Advances in Clinical and Experimental Medicine
2019, vol. 28, nr 3, March, p. 369–373
Publication type: original article
Hair cortisol concentration in a population without hypothalamic–pituitary–adrenal axis disorders
1 Department of Endocrinology and Internal Medicine, Medical University of Gdańsk, Poland
2 Department of Clinical Nutrition and Dietetics, Medical University of Gdańsk, Poland
Background. Measuring hair cortisol seems to be a good alternative to laboratory tests used thus far in routine endocrine diagnostics, primarily because it is independent of the circadian rhythm of cortisol. Due to the average hair growth of 1 cm per month, the results are related to the average blood cortisol levels over the previous weeks, months or years (depending on the length of the hair sample).
Objectives. The aim of this study is an attempt to apply hair cortisol concentration (HCC) measurements to clinical endocrine diagnostics, based on reference cortisol concentrations in the blood in a population without disorders of the hypothalamic–pituitary–adrenal axis (HPA).
Material and Methods. In the final selection process, 44 patients were enrolled in the study, all with negative interviews regarding disorders of the HPA and with reference levels of cortisol concentration obtained in routine laboratory tests. In the pre-analytic phase, we used 1 cm proximal hair strands cut from the posterior vertex area of the head, followed by the incubation of a 20 mg hair sample in methanol. The final cortisol measurement was done using an enzyme-linked immunosorbent assay (ELISA).
Results. The results of HCC ranged from 2 pg/mg up to 51.63 pg/mg. The diurnal decrease in cortisol levels was significantly lower in females than in males (p = 0.031), but we do not consider that difference to be clinically significant. The difference in the HCC between males and females was not statistically significant (p = 0.767). The linear regression coefficient for age was not statistically significant (p = 0.847). Neither the regression coefficients for gender nor the gender and age interactions were statistically significant (p = 0.815).
Conclusion. Hair cortisol concentration measurement, unlike other endocrinological tests, gives information about the cortisol concentration in the long-term perspective. The results obtained in this study may be used as a reference for further research aimed at determining normal values of HCC.
measurements, validity, hair cortisol, reference
- Isidori AM, Kaltsas GA, Pozza C, et al. The ectopic adrenocorticotropin syndrome: Clinical features, diagnosis, management, and long-term follow-up. J Clin Endocrinol Metab. 2006;91(2):371–377.
- Nieman LK, Biller BM, Findling JW, et al. The diagnosis of Cushing’s syndrome: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93(5):1526–1540.
- Cieszyński L, Berendt-Obołonczyk M, Szulc M, Sworczak K. Cushing’s syndrome due to ectopic ACTH secretion. Endokrynol Pol. 2016;67(4):458–464.
- Stalder T, Kirschbaum C. Analysis of cortisol in hair: State of the art and future directions. Brain Behav Immun. 2012;26(7):1019–1029.
- D’Anna-Hernandez KL, Ross RG, Natvig CL, et al. Hair cortisol levels as a retrospective marker of hypothalamic–pituitary axis activity throughout pregnancy: Comparison to salivary cortisol. Physiol Behav. 2011;104(2):348–353.
- Vanaelst B, Michels N, De Vriendt T, et al. Cortisone in hair of elementary school girls and its relationship with childhood stress. Eur J Pediatr. 2013;172(6):843–846.
- Kamps AW, Molenmaker M, Kemperman R, et al. Children with asthma have significantly lower long-term cortisol levels in their scalp hair than healthy children. Acta Paediatr. 2014;103(9):957–961.
- Kirschbaum C, Tietze A, Skoluda N, et al. Hair as a retrospective calendar of cortisol production: Increased cortisol incorporation into hair in the third trimester of pregnancy. Psychoneuroendocrinology. 2009;34(1):32–37.
- Stalder T, Kirschbaum C, Heinze K, et al. Use of hair cortisol analysis to detect hypercortisolism during active drinking phases in alcohol-dependent individuals. Biol Psychol. 2010;85(3):357–360.
- Veldhorst MA, Noppe G, Jongejan MH, et al. Increased scalp hair cortisol concentrations in obese children. J Clin Endocrinol Metab. 2014;99(1):285–290.
- Dettenborn L, Muhtz C, Skoluda N, et al. Introducing a novel method to assess cumulative steroid concentrations: Increased hair cortisol concentrations over 6 months in medicated patients with depression. Stress. 2012;15(3):348–353.
- Vives AH, De Angel V, Papadopoulos A, et al. The relationship between cortisol, stress and psychiatric illness: New insights using hair analysis. J Psychiatr Res. 2015;70:38–49.
- Thomson S, Koren G, Fraser LA, et al. Hair analysis provides a historical record of cortisol levels in Cushing’s syndrome. Exp Clin Endocrinol Diabetes. 2010;118(2):133–138.
- Staufenbiel SM, Andela CD, Manenschijn L, et al. Increased hair cortisol concentrations and BMI in patients with pituitary-adrenal disease on hydrocortisone replacement. J Clin Endocrinol Metab. 2015;100(6):2456–2462.
- Manenschijn L, Koper JW, van den Akker ELT, et al. A novel tool in the diagnosis and follow-up of (cyclic) Cushing’s syndrome: Measurement of long-term cortisol in scalp hair. J Clin Endocrinol Metab. 2012;97(10):E1836–E1843.
- Gow R, Koren G, Rieder M, et al. Hair cortisol content in patients with adrenal insufficiency on hydrocortisone replacement therapy. Clin Endocrinol (Oxf). 2011;74(6):687–693.
- Wester VL, Reincke M, Koper JW, et al. Scalp hair cortisol for diagnosis of Cushing’s syndrome. Eur J Endocrinol. 2017;176(6):695–703.
- Manenschijn L, Quinkler M, van Rossum EFC. Hair cortisol measurement in mitotane-treated adrenocortical cancer patients. Horm Metab Res. 2014;46(4):299–304.
- Noppe G, Rossum EFC, Vliegenthart J, et al. Elevated hair cortisol concentrations in children with adrenal insufficiency on hydrocortisone replacement therapy. Clin Endocrinol (Oxf). 2014;81(6):820–825.
- Hodes A, Lodish MB, Tirosh A, et al. Hair cortisol in the evaluation of Cushing syndrome. Endocrine. 2017;56(1):164–174.
- Wennig R. Potential problems with the interpretation of hair analysis results. Forensic Sci Int. 2000;107(1):5–12.
- Balíková M. Hair analysis for drug abuse. Plausibility of interpretation. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2005; 149(2):199–207.
- LeBeau MA, Montgomery MA, Brewer JD. The role of variations in growth rate and sample collection on interpreting results of segmental analyses of hair. Forensic Sci Int. 2011;210(1):110–116.
- Staufenbiel SM, Penninx BW, Rijke YB, et al. Determinants of hair cortisol and hair cortisone concentrations in adults. Psychoneuroendocrinology. 2015;60:182–194.
- Feller S, Vigl M, Bergmann MM, et al. Predictors of hair cortisol concentrations in older adults. Psychoneuroendocrinology. 2014;39:132–140.
- Stalder T, Steudte S, Miller R, et al. Intraindividual stability of hair cortisol concentrations. Psychoneuroendocrinology. 2012;37(5):602–610.
- Manenschijn L, Koper JW, Lamberts SW, et al. Evaluation of a method to measure long term cortisol levels. Steroids. 2011;76(10):1032–1036.
- Grass J, Kirschbaum C, Miller R, et al. Sweat-inducing physiological challenges do not result in acute changes in hair cortisol concentrations. Psychoneuroendocrinology. 2015;53:108–116.
- Wester VL, van der Wulp NR, Koper JW, et al. Hair cortisol and cortisone are decreased by natural sunlight. Psychoneuroendocrinology. 2016;72:94–96.
- Hoffman MC, Karban LV, Benitez P, et al. Chemical processing and shampooing impact cortisol measured in human hair. Clin Invest Med. 2014;37(4):E252–E257.
- Hamel AF, Meyer JS, Henchey E, et al. Effects of shampoo and water washing on hair cortisol concentrations. Clin Chim Acta. 2011;412(3): 382–385.
- Gow R, Thomson S, Rieder M, et al. An assessment of cortisol analysis in hair and its clinical applications. Forensic Sci Int. 2010;196(1):32–37.
- Gao W, Xie Q, Jin J, et al. HPLC-FLU detection of cortisol distribution in human hair. Clin Biochem. 2010;43(7):677–682.
- Noppe G, Rijke YB, Dorst K, et al. LC-MS/MS-based method for long-term steroid profiling in human scalp hair. Clin Endocrinol (Oxf). 2015; 83(2):162–166.
- Bévalot F, Gaillard Y, Lhermitte MA, et al. Analysis of corticosteroids in hair by liquid chromatography–electrospray ionization mass spectrometry. J Chromatogr B Biomed Sci Appl. 2000;740(2):227–236.
- Raul JS, Cirimele V, Ludes B, et al. Detection of physiological concentrations of cortisol and cortisone in human hair. Clin Biochem. 2004;37(12):1105–1111.
- Cirimele V, Kintz P, Dumestre V, et al. Identification of ten corticosteroids in human hair by liquid chromatography–ionspray mass spectrometry. Forensic Sci Int. 2000;107(1):381–388.
- Sauvé B, Koren G, Walsh G, et al. Measurement of cortisol in human hair as a biomarker of systemic exposure. Clin Invest Med. 2007;30(5):183–191.
- Tanada N, Kashimura S, Kageura M, et al. Utility of caffeine analysis for forensic hair discrimination. Nihon Hoigaku Zasshi. 1998;52:233–237.
- Slominski R, Rovnaghi CR, Anand KJ. Methodological considerations for hair cortisol measurements in children. Ther Drug Monit. 2015; 37(6):812–820.
- Wester VL, Rossum EF. Clinical applications of cortisol measurements in hair. Eur J Endocrinol. 2015;173(4):M1–M10.
- Russell E, Kirschbaum C, Laudenslager ML, et al. Toward standardization of hair cortisol measurement: Results of the first international interlaboratory round robin. Ther Drug Monit. 2015;37(1):71–75.