Hair cortisol in the evaluation of Cushing syndrome
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ORIGINAL ARTICLE
Hair cortisol in the evaluation of Cushing syndrome Aaron Hodes1,2 Maya B. Lodish1 Amit Tirosh1,3 Jerrold Meyer4 Elena Belyavskaya1 Charalampos Lyssikatos1 Kendra Rosenberg4 Andrew Demidowich1 Jeremy Swan1 Nichole Jonas1 Constantine A. Stratakis1 Mihail Zilbermint1,5,6 ●
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Received: 26 September 2016 / Accepted: 6 January 2017 © Springer Science+Business Media New York 2017
Abstract Purpose Hair cortisol evaluation has been used to help detect patients with suspected Cushing syndrome. Our goal was to correlate segmental hair cortisol with biochemical testing in patients with Cushing syndrome and controls. This study was a prospective analysis of hair cortisol in confirmed Cushing syndrome cases over 16 months. Methods Thirty-six subjects (26.5 ± 18.9 years, 75% female, and 75% Caucasian) were analyzed by diurnal serum cortisol, 24 h urinary free cortisol corrected for body surface area (UFC/BSA), and 24 h urinary 17hydroxysteroids corrected for creatinine (17OHS/Cr).
Electronic supplementary material The online version of this article (doi:10.1007/s12020-017-1231-7) contains supplementary material, which is available to authorized users. Aaron Hodes, Maya B. Lodish, Constantine A. Stratakis, and Mihail Zilbermint have contributed equally to this manuscript. * Mihail Zilbermint [email protected] 1
Keywords Hair cortisol Hair Cortisol Cushing syndrome Cushing disease Children Adolescence ●
Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
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Albert Einstein College of Medicine, Department of Radiology, Jacobi Medical Center, Bronx, NY 10461, USA
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Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Thirty patients were diagnosed with Cushing syndrome, and six were defined as controls. 3-cm hair samples nearest to the scalp, cut into 1-cm segments (proximal, medial, and distal), were analyzed for cortisol by enzyme immunoassay and measured as pmol cortisol/g dry hair. Hair cortisol levels were compared with laboratory testing done within previous 2 months of the evaluation. Results Proximal hair cortisol was higher in Cushing syndrome patients (266.6 ± 738.4 pmol/g) than control patients (38.9 ± 25.3 pmol/g) (p = 0.003). Proximal hair cortisol was highest of all segments in 25/36 (69%) patients. Among all subjects, proximal hair cortisol was strongly correlated with UFC/BSA (r = 0.5, p = 0.005), midnight serum cortisol (r = 0.4, p = 0.03), and 17OHS/Cr, which trended towards significance (r = 0.3, p = 0.06). Conclusions Among the three examined hair segments, proximal hair contained the highest cortisol levels and correlated the most with the initial biochemical tests for Cushing syndrome in our study. Further studies are needed to validate proximal hair cortisol in the diagnostic workup for Cushing syndrome.
Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA 01003, USA
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