title: Hair cortisol content in patients with adrenal insufficiency on hydrocortisone replacement therapy.
abstract: OBJECTIVE
  Patients with adrenal insufficiency (AI) require life-long replacement therapy with exogenous glucocorticoids. Several studies have shown impaired subjective health status in these patients as well as increased morbidity and mortality risk, which may be caused by glucocorticoid over-replacement. As a measure of long-term cortisol exposure, the usefulness of hair cortisol analysis in patients receiving glucocorticoid replacement therapy was investigated.
  
  
  METHODS
  Hair samples, demographics, medical history and perceived stress scale questionnaires were collected from 93 patients across North America diagnosed with primary or secondary AI. Sixty-two household partners served as a control group. Cortisol was measured in the proximal 2 cm of hair, representing the most recent 2 months of exposure. A modified enzyme immunoassay was used for the measurement of cortisol.
  
  
  RESULTS
  The male patients had significantly higher hair cortisol levels than the male controls (P < 0·05), while there was no significant difference among females. Hair cortisol content correlated significantly with glucocorticoid dose (r = 0·3, P < 0·01). Patients with AI had significantly higher subjective stress scores than control subjects.
  
  
  CONCLUSIONS
  Hair cortisol content correlates with hydrocortisone (HC) dose in patients with AI. Our results suggest that some AI patients may be over-treated and hence may be at risk for the adverse effects of cortisol. Measurement of HC in hair may become a useful monitoring tool for long-term cortisol exposure in patients treated with glucocorticoids.
authors.affiliation: Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
authors.forename: Rachel
authors.initials: R
authors.lastname: Gow
authors.forename: Gideon
authors.initials: G
authors.lastname: Koren
authors.forename: Michael
authors.initials: M
authors.lastname: Rieder
authors.forename: Stan
authors.initials: S
authors.lastname: Van Uum
mesh_terms: D000309:Adrenal Insufficiency / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000032:analysis / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D006197:Hair / Q000737:chemistry*; D020249:Hormone Replacement Therapy; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis* / Q000627:therapeutic use*; D007124:Immunoenzyme Techniques; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone