The body produces more cortisol when people are interrupted during work


ETH researchers have used an experiment in a simulated group office environment to show for the first time that the body produces more stress hormones when people are repeatedly interrupted at work.

And yet the subjects did not experience an equal rise in their consciously perceived sense of psychological stress.

According to the Job Stress Index 2020 compiled by Stiftung Gesundheitsförderung Schweiz, a Swiss health foundation, almost one-​third of the Swiss workforce experience work-​related stress. Should this stress become chronic, it can lead to states of exhaustion that have a negative impact on public health and carry a significant economic cost.

The goal: a digital early warning system

At the Mobiliar Lab for Analytics at ETH Zurich, an interdisciplinary team is working to pre-​empt such states of exhaustion by developing a digital early warning system that uses machine learning to detect stress in the workplace in real time.

“Our first step was to find out how to measure the effects of social pressure and interruptions – two of the most common causes of stress in the workplace,” says psychologist Jasmine Kerr. Kerr is driving the project forward together with mathematician Mara Nägelin and computer scientist Raphael Weibel.

The three doctoral students are all lead authors on a recent study, details of which appeared in the journal Psychoneuroendocrinology.

They used a university platform to recruit 90 participants, who agreed to take part in an experiment lasting just under two hours. To conduct their experiment, Kerr, Nägelin and Weibel transformed the Decision Science Laboratory at ETH Zurich into three group office environments.

Each workstation was equipped with a chair, a computer with monitor and kits for collecting samples of saliva.

Playing the parts of employees at a fictional insurance company, the participants were asked to perform typical office tasks, such as typing up information from hand-​written forms and arranging appointments with clients. While they did so, the researchers observed their psychobiological responses.

At a total of six points during the experiment, the participants rated their mood on questionnaires, while a portable ECG device continuously measured their heartbeat. The researchers used the saliva samples to measure the concentration of the stress hormone cortisol.

In line for a promotion

For their experiment, the researchers divided the participants into three groups and exposed each group to a different level of stress. All groups were given the same workload.

In the middle of the experiment, all participants were visited by two actors masquerading as representatives of the insurance company’s HR department. For participants in the control group, the actors staged a sales pitch dialogue, while in the two stress groups they pretended to be looking for the most suitable candidates for a promotion.

The difference between the two stress groups was that participants in the first group stopped work only to have samples of their saliva taken. But the participants in the second stress group had to contend with additional interruptions in the form of chat messages from their superiors urgently requesting information.

Almost twice the level of cortisol

Upon evaluation, the data indicated that asking participants to compete for a fictional promotion was enough to raise their heart rate and trigger the release of cortisol. “But participants in the second stress group released almost twice the level of cortisol as those in the first stress group,” Nägelin says.

Weibel adds: “Most research into workplace interruptions carried out to date focused only on their effect on performance and productivity. Our study shows for the first time that they also affect the level of cortisol a person releases, in other words they actually influence a person’s biological stress response.”

What surprised the researchers were participants’ subjective responses in terms of how they perceived psychological stress.

They observed that participants in the second stress group, who were interrupted by chat messages, reported being less stressed and in a better mood than the participants in the first stress group, who didn’t have these interruptions.

Interestingly, although the two groups rated the situation as equally challenging, the second group found it less threatening.

The researchers inferred that the release of cortisol triggered by the additional interruptions mobilised more physical resources, which in turn led to a better emotional and cognitive response to stress.

It is also possible that the interruptions distracted the participants from the impending social stress situation, meaning that they felt less threatened and thus less stressed.

Cortisol, though widely known as the body’s stress hormone, has a variety of effects on different functions throughout the body. It is the main glucocorticoid released from the zona fasciculata layer of the adrenal cortex. Both production and secretion of cortisol is regulated by the hypothalamus-pituitary-adrenal axis. Loss of regulation can lead to disorders of cortisol excess, such as Cushing Syndrome, or cortical insufficiency, such as Addison Disease.


Cortisol, a steroid hormone, is synthesized from cholesterol. It is synthesized in the zona fasciculata layer of the adrenal cortex. Adrenocorticotropic hormone (ACTH), released from the anterior pituitary, functions to increase LDL receptors and increase the activity of cholesterol desmolase, which converts cholesterol to pregnenolone and is the rate-limiting step of cortisol synthesis [1].

The majority of glucocorticoids circulate in an inactive form, bound to either corticosteroid binding globulin (CBG) or albumin [2]. The inactive form is converted to its active form by 11-beta-hydroxysteroid dehydrogenase 1 (11-beta-HSD1) in most tissues, while 11-beta-HSD2 inactivates cortisol back to cortisone in the kidney and pancreas [2].

Organ Systems Involved

Glucocorticoid receptors are present in almost all tissues in the body. Therefore, cortisol is able to affect nearly every organ system [3]:

  • Nervous
  • Immune
  • Cardiovascular
  • Respiratory
  • Reproductive
  • Musculoskeletal
  • Integumetary


Cortisol has many functions in the human body, such as mediating the stress response, regulating metabolism, the inflammatory response, and immune function [4].

Immune response: Glucocorticoids have a number of actions in the immune system. For example, they induce apoptosis of proinflammatory T cells, suppress B cell antibody production, and reduce neutrophil migration during inflammation [3].

Stress response: The human body is continually responding to internal and external stressors. The body processes the stressful information and elicits a response depending on the degree of threat. The body’s autonomic nervous system is broken down into the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS).

In times of stress, the SNS gets activated. The SNS is responsible for the fight or flight response, which causes a cascade of hormonal and physiological responses. The amygdala is responsible for processing fear, arousal, and emotional stimuli to determine the appropriate response.

If necessary, the amygdala sends a stress signal to the hypothalamus [5]. The hypothalamus subsequently activates the SNS, and the adrenal glands release a surge of catecholamines, such as epinephrine. This results in effects such as increased heart rate and respiratory rate. As the body continues to perceive the stimuli as a threat, the hypothalamus activates the HPA axis.

Cortisol is released from the adrenal cortex and allows the body to continue to stay on high alert. Acutely, cortisol’s catabolic mechanisms provide energy to the body [6].

Glucose homeostasis: Blood glucose levels drive key systemic and intracellular pathways. The presence of glucocorticoids, such as cortisol, increase the availability of blood glucose to the brain. Cortisol acts on the liver, muscle, adipose tissue, and the pancreas. In the liver, high cortisol levels increase gluconeogenesis and decrease glycogen synthesis [7].

Gluconeogenesis is a metabolic pathway that results in the production of glucose from glucogenic amino acids, lactate, or glycerol 3- phosphate found in triglycerides. Gluconeogenesis reverses glycolysis, a cytoplasmic pathway used to convert glucose into pyruvate molecules.

This pathway is used to release energy through substrate-level phosphorylation and oxidation reactions. Unlike glycolysis, gluconeogenesis becomes active when the body needs energy. Muscles have their own internal glycogen supply that allows them to respond to changes in ATP requirements rapidly.

In the presence of cortisol, muscle cells decrease glucose uptake and consumption and increase protein degradation; this supplies gluconeogenesis with glucogenic amino acids.[8] In adipose tissues, cortisol increases lipolysis. Lipolysis is a catabolic process that results in the release of glycerol and free fatty acids.

These free fatty acids can be used in B oxidation and as an energy source for other cells as they continue to produce glucose. Lastly, cortisol acts on the pancreas to decrease insulin and increase glucagon. Glucagon is a peptide hormone secreted by the pancreatic alpha cells to increase liver glycogenolysis, liver gluconeogenesis, liver ketogenesis, lipolysis, as well as decrease lipogenesis. Cortisol enhances the activity of glucagon, epinephrine, and other catecholamines.


The release of cortisol is under control of the hypothalamus-pituitary-adrenal (HPA) axis. Corticotropin releasing hormone (CRH) is released by the para-ventricular nucleus (PVN) of the hypothalamus [2]. It then acts on the anterior pituitary to release adrenocorticotropic hormone (ACTH), which subsequently acts on the adrenal cortex.

In a negative feedback loop, sufficient cortisol inhibits release of both ACTH and CRH. The HPA axis follows a circadian rhythm. Thus, cortisol levels will be high in the morning and low at night [2].

Steroid hormones, such as cortisol, are primary messengers. They can cross the cytoplasmic membrane because of their fat-soluble properties. Cell membranes are composed of phospholipid bilayers; these prevent fat-insoluble molecules from passing through.

Once cortisol passes through the cell membrane and enters into the cell, it binds to specific receptors in the cytoplasm. In the absence of cortisol, the glucocorticoid receptor binds to an Hsp90 chaperone protein in the cytosol. The binding of cortisol to the glucocorticoid receptor dissociates the Hsp90. The cortisol-receptor complex then enters the nucleus of the cell and affects gene transcription.

Related Testing

Salivary cortisol levels are thought to correlate with the levels of free cortisol in plasma and serum [6]. Late night measurement of salivary cortisol is used as an initial diagnostic test for Cushing syndrome, a syndrome of glucocorticoid excess [6]. As cortisol levels are supposed to be high in the morning, one of the initial diagnostic tests for Addison’s disease is to check early morning serum cortisol levels [9].

Clinical Significance
Cortisol levels are continuously monitored in the body to maintain homeostasis. Unregulated levels can be detrimental.

Hypercortisolism: Cushing’s syndrome occurs when the human body is exposed to high cortisol levels for an extended period of time. The different etiologies for Cushing’s syndrome can be categorized as ACTH-dependent or ACTH-independent. In the ACTH-dependent subtypes, there is an excess of ACTH due to either a pituitary tumor or an ectopic source, such as a neuroendocrine tumor [10].

In both cases, the overproduction of ACTH stimulates the adrenal gland to produce excess cortisol. In the ACTH-independent subtypes, there is an endogenous etiology and an exogenous etiology. The endogenous cause is usually due to a tumor on the adrenal gland, which leads to excess cortisol production.

The exogenous cause is due excessive oral or injectable corticosteroid use [10]. Oral corticosteroids, such as prednisone, increase the amount of cortisol in the body. They are prescribed to help alleviate symptoms associated with chronic inflammatory diseases, such as systemic erythematous lupus (SLE) and rheumatoid arthritis.

The symptoms of Cushing syndrome are dependent on how elevated the cortisol levels are. Common signs and symptoms of excess cortisol include weight gain (especially in the face and abdomen), fatty deposits between the shoulder blades, diabetes, hypertension, hirsutism in women, proximal muscle weakness, and osteoporosis [11].

The treatment for Cushing syndrome is dependent on the cause. The most common treatment is through surgical intervention. However, glucocorticoid-receptor antagonists are also an option when there are contraindications to surgery.

Hypocortisolism: Primary adrenal insufficiency, also known as Addison disease, is most commonly caused by autoimmune adrenalitis [9]. Other causes include malignancy, infection, or adrenal hemorrhage. Autoimmune adrenalitis results from the body attacking its adrenal cortex [12].

Secondary adrenal insufficiency is due to insufficient production of ACTH from the anterior pituitary gland. This can be caused by pituitary disease, but the most common cause is due to suppression of the HPA axis from chronic exogenous glucocorticoid use [13].

Tertiary adrenal insufficiency is due to a lack of CRH release from the hypothalamus. Symptoms of adrenal insufficiency include fatigue, weight loss, hypotension, and hyperpigmentation of the skin [14]. Since aldosterone will also be deficient, laboratory results will show hyperkalemia. Glucocorticoid replacement therapy, such as hydrocortisone, is required to treat the symptoms of hypocortisolism. It is important to remember to increase the dosage for acute stressors, such as illness and surgery to avoid adrenal crisis [14].


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Source: ETH Zurich


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