A Novel Tool in the Diagnosis and Follow-Up of (Cyclic) Cushing's Syndrome: Measurement of Long-Term Cortisol in Scalp Hair

Manenschijn, Laura; Koper, Jan W.; Akker, Erica L T van den; Heide, Loek J M de; Geerdink, E. A. M.; Jong, Frank H. de; Feelders, Richard A; Rossum, Elisabeth F.C. van

doi:10.1210/jc.2012-1852

Cited by 105 publications

(106 citation statements)

References 13 publications

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“…For example, HCC has been validated in conditions known to be associated with altered corstiol secretion, such as Cushing Syndrome (Manenschijn et al, 2012;Thomson et al, 2010) and pregnancy (Kirschbaum et al, 2009;Steptoe et al, 2003); HCC appears higher in chronically stressed dementia caregivers who report depressive symptoms , and has been linked with cardiovascular disease (Manenschijn et al, 2013). In the general population, in the absence of such manifest (or developing) conditions, HCC could still provide a useful biomarker of stress, but its association with perceived stress is perhaps not a useful means of validation.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence is accumulating for the potential application of HCC in clinical and epidemiological studies (Wester and van Rossum, 2015;Wosu et al, 2013) and various relationships have been demonstrated between HCC and, for example, Cushing's Syndrome (Manenschijn et al, 2012), cardiovascular disease (Manenschijn et al, 2013), depression and mood disorders (Dettenborn et al, 2012b), and anxiety (Steudte et al, 2011). However, the association between HCC and subjectively measured stress remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Hair cortisol and self-reported stress in healthy, working adults

Gidlow

Randall²,

Gillman

et al. 2016

Psychoneuroendocrinology

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Chronic stress can be important in the pathology of chronic disease. Hair cortisol concentrations (HCC) are proposed to reflect long term cortisol secretion from exposure to stress. To date, inconsistencies in the relationship between HCC and self-reported stress have been attributed to variation and limitations of perceived stress measurement. We report data from employees of two large public sector worksites (n=132). Socio-demographic, health, lifestyle, Perceived Stress Scale (PSS), and work-related Effort Reward Imbalance (ERI) were collected at baseline. Participants were asked to respond to mobile text messages every two days, asking them to report current stress levels (Ecological Momentary Assessment, EMA), and mean stress was determined overall, during work hours, and out of work hours. At 12 weeks, the Appraisal of Stressful Life Events Scale (ALES) was completed and 3cm scalp hair samples were taken, from which HCC was determined (to reflect cortisol secretion over the past 12 weeks). Mean response rate to EMA was 81.9±14.9%. Associations between HCC and the various self-reported stress measures (adjusted for use of hair dye) were weak (all <.3). We observed significant associations with HCC for EMA measured stress responses received out of work hours (ρ=.196, p=.013) and ALES Loss subscale (ρ=.241, p=.003), and two individual items from ERI (relating to future work situation). In regression analysis adjusting for other possible confounders, only the HCC-ALES Loss association remained significant (p=.011). Overall, our study confirms that EMA provides a useful measurement tool that can gather perceived stress measures in real-time. But, there was no relationship between self-reported stress collected in this way, and HCC. The modest association between HCC and stress appraisal does however, provide some evidence for the role of cognitive processes in chronic stress.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hair cortisol and self-reported stress in healthy, working adults

Gidlow

Randall²,

Gillman

et al. 2016

Psychoneuroendocrinology

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“…The measurements of hair cortisol have been shown to be a sensitive biomarker of Cushing syndrome (10,14), as well as stress associated with chronic pain, myocardial infarction, congestive heat failure, and numerous other conditions (8). Changes in hair cortisol can be detected in hair within 2 mo of the corresponding changes in plasma cortisol.…”

Section: Resultsmentioning

confidence: 99%

Hair cortisol as a novel biomarker of HPA suppression by inhaled corticosteroids in children

et al. 2015

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Background: Asthma is the most common chronic condition in childhood, and the recommended pharmacotherapy for long-term control includes the use of inhaled corticosteroids (ICS). ICS were designed to act at the site of inflammation in the lung, thus decreasing systemic absorption and reducing the risk of adverse effects associated with corticosteroid use (e.g., HPA suppression and its consequent effects). Available data show that measurement of hair cortisol successfully reflects endogenous cortisol levels. We sought to examine whether hair cortisol measurements can be used to identify HPA suppression surrounding ICS therapy in children with asthma. Methods: Hair samples were collected from the vertex posterior region of the head of 18 asthmatic children. We compared their hair cortisol concentration during ICS use with the concentration prior to ICS use. results: During ICS therapy, median hair cortisol levels were twofold lower compared with the period of no ICS use (median 89.8 ng/g vs. 198.2 ng/g, P = 0.0015). conclusion: Hair cortisol is an effective biomarker of the HPA suppression associated with ICS therapy and can be a sensitive tool for determining systemic effects of ICS use and monitoring adherence. Future research is needed to characterize the effect of untreated asthma on hair cortisol concentrations, if any.

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“…Hair cortisol levels are known to be significantly elevated in patients with CS over those in the general population (sensitivity 86%, specificity 98%). 6 The advantage of using hair cortisol levels is that they can pro vide data over the previous several months in one analyti cal setting. In one study, hair samples were obtained from one lock of hair each from healthy controls, patients with CS, and patients with cyclic CS.…”

Section: Discussionmentioning

confidence: 99%

“…In one study, hair samples were obtained from one lock of hair each from healthy controls, patients with CS, and patients with cyclic CS. 6 Cortisol measurements at 1cm intervals correspond to monthly time frames. In patients with cyclic CS, hair cortisol-level fluctuations were found to correlate with the clinical course of CS.…”

Section: Discussionmentioning

confidence: 99%

Cyclic Cushing's disease with misleading inferior petrosal sinus sampling results during a trough phase

Bonert

Bose

Carmichael

2015

FOC

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Diagnosing Cushing's syndrome is challenging and is further hampered when investigations are performed in a patient with cyclic Cushing's syndrome. A subset of patients with Cushing's syndrome exhibit periods of abnormal cortisol secretion with interspersed normal secretion. Patients can have periods of clinical improvement during these quiescent phases or remain symptomatic. Initial diagnostic testing can be challenging because of the unpredictable durations of the peak and trough phases, and it is especially challenging when the diagnosis of cyclic Cushing's syndrome has not yet been determined. Here, the authors present the case of a patient with Cushing's disease with a pathology-proven adrenocorticotropic hormone (ACTH)–secreting pituitary adenoma and whose initial inferior petrosal sinus sampling (IPSS) results were deemed indeterminate; further studies elucidated the diagnosis of cyclic Cushing's syndrome. Repeat IPSS was diagnostic of a central source for ACTH secretion, and the patient was treated successfully with transsphenoidal resection. Literature concerning the diagnosis and management of cyclic Cushing's syndrome is also reviewed.

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A Novel Tool in the Diagnosis and Follow-Up of (Cyclic) Cushing's Syndrome: Measurement of Long-Term Cortisol in Scalp Hair

Abstract: Hair samples can provide a historical timeline that corresponds with clinical course in patients with (cyclic) CS. This new diagnostic tool can contribute significantly to early recognition of patients suffering from cyclic CS.

Cited by 105 publications

References 13 publications

Hair cortisol and self-reported stress in healthy, working adults

Hair cortisol and self-reported stress in healthy, working adults

Hair cortisol as a novel biomarker of HPA suppression by inhaled corticosteroids in children

Cyclic Cushing's disease with misleading inferior petrosal sinus sampling results during a trough phase

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