Can Too Much Stress Hormone Really Cause Cortisol Face?

It’s no surprise that stress can wreak havoc on your body, from random pains to an upset stomach to panic attacks. But there’s a new symptom of stress, according to the internet: a puffy face.  

Deemed “cortisol face” on social media, people claim that their face looking rounder or puffier is caused by higher-than-normal levels of the hormone cortisol.  

Dr. Kathryn Weaver, an endocrinologist at UW Medicine, only recently started hearing concerns about high cortisol levels among her patients. 

“A few years ago, cortisol deficiency was a big concern,” she says.

That’s not to dismiss any fears you might have about high cortisol, though. High cortisol (and low cortisol) are real medical conditions that definitely warrant attention — and treatment.  

How cortisol works in the body

Cortisol often gets a bad rap due to its role as a stress hormone. But let’s get one thing straight: Cortisol is a really important hormone for your body.

“It’s a life-essential hormone, meaning you can’t be alive without it,” Weaver says. “It’s a fuel mobilization hormone, so it mobilizes all sorts of fuels like sugar and fat in your body. It also plays a role in metabolism, immune response, and mediating blood pressure and heart rate.”

In most people, the body regulates cortisol levels: They typically go up in the morning and slowly decrease as the day goes on. Cortisol can temporarily increase to higher-than-normal levels in response to stressful events, too, like emotional stress or illness like COVID-19.  

This is what cortisol is supposed to do and is a healthy and necessary bodily response to stressors, Weaver says. In most cases, cortisol will return to normal levels on its own after the worst of the stress has ended. 

Can high cortisol cause a puffy face?

The short answer is: It depends on what you mean by “high cortisol.”

If your cortisol levels temporarily increase as a natural response to stress, you won’t experience symptoms like a puffy or rounded face, Weaver says.  

To get changes in your face due to cortisol requires prolonged exposure to high levels of the hormone, not brief upticks due to stress or a short illness. In reality, problematic high cortisol is not usually something that happens quickly; it develops gradually over time. Because of this, it’s extremely unlikely to see sudden physical symptoms — like a puffy, rounded face — unless you’ve been dealing with abnormally high cortisol levels for years.

“If you’re seeing changes in your body that are concerning, you’d want to monitor it and see what the trajectory is,” Weaver says. “It would be dangerous to chalk it up to, ‘Oh I’m stressed, my cortisol is high,’ because that doesn’t usually happen and there could be something else going on that you may be missing.”

What high cortisol actually means

Abnormally high cortisol means there is continuously too much cortisol in your body. It is this continuous exposure to high cortisol levels, without the typical variation in levels through the day, that causes symptoms of cortisol excess, like a puffy face. Again, this doesn’t just happen with stress or mild illness.  

Some medications, like prednisone, can cause symptoms of high cortisol while you’re taking the drug. This is called Cushing’s syndrome, and it usually only lasts while someone is taking the medication. Cushing’s syndrome can be caused by tumors on the adrenal glands, which produce cortisol. The syndrome can also be caused by tumors on the pituitary gland that make too much of the adrenocorticotropic hormone (ACTH), which then triggers the adrenal glands to overproduce cortisol.

There’s also a condition called pseudo-Cushing’s syndrome where someone has none of the typical causes for the condition but instead is exposed to chronic, high levels of stress that lead to high cortisol. But this condition is extremely rare.  

“Pseudo-Cushing’s is rare but if it does occur, we see it in people with chronic, severe mental health issues, like refractory depression, severe schizophrenia, and chronic, severe, untreated alcohol use disorder,” Weaver says. 

How can you tell if you have high cortisol?  

Symptoms of Cushing’s syndrome and disease include more than just a puffy face: fat redistribution to the stomach, face and upper back near the neck; easy bruising and bleeding; a red, ruddy face; more frequent infections; fluid retention; and the development of high blood pressure and diabetes.  

Because of the gradual way high cortisol typically develops, it can be a difficult condition to diagnose. It is not possible to diagnose high cortisol just through symptoms or even through a blood test alone, Weaver says.

A combination of urinary tests, saliva tests, blood tests and scans like an MRI or CT are used to diagnose high cortisol. Treatment depends on what’s causing the condition, but can involve surgery, radiation and chemotherapy, or hormone-suppressing medications.  

But it’s important to get a diagnosis, because too much or too little cortisol isn’t good.

“There are cortisol receptors on basically every organ in the body, so every organ is subject to its effects,” Weaver says. In other words, your whole body is impacted if you have abnormal cortisol levels.  

Why low cortisol is dangerous, too

Low cortisol is called adrenal insufficiency or Addison’s disease, depending on the cause. It can happen when your pituitary gland doesn’t make enough ACTH, your hypothalamus in your brain doesn’t function properly, or your immune system attacks your adrenal glands.

There are many symptoms, including fatigue, dizziness, weight loss, darkened skin, dehydration, muscle aches and low blood pressure. If untreated, the condition can lead to dangerous complications like kidney failure, shock or even death, so it’s important to get checked out by a doctor if you have symptoms.

The bottom line

Unless you have multiple symptoms of high or low cortisol, in addition to what might look like a puffy face, your cortisol levels are probably normal. If you have any concerns, talk with your doctor. 

“I’d caution people against testing for this on their own, since cortisol changes a lot through the day and it also changes depending on what’s going on in your life,” Weaver says. “The number by itself is usually irrelevant, it has to be in the context of other tests and symptoms.”