Question:  I’ve read that lots of common medicines and treatments can raise or lower cortisol.  There’s not much mention of the quantity of these meds that affect cortisol though.  Xanax and codeine lower, for example, and Zoloft, Ritalin, St. John’s Wort, alcohol, and even marijuana raise cortisol.  Growth and thyroid hormones are reported to lower cortisol.  If I take one or more of these substances or others that are listed as affecting cortisol, at what point should I be concerned that they could be affecting my testing results or cortisol levels before or after surgery? 

Answer:  Although several medications have been reported to either raise or lower cortisol after acute administration, there is a more limited number of pharmacologic agents that are known to influence the results of diagnostic tests. For example, regular use of opioids, especially long acting opioids, can lower cortisol levels, leading to biochemical evidence of adrenal insufficiency (sometimes with associated symptoms of hypoadrenalism). On the other hand, consumption of alcohol in excess is well known to raise cortisol levels and lead to falsely positive results on many tests used to diagnose Cushing’s. Of course, glucocorticoid use in any form can confound the interpretation of diagnostic tests for Cushing’s and needs to be carefully considered in every case.

By Dr. Nicholas Tritos, Massachusetts General Hospital, Boston, MA  (Fall 2018)