Hair cortisol content in patients with adrenal insufficiency on hydrocortisone replacement therapy

Gow, Rachel V.; Koren, Gideon; Rieder, Michael J.; Uum, Stan Van

doi:10.1111/j.1365-2265.2011.04001.x

Cited by 52 publications

(32 citation statements)

References 33 publications

(72 reference statements)

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“…Recently, its clinical application has expanded as a monitoring tool for drug therapy [14,15] or for biomarker studies for disease [16] and alcohol addiction [17]. Since anorectics have high abuse potential, their abuse can be proved by segmental hair analysis along with individual prescription records in forensic and clinical areas.…”

Section: Discussionmentioning

confidence: 99%

Development of a simultaneous analytical method for selected anorectics, methamphetamine, MDMA, and their metabolites in hair using LC-MS/MS to prove anorectics abuse

Lee

Kim

et al. 2012

Anal Bioanal Chem

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Owing to the tight control of methamphetamine, it is presumed that phentermine, an amphetamine-type anorectic, has recently been considered a supplement for methamphetamine abusers in Korea. In addition, the abuse of other anorectics obtained by inappropriate means has become a social issue. Hair is a useful specimen to prove chronic drug use. Therefore, an analytical method for the simultaneous detection of phentermine, phendimetrazine, amfepramone, fenfluramine, mazindol, methamphetamine, and 3,4-methylenedioxymethamphetamine (MDMA), as well as their metabolites, which covers the major amphetamines and anorectic agents in Korea, in hair was established and validated using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The drugs and their metabolites in hair were extracted using 1 % HCl in methanol and then filtered and analyzed by LC-MS/MS with electrospray ionization in positive mode. The validation results for selectivity, linearity, matrix effect, recovery, process efficiency, intra- and interassay precision and accuracy, and processed sample stability were satisfactory. The limits of detection ranged from 0.025 to 1 ng/10 mg hair and the limits of quantification were 0.25 ng/10 mg hair for every analyte except mazindol and phentermine, for which they were 10 ng/10 mg hair. The method was successfully applied for the segmental determination of selected anorectics, methamphetamine, MDMA, and their metabolites in hair from 39 drug suspects. Among the anorectics, phentermine and/or phendimetrazine were identified with or without methamphetamine in the hair samples. Closer supervision of the inappropriate use of anorectics is necessary. Also, hair analysis is useful for monitoring the abuse potential of unnoticed drugs.

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Section: Discussionmentioning

confidence: 99%

Development of a simultaneous analytical method for selected anorectics, methamphetamine, MDMA, and their metabolites in hair using LC-MS/MS to prove anorectics abuse

Lee

Kim

et al. 2012

Anal Bioanal Chem

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“…All studies reported higher mean HCC in hydrocortisone-treated patients compared to healthy individuals or non-AI controls. In the two studies performed in adult AI patients, (19,20), while in the other two studies, HCC correlated significantly with BMI but not with hydrocortisone dose (21,22). In the adrenocortical carcinoma patients, this can be explained by mitotane treatment, which alters the metabolism of hydrocortisone.…”

Section: Hydrocortisone Replacement Therapy Monitoringmentioning

confidence: 90%

“…Several published studies have investigated HCC in patients treated with hydrocortisone for AI. The studies included 132 adults with AI, 93 adults with AI, 54 children with AI and 15 adults who were treated with the adrenolytic drug mitotane for adrenocortical carcinoma (19,20,21,22). All studies reported higher mean HCC in hydrocortisone-treated patients compared to healthy individuals or non-AI controls.…”

Section: Hydrocortisone Replacement Therapy Monitoringmentioning

confidence: 99%

Clinical applications of cortisol measurements in hair

Wester

Rossum

2015

European Journal of Endocrinology

171

141

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Cortisol measurements in blood, saliva and urine are frequently used to examine the hypothalamus-pituitary-adrenal (HPA) axis in clinical practice and in research. However, cortisol levels are subject to variations due to acute stress, the diurnal rhythm and pulsatile secretion. Cortisol measurements in body fluids are not always a reflection of long-term cortisol exposure. The analysis of cortisol in scalp hair is a relatively novel method to measure cumulative cortisol exposure over months up to years. Over the past years, hair cortisol concentrations (HCC) have been examined in association with a large number of somatic and mental health conditions. HCC can be used to evaluate disturbances of the HPA axis, including Cushing's syndrome, and to evaluate hydrocortisone treatment. Using HCC, retrospective timelines of cortisol exposure can be created which can be of value in diagnosing cyclic hypercortisolism. HCC have also been shown to increase with psychological stressors, including major life events, as well as physical stressors, such as endurance exercise and shift work. Initial studies show that HCC may be increased in depression, but decreased in general anxiety disorder. In posttraumatic stress disorder, changes in HCC seem to be dependent on the type of traumatic experience and the time since traumatization. Increased hair cortisol is consistently linked to obesity, metabolic syndrome and cardiovascular disease. Potentially, HCC could form a future marker for cardiovascular risk stratification, as well as serve as a treatment target.

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“…Conversely, Thomson et al showed great variability in salivary cortisol in a crossover study of 27 patients being treated with hydrocortisone (oral or IV), and did not show a good correlation between plasma and saliva levels, making it difficult to employ in current practice [51]; • cortisol in hair: hair growth (1 cm per month) and the correlation between cortisol level in the hair and exposure to glucocorticoids could allow detection of overdose or underdosage in patients with adrenal insufficiency. A pilot study showed no significant difference between patients and female control subjects, but a difference was observed between male subjects [52]; • plasma ACTH: plasma ACTH does not assist in evaluating glucocorticoid replacement therapy with classic rapid release hydrocortisone since ACTH is always high in the morning on waking and then decreases rapidly after administration of hydrocortisone in primary adrenal insufficiency [53]. In the study by Rousseau et al, the amplitude of the fall in ACTH after the morning administration of hydrocortisone correlated less well with area under the curve for cortisol than cortisol measured at the morning peak of 10 am [49].…”

Section: Adult Patientsmentioning

confidence: 88%