Mini-review of hair cortisol concentration for evaluation of Cushing syndrome
Aaron Hodes, Jerrold Meyer, Maya B Lodish, Constantine A Stratakis, Mihail Zilbermint, Aaron Hodes, Jerrold Meyer, Maya B Lodish, Constantine A Stratakis, Mihail Zilbermint
Abstract
Introduction: 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.
Trial registration: ClinicalTrials.gov NCT00001595 NCT00005927.
Keywords: Cushing disease; Cushing syndrome; Hair; cortisol; hair cortisol; hypercortisolemia.
Conflict of interest statement
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
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Source: PubMed