Dr. Amy Nett: This is a great question and I think Chris talked about some of the complexity of cortisol signaling in the presentation, so I think that there can be at least two answers to this. One is I would say first of all cortisol has biphasic regulation of inflammation. So what that basically means is that an intermediate or moderate cortisol level is going to augment inflammation, but high cortisol is neither pro-inflammatory or anti-inflammatory. So high levels of cortisol are not necessarily going to affect inflammation.
The other things to remember, again from the presentations we’ve been seeing this week and in the past couple weeks, you can have high cortisol at the local tissue level and low in the blood or urine or vice versa. So while you might be measuring really high levels of free cortisol, it could actually be that there’s low cortisol at the local tissue level. So again, remember that we’re doing the best we can in terms of the testing that we have available and trying to understand what’s going on with the cholesterol, but remember there are so many nuances in terms of the cholesterol binding, cortisol receptor, up regulation, down regulation, and metabolism. So while we can get total cortisol levels, we don’t always know what things look like at that local tissue level.