Cortisol and stress will forever be linked — and for good reason.

Cortisol, a steroid hormone produced by the adrenal glands, exists mainly to support the body in times of severe physical stress.

If someone is in a car accident or having surgery or gravely ill, for example, cortisol helps keep their blood pressure and blood sugar up to help the body function. But cortisol can also affect many other things such as inflammation and sleep-wake cycles.

And it isn’t always helpful. Too much or too little can cause wide-ranging health issues, which is why it sometimes gets a bad rap. And while the body continuously monitors cortisol to maintain homeostasis, it’s not a foolproof system and different factors can impact those levels.

It’s a lot to keep up with, so we checked in with endocrinologists Dr. Avni Vora of Northwestern Medicine Palos Hospital and Dr. Amna Ijaz of Methodist Hospitals Specialty Center in Crown Point to learn a little bit more about the ups and downs of cortisol. Here are some important things they think people need to keep in mind.

The trouble with high cortisol levels

Abnormally elevated cortisol levels can occur when there is a mass in the adrenal or pituitary glands. Most adrenal masses are benign and do not produce excess hormones, but they can. The adrenal glands sit on top of the kidneys and produce cortisol. The pituitary gland sits underneath our brain and makes a hormone called ACTH, which stimulates the adrenal gland to make cortisol. If someone has a mass in the pituitary producing too much ACTH, that can lead to high cortisol levels.

Vora says common symptoms of too much cortisol can include elevated blood pressure, elevated blood sugar, weight gain, round face or fat pads on the cervical spine and above the collarbone.

“Sometimes these symptoms are not cortisol but rather just related to weight gain and obesity,” she explains. “The more specific symptoms that are more concerning for cortisol production would be the presence of purple stretch marks on the skin and muscle weakness when trying to get out of a chair or go up the stairs.”

Vora notes that having a mass that makes too much cortisol is rare. For those that do have such a mass, the most common treatment is surgery to remove the adrenal gland or part of the pituitary gland.

The trouble with low cortisol levels

Low cortisol can occur when someone has an autoimmune disease called Addison’s disease, an adrenal insufficiency in which the immune system attacks the adrenal glands.

More commonly, low cor