The impact of night shift work on cortisol secretion
DOI:
https://doi.org/10.12775/QS.2026.50.68003Keywords
night-shift work, cortisol circadian rhythm, cortisol, corisol awakening response, CAR, hypothalamic-pituitary-adrenal axis, HPA, metabolic dysregulation, cardiovascular diseases, sleep debtAbstract
Night-shift work poses significant challenges to human health, largely through disruption of circadian rhythms and dysregulation of cortisol secretion. Cortisol, a key glucocorticoid, regulates metabolism, immune function, and stress responses, following a distinct diurnal pattern characterized by a morning peak and gradual decline throughout the day. Night-shift work alters this rhythm, often causing blunted cortisol awakening responses, elevated evening cortisol levels, and overall circadian misalignment. These hormonal disturbances contribute to a spectrum of adverse health outcomes, including metabolic dysregulation (insulin resistance, hyperglycemia, obesity), cardiovascular disorders (hypertension, atherosclerosis, increased cardiovascular mortality), impaired cognitive function, and heightened susceptibility to mood disorders such as anxiety and depression. Sleep disruption further exacerbates cortisol dysregulation and associated physiological and psychological effects. Understanding the mechanisms linking night-shift work to cortisol rhythm alterations is crucial for developing interventions aimed at mitigating health risks in shift-working populations. This review synthesizes current evidence on the effects of night-shift work on cortisol dynamics and the broader implications for metabolic, cardiovascular, and mental health.
References
Costa G. The impact of shift and night work on health. Appl Ergon. 1996;27(1):9-16. doi:10.1016/0003-6870(95)00047-X.
Andreadi A, Andreadi S, Todaro F, Ippoliti L, Bellia A, Magrini A, Chrousos GP, Lauro D. Modified Cortisol Circadian Rhythm: The Hidden Toll of Night-Shift Work. Int J Mol Sci. 2025;26(5):2090. doi:10.3390/ijms26052090.
Nicolson NA. Measurement of cortisol. In: Handbook of Physiological Research Methods in Health Psychology. 2008;1:37–74.
El-Farhan N, Rees DA, Evans C. Measuring cortisol in serum, urine and saliva – are our assays good enough? Ann Clin Biochem. 2017;54(3):308–322. doi:10.1177/0004563216687335.
Angelousi A, Margioris AN, Tsatsanis C. ACTH Action on the Adrenals. In: Feingold KR, Ahmed SF, Anawalt B, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000‑.
Fries E, Dettenborn L, Kirschbaum C. The cortisol awakening response (CAR): Facts and future directions. Int J Psychophysiol. 2009;72(1):67‑73. doi:10.1016/j.ijpsycho.2008.03.014.
Touitou Y, Haus E. Alterations with aging of the endocrine and neuroendocrine circadian system in humans. Chronobiol Int. 2000;17(3):369‑90.
Juliana N, Maluin SM, Effendy NM, Abu IF, Azmani S. Cortisol detection methods and the hormone’s role in evaluating circadian rhythm disruption. Int J Mol Sci. 2025;26(18):9141. doi:10.3390/ijms26189141.
Kervezee L, Kosmadopoulos A, Boivin DB. Metabolic and cardiovascular consequences of shift work: the role of circadian disruption and sleep disturbances. Eur J Neurosci. 2018;48(12): 4238–4250. doi:10.1111/ejn.14216.
Kecklund G, Axelsson J. Health consequences of shift work and insufficient sleep. BMJ. 2016;355:i5210. doi:10.1136/bmj.i5210.
Chrousos GP. Stress and disorders of the stress system. Nat Rev Endocrinol. 2009;5:374–81. doi:10.1038/nrendo.2009.106.
Physiology, Cortisol. In: NCBI Bookshelf. 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538239/
Jones C, Gwenin C. Cortisol level dysregulation and its prevalence—Is it nature's alarm clock? Physiol Rep. 2020;8(24):e14644. doi:10.14814/phy2.14644.
Dinneen SF, Alzaid A, Miles JM, Rizza RA. Effects of the normal overnight rise in cortisol on carbohydrate and fat metabolism in normal humans. J Clin Invest. 1993;92(5):2283–2290.
Andrews RC, Walker BR. Glucocorticoids and insulin resistance: old hormones, new targets. Clin Sci (Lond). 1999;96(5):513–523.
Lee MJ, Pramyothin P, Karastergiou K, Fried SK. Deconstructing the roles of glucocorticoids in adipose tissue biology and the development of central obesity. Biochim Biophys Acta. 2014;1842(3):473–481.
Lambillotte C, Gilon P, Henquin JC. Direct glucocorticoid inhibition of insulin secretion. J Clin Invest. 1997;99(3):414–423.
Boden G, et al. Cushing syndrome, hypercortisolism, and glucose homeostasis: a review. Diabetes. 2025;74(12):2168–2182.
Newell-Price J, Bertagna X, Grossman AB, Nieman LK. Cushing's syndrome. Lancet. 2006;367:1605–1617.
Terzolo M, Pia A, Reimondo G, et al. Subclinical hypercortisolism in adrenal incidentalomas: clinical and biochemical features. J Clin Endocrinol Metab. 2002;87:1301–1307.
Nieman LK, Biller BMK, Findling JW, et al. Treatment of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100:2807–2831.
Pecori Giraldi F, Ambrosi B, Cavagnini F. Epidemiology of Cushing’s syndrome. Endocrinol Metab Clin North Am. 2002;31:1–16.
Bancos I, et al. Cardiovascular risk and mortality in patients with active and treated hypercortisolism. Gland Surg. 2020;9(1):43–58.
Kudielka BM, Kirschbaum C. Awakening cortisol responses: Methodological issues and significance. Stress. 2003;6(1):1–14.
Pruessner JC, Wolf OT, Hellhammer DH, et al. Free cortisol levels after awakening: A reliable biological marker. Life Sci. 1997;61:2539–2549.
Huang XX, Jiang XM, Zheng QX, Chen XQ, et al. Relationship between cortisol secretion and psychiatric morbidity. Int J Mol Sci. 2025;26:2090.
Niu SF, Yang CC, Chu H, et al. The Effect of Shift Rotation on Employee Cortisol Profile, Sleep Quality, Fatigue, and Attention Level. J Nurs Res. 2011;19(1):23–32.
Åkerstedt T. Shift work and disturbed sleep/wakefulness. Occup Med (Lond). 2003;53:89–94.
Van Dongen HP, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: Dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep. 2003;26:117–126.
Czeisler CA, Buxton OM, Khalsa SB. The human circadian timing system and sleep-wake regulation. In: Kryger MH, Roth T, Dement WC, editors. Principles and Practice of Sleep Medicine. 6th ed. Philadelphia: Elsevier; 2017. p. 362–379.
Wright KP Jr, Bogan RK, Wyatt JK. Shift work and the assessment and management of shift work disorder (SWD). Sleep Med Rev. 2013;17:41–54.
Folkard S, Tucker P. Shift work, safety and productivity. Occup Med (Lond). 2003;53:95–101.
References:
Costa G. The impact of shift and night work on health. Appl Ergon. 1996;27(1):9-16. doi:10.1016/0003-6870(95)00047-X.
Andreadi A, Andreadi S, Todaro F, Ippoliti L, Bellia A, Magrini A, Chrousos GP, Lauro D. Modified Cortisol Circadian Rhythm: The Hidden Toll of Night-Shift Work. Int J Mol Sci. 2025;26(5):2090. doi:10.3390/ijms26052090.
Nicolson NA. Measurement of cortisol. In: Handbook of Physiological Research Methods in Health Psychology. 2008;1:37–74.
El-Farhan N, Rees DA, Evans C. Measuring cortisol in serum, urine and saliva – are our assays good enough? Ann Clin Biochem. 2017;54(3):308–322. doi:10.1177/0004563216687335.
Angelousi A, Margioris AN, Tsatsanis C. ACTH Action on the Adrenals. In: Feingold KR, Ahmed SF, Anawalt B, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000‑.
Fries E, Dettenborn L, Kirschbaum C. The cortisol awakening response (CAR): Facts and future directions. Int J Psychophysiol. 2009;72(1):67‑73. doi:10.1016/j.ijpsycho.2008.03.014.
Touitou Y, Haus E. Alterations with aging of the endocrine and neuroendocrine circadian system in humans. Chronobiol Int. 2000;17(3):369‑90.
Juliana N, Maluin SM, Effendy NM, Abu IF, Azmani S. Cortisol detection methods and the hormone’s role in evaluating circadian rhythm disruption. Int J Mol Sci. 2025;26(18):9141. doi:10.3390/ijms26189141.
Kervezee L, Kosmadopoulos A, Boivin DB. Metabolic and cardiovascular consequences of shift work: the role of circadian disruption and sleep disturbances. Eur J Neurosci. 2018;48(12): 4238–4250. doi:10.1111/ejn.14216.
Kecklund G, Axelsson J. Health consequences of shift work and insufficient sleep. BMJ. 2016;355:i5210. doi:10.1136/bmj.i5210.
Chrousos GP. Stress and disorders of the stress system. Nat Rev Endocrinol. 2009;5:374–81. doi:10.1038/nrendo.2009.106.
Physiology, Cortisol. In: NCBI Bookshelf. 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538239/
Jones C, Gwenin C. Cortisol level dysregulation and its prevalence—Is it nature's alarm clock? Physiol Rep. 2020;8(24):e14644. doi:10.14814/phy2.14644.
Dinneen SF, Alzaid A, Miles JM, Rizza RA. Effects of the normal overnight rise in cortisol on carbohydrate and fat metabolism in normal humans. J Clin Invest. 1993;92(5):2283–2290.
Andrews RC, Walker BR. Glucocorticoids and insulin resistance: old hormones, new targets. Clin Sci (Lond). 1999;96(5):513–523.
Lee MJ, Pramyothin P, Karastergiou K, Fried SK. Deconstructing the roles of glucocorticoids in adipose tissue biology and the development of central obesity. Biochim Biophys Acta. 2014;1842(3):473–481.
Lambillotte C, Gilon P, Henquin JC. Direct glucocorticoid inhibition of insulin secretion. J Clin Invest. 1997;99(3):414–423.
Boden G, et al. Cushing syndrome, hypercortisolism, and glucose homeostasis: a review. Diabetes. 2025;74(12):2168–2182.
Newell-Price J, Bertagna X, Grossman AB, Nieman LK. Cushing's syndrome. Lancet. 2006;367:1605–1617.
Terzolo M, Pia A, Reimondo G, et al. Subclinical hypercortisolism in adrenal incidentalomas: clinical and biochemical features. J Clin Endocrinol Metab. 2002;87:1301–1307.
Nieman LK, Biller BMK, Findling JW, et al. Treatment of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100:2807–2831.
Pecori Giraldi F, Ambrosi B, Cavagnini F. Epidemiology of Cushing’s syndrome. Endocrinol Metab Clin North Am. 2002;31:1–16.
Bancos I, et al. Cardiovascular risk and mortality in patients with active and treated hypercortisolism. Gland Surg. 2020;9(1):43–58.
Kudielka BM, Kirschbaum C. Awakening cortisol responses: Methodological issues and significance. Stress. 2003;6(1):1–14.
Pruessner JC, Wolf OT, Hellhammer DH, et al. Free cortisol levels after awakening: A reliable biological marker. Life Sci. 1997;61:2539–2549.
Huang XX, Jiang XM, Zheng QX, Chen XQ, et al. Relationship between cortisol secretion and psychiatric morbidity. Int J Mol Sci. 2025;26:2090.
Niu SF, Yang CC, Chu H, et al. The Effect of Shift Rotation on Employee Cortisol Profile, Sleep Quality, Fatigue, and Attention Level. J Nurs Res. 2011;19(1):23–32.
Åkerstedt T. Shift work and disturbed sleep/wakefulness. Occup Med (Lond). 2003;53:89–94.
Van Dongen HP, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: Dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep. 2003;26:117–126.
Czeisler CA, Buxton OM, Khalsa SB. The human circadian timing system and sleep-wake regulation. In: Kryger MH, Roth T, Dement WC, editors. Principles and Practice of Sleep Medicine. 6th ed. Philadelphia: Elsevier; 2017. p. 362–379.
Wright KP Jr, Bogan RK, Wyatt JK. Shift work and the assessment and management of shift work disorder (SWD). Sleep Med Rev. 2013;17:41–54.
Folkard S, Tucker P. Shift work, safety and productivity. Occup Med (Lond). 2003;53:95–101.
References:
Costa G. The impact of shift and night work on health. Appl Ergon. 1996;27(1):9-16. doi:10.1016/0003-6870(95)00047-X.
Andreadi A, Andreadi S, Todaro F, Ippoliti L, Bellia A, Magrini A, Chrousos GP, Lauro D. Modified Cortisol Circadian Rhythm: The Hidden Toll of Night-Shift Work. Int J Mol Sci. 2025;26(5):2090. doi:10.3390/ijms26052090.
Nicolson NA. Measurement of cortisol. In: Handbook of Physiological Research Methods in Health Psychology. 2008;1:37–74.
El-Farhan N, Rees DA, Evans C. Measuring cortisol in serum, urine and saliva – are our assays good enough? Ann Clin Biochem. 2017;54(3):308–322. doi:10.1177/0004563216687335.
Angelousi A, Margioris AN, Tsatsanis C. ACTH Action on the Adrenals. In: Feingold KR, Ahmed SF, Anawalt B, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000‑.
Fries E, Dettenborn L, Kirschbaum C. The cortisol awakening response (CAR): Facts and future directions. Int J Psychophysiol. 2009;72(1):67‑73. doi:10.1016/j.ijpsycho.2008.03.014.
Touitou Y, Haus E. Alterations with aging of the endocrine and neuroendocrine circadian system in humans. Chronobiol Int. 2000;17(3):369‑90.
Juliana N, Maluin SM, Effendy NM, Abu IF, Azmani S. Cortisol detection methods and the hormone’s role in evaluating circadian rhythm disruption. Int J Mol Sci. 2025;26(18):9141. doi:10.3390/ijms26189141.
Kervezee L, Kosmadopoulos A, Boivin DB. Metabolic and cardiovascular consequences of shift work: the role of circadian disruption and sleep disturbances. Eur J Neurosci. 2018;48(12): 4238–4250. doi:10.1111/ejn.14216.
Kecklund G, Axelsson J. Health consequences of shift work and insufficient sleep. BMJ. 2016;355:i5210. doi:10.1136/bmj.i5210.
Chrousos GP. Stress and disorders of the stress system. Nat Rev Endocrinol. 2009;5:374–81. doi:10.1038/nrendo.2009.106.
Physiology, Cortisol. In: NCBI Bookshelf. 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538239/
Jones C, Gwenin C. Cortisol level dysregulation and its prevalence—Is it nature's alarm clock? Physiol Rep. 2020;8(24):e14644. doi:10.14814/phy2.14644.
Dinneen SF, Alzaid A, Miles JM, Rizza RA. Effects of the normal overnight rise in cortisol on carbohydrate and fat metabolism in normal humans. J Clin Invest. 1993;92(5):2283–2290.
Andrews RC, Walker BR. Glucocorticoids and insulin resistance: old hormones, new targets. Clin Sci (Lond). 1999;96(5):513–523.
Lee MJ, Pramyothin P, Karastergiou K, Fried SK. Deconstructing the roles of glucocorticoids in adipose tissue biology and the development of central obesity. Biochim Biophys Acta. 2014;1842(3):473–481.
Lambillotte C, Gilon P, Henquin JC. Direct glucocorticoid inhibition of insulin secretion. J Clin Invest. 1997;99(3):414–423.
Boden G, et al. Cushing syndrome, hypercortisolism, and glucose homeostasis: a review. Diabetes. 2025;74(12):2168–2182.
Newell-Price J, Bertagna X, Grossman AB, Nieman LK. Cushing's syndrome. Lancet. 2006;367:1605–1617.
Terzolo M, Pia A, Reimondo G, et al. Subclinical hypercortisolism in adrenal incidentalomas: clinical and biochemical features. J Clin Endocrinol Metab. 2002;87:1301–1307.
Nieman LK, Biller BMK, Findling JW, et al. Treatment of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100:2807–2831.
Pecori Giraldi F, Ambrosi B, Cavagnini F. Epidemiology of Cushing’s syndrome. Endocrinol Metab Clin North Am. 2002;31:1–16.
Bancos I, et al. Cardiovascular risk and mortality in patients with active and treated hypercortisolism. Gland Surg. 2020;9(1):43–58.
Kudielka BM, Kirschbaum C. Awakening cortisol responses: Methodological issues and significance. Stress. 2003;6(1):1–14.
Pruessner JC, Wolf OT, Hellhammer DH, et al. Free cortisol levels after awakening: A reliable biological marker. Life Sci. 1997;61:2539–2549.
Huang XX, Jiang XM, Zheng QX, Chen XQ, et al. Relationship between cortisol secretion and psychiatric morbidity. Int J Mol Sci. 2025;26:2090.
Niu SF, Yang CC, Chu H, et al. The Effect of Shift Rotation on Employee Cortisol Profile, Sleep Quality, Fatigue, and Attention Level. J Nurs Res. 2011;19(1):23–32.
Åkerstedt T. Shift work and disturbed sleep/wakefulness. Occup Med (Lond). 2003;53:89–94.
Van Dongen HP, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: Dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep. 2003;26:117–126.
Czeisler CA, Buxton OM, Khalsa SB. The human circadian timing system and sleep-wake regulation. In: Kryger MH, Roth T, Dement WC, editors. Principles and Practice of Sleep Medicine. 6th ed. Philadelphia: Elsevier; 2017. p. 362–379.
Wright KP Jr, Bogan RK, Wyatt JK. Shift work and the assessment and management of shift work disorder (SWD). Sleep Med Rev. 2013;17:41–54.
Folkard S, Tucker P. Shift work, safety and productivity. Occup Med (Lond). 2003;53:95–101.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Aleksandra Strawińska, Michał Karol , Kamila Kosecka, Jan Borowicz, Bartosz Górecki , Kinga Kloch , Patryk Romaniuk, Mariia-Khrystyna Lohin, Małgorzata Bednarczyk
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 7
Number of citations: 0
