones that activate the melanocyte cells responsible for skin pigmentation. The overall effect of low cortisol is weakness, dehydration and diminished ability to fight infection, trauma and stress. These issues are often first noticed during periods of extreme stress or trauma. Additionally, infection, surgery or loss of sodium due to
excessive sweating can elevate the imbalances to the level of an adrenal crisis.
Blood tests must be performed to verify levels of cortisol and other hormones that stimulate the release of cortisol. Treatment consists of medication to replace the cortisol (hydrocortisone or prednisone) and to correct imbalances of other elements such as sodium and potassium, which are influenced by the level of cortisol in the blood. Additionally, the physician will screen for any other conditions or diseases that may impact cortisol production. If found, these would have to be treated.