Elevated content of cortisol in hair of patients with severe chronic pain: A novel biomarker for stress

Abstract

Hair analysis has been used to reflect long-term systemic exposure to exogenous drugs and toxins. Several studies have demonstrated the feasibility of measuring endogenous steroid hormones, e.g. cortisol, in hair. Recently, a study in macaques showed a significant increase in hair cortisol levels induced by stress. We explored whether hair cortisol levels may be used as a biomarker for long-term stress in humans. Patients with severe chronic pain, aged 18 years or older, receiving opioid treatment for at least one year were recruited. Controls were non-obese (body mass index, BMI < 30 mg/kg(2)) adults. The Perceived Stress Scale (PSS) questionnaire was used to assess perceived stress over the last 4 weeks. A hair sample was obtained from the vertex posterior. Cortisol was measured using an enzyme-linked immunosorbent assay. We included fifteen patients (nine females and six males) and 39 non-obese control subjects (20 females, 19 males). PSS scores (median and range) were significantly higher in chronic pain patients (24: 12-28) than in controls (12: 3-31)(P < 0.001). Hair cortisol contents (median and range) were significantly greater in chronic pain patients (83.1: 33.0-205 g/mg) than in controls (46.1: 27.2-200 pg/mg) (P < 0.01). We conclude that hair cortisol contents are increased in patients with major chronic stress. Measurement of cortisol levels in hair constitutes a novel biomarker of prolonged stress.

Hair cortisol in drug-naïve first-episode individuals with psychosis

“…34 Moreover, we were also careful to only include patients without other psychiatric comorbidities such as depression and PTSD, which induce abnormalities in HPA axis. 3,14,15 Therefore, we were able to demonstrate HPA axis abnormalities in the absence of major confounders, and these findings strengthen the idea that the stress response system is independently involved in the pathophysiology of psychotic illness. This is the first study to assess long-term HPA axis function through hair cortisol analysis.…”

“…Hair steroid extraction was performed using the protocol described by Van Uum et al 15 adapted by our laboratory. 14 At least 10 mg of powdered hair per 1-cm section were weighed and separated into different glass vials, to which 1 mL of 50 o C methanol was added.…”

“…3,12 In the last decade, HCC has been studied in many disorders, such as posttraumatic stress disorder, 13 and drug abstinence, 14 among other conditions. 3,15 Nevertheless, HCC has never been investigated in individuals with first episodes of psychosis.…”

Increased cortisol concentrations in hair of severely traumatized Ugandan individuals with PTSD

“…Furthermore, several studies have now provided support for the potential of hair cortisol levels to serve as a biological marker of chronic stress (e.g. Kalra et al, 2007;Van Uum et al, 2008;Dettenborn et al, 2010). The aim of the present study was to utilize hair cortisol analysis to obtain an index of cumulative cortisol secretion in PTSD patients and traumatized controls under naturalistic living circumstances.…”

DIAGNOSIS OF ENDOCRINE DISEASE: Differentiation of pathologic/neoplastic hypercortisolism (Cushing’s syndrome) from physiologic/non-neoplastic hypercortisolism (formerly known as pseudo-Cushing’s syndrome)

“…As a result, patients who use significant amounts of narcotics may have confusing biochemical findings related to HPA axis function. This rollercoaster effect on pituitary-adrenal function in opioid-treated patients may actually cause some evidence of overall cortisol excess as measured by increases in hair cortisol concentration (75).…”