A puffy face, often referred to as ‘cortisol face,’ can be a telltale sign of elevated cortisol levels, the primary stress hormone produced by the adrenal glands. While occasional cortisol spikes are normal as part of the body’s stress response, consistently high levels can signal a more serious health problem and should be addressed.
The reasons for high cortisol levels can vary: chronic, emotional, or physical stress are the most common causes. Stressful situations activate the hypothalamic-pituitary-adrenal axis (HPA axis), leading to the release of cortisol. Diseases such as Cushing’s syndrome, where the body produces too much cortisol, can also trigger high levels. Additionally, genetic disorders, medication, dietary habits, and hormonal imbalances can contribute.
Dr Petra Algenstaedt, a preventive, nutritional, and metabolic physician and medical director at the UKE Hamburg, explains that high cortisol production from the adrenal gland or an overproduction of ACTH, the hormone regulating cortisol production, can cause elevated levels. High doses of cortisone can also lead to increased cortisol levels. Prolonged intake of higher doses of cortisol or overproduction of cortisol from the adrenal gland or pituitary gland leads to Cushing’s syndrome, a rare condition.
Elevated cortisol levels often lead to increased fat deposits in the cheeks, changing the face’s shape, resulting in a ‘full moon face’. This can also lead to a ‘bull neck’ in the shoulder and neck area. If excessive stress is the cause, stress eating can contribute to weight gain in the face, intensifying the cortisol face.
Cortisol is strongly linked to well-being and health. Additional indicators of excess cortisol include weight gain, particularly in the abdominal area, known as truncal obesity. This involves an increase in abdominal girth with less fat distribution in the arms and legs. Other physical symptoms associated with high cortisol levels, especially if they persist over a longer period, include high blood pressure, increased body hair, acne, wound healing disorders, and myopathies.
If cortisol levels are constantly too high, not only does the face change in shape, but the skin structure is also affected. The skin becomes thinner (parchment-like) and small hemorrhages often occur under the skin. It can also lead to cycle disorders, mood swings, and psychological changes. Hormones influence various bodily functions, including memory, concentration, and the psyche.
According to Dr. Algenstaedt, if the body produces too much cortisol long-term, the risk of developing diabetes and osteoporosis also increases significantly. Menopausal women are particularly at risk due to female hormone deficiency.
If Cushing’s syndrome is suspected, blood analyses and specific endocrinological tests are conducted to confirm the diagnosis and allow for appropriate treatment. The right treatment or therapy depends on the cause of the excess cortisol. Long-term cortisol administration should be avoided or limited in time and replaced with another therapy with fewer side effects. If a benign enlargement or tumor of the pituitary gland or adrenal gland is the cause, surgical removal may be an option.
If the ‘cortisol face’ is caused by excessive stress, stress management measures can help. Regular physical activity, a healthy diet, and sufficient sleep are crucial factors in coping with stress and lowering cortisol levels, provided the increase is not due to an underlying illness.
