Mini-review of hair cortisol concentration for evaluation of Cushing syndrome

Abstract

The diagnosis of endogenous Cushing syndrome is often challenging and requires multiple repeated blood, urine, and saliva tests to detect elevated cortisol levels. Hair cortisol concentration has been described as a marker of long-term exposure to systemic cortisol in patients with Cushing syndrome. Like hemoglobin A1c is used to detect serum glucose exposure over months, segmental hair cortisol can help identify patients with milder forms of and/or periodic or cyclical Cushing syndrome, which may reduce time and costs associated with collection of urine, salivary, and serum cortisol. Areas covered: Success of hair cortisol in detection of Cushing syndrome will be discussed in context of current literature, including differences between total or segmental hair cortisol in accurately determining timeline of cortisol exposure. Optimal methods of hair collection, storage, processing, and analysis and efforts toward standardization will be a major focus. Expert commentary: Recent evidence suggests increased sensitivity and specificity of hair cortisol in detecting Cushing syndrome. Future guidelines should consider this test as a routine part of the repertoire of screening tests for Cushing syndrome. Possible confounders to explain discrepant results in the literature will be discussed.

Cushing’s Disease

“…Recent evidence suggests an increased sensitivity and specificity of hair cortisol level measurements in detecting CS [80,81,82]. Its uniqueness is its ability to provide retrospective information about systemic cortisol exposure over months or even years.…”

“…Hair cortisol levels can be reliably measured in childhood, and the reference range increases with age [83]. Segmental hair cortisol levels may help identify patients with milder forms of CS and/or cyclic CS [80,81,84].…”

Hair glucocorticoids are not a historical marker of stress – exploring the time-scale of corticosterone incorporation into hairs in a rat model

“…The popular model (outlined in e.g., Russell et al 16 42 ) proposes that glucocorticoids are 1) deposited into the growing hair at the level of the follicle; 2) that they remain largely stationary in a particular segment as the hair grows; 3) that limited post-deposition degradation of glucocorticoids happens. The unknowns of the model are often emphasized: other routes for incorporation are, for example, occasionally discussed [43][44][45] and treatments of hair in humans (dyeing, shampooing, etc.)…”

Síndrome de Cushing: Revisao Integrativa

“…A DC apresenta-se principalmente pelo ganho de peso em obesidade central, fadiga com miopatia proximal, afinamento da pele com estrias arroxeadas e hematomas difusos 2,12 . Alguns pacientes apresentam menores picos hipercortisolêmicos, com diagnóstico alcançado depois de muitos anos e consultas médicas 13 . As manifestações do hipercortisolismo incluem hipertensão, distribuição anormal de gordura, pele fina sensível a hematomas, fraqueza muscular, osteoporose, hirsutismo e disfunção gonadal.…”

“…Dentre os métodos diagnósticos existentes, a concentração de cortisol no cabelo também é descrita em alguns estudos como marcador de exposição excessiva a longo prazo, visto que a aferição de algumas substâncias presentes no cabelo fornece informações históricas sobre suas evoluções no organismo. Além disso, a obtenção destas respostas através da medição capilar é rápida, fácil e conveniente ao diagnóstico precoce 13 .…”