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Hair cortisol in the evaluation of Cushing syndrome

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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 17-hydroxysteroids corrected for creatinine (17OHS/Cr). 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.

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Acknowledgments

This research was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), clinical trials NCT00005927 (Clinical and Molecular Analysis of ACTH-Independent Steroid Hormone Production in Adrenocortical Tissue) and NCT00001595 (A Clinical and Genetic Investigation of Pituitary Tumors and Related Hypothalmic Disorders). We thank the nurses of the NIH Clinical Research Center for assistance with hair cortisol collection. We thank Diane Cooper, MSLS, NIH Library, for assistance in writing this manuscript.

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    1. Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA

      Aaron Hodes, Maya B. Lodish, Amit Tirosh, Elena Belyavskaya, Charalampos Lyssikatos, Andrew Demidowich, Jeremy Swan, Nichole Jonas, Constantine A. Stratakis & Mihail Zilbermint

    2. Albert Einstein College of Medicine, Department of Radiology, Jacobi Medical Center, Bronx, NY, 10461, USA

      Aaron Hodes

    3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel

      Amit Tirosh

    4. Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, 01003, USA

      Jerrold Meyer & Kendra Rosenberg

    5. Johns Hopkins University School of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Baltimore, MD, 21287, USA

      Mihail Zilbermint

    6. Suburban Hospital, Bethesda, MD, 20814, USA

      Mihail Zilbermint

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    Aaron Hodes, Maya B. Lodish, Constantine A. Stratakis, and Mihail Zilbermint have contributed equally to this manuscript.

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    Hodes, A., Lodish, M.B., Tirosh, A. et al. Hair cortisol in the evaluation of Cushing syndrome. Endocrine 56, 164–174 (2017). https://doi.org/10.1007/s12020-017-1231-7

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