title: Elevated hair cortisol concentrations in children with adrenal insufficiency on hydrocortisone replacement therapy.
abstract: BACKGROUND
  Glucocorticoid replacement therapy in patients with adrenal insufficiency needs to be tailored to the individual patient based on body composition and clinical signs and symptoms as no objective method for assessment of treatment adequacy is available. Current treatment regimens are often not satisfactory, which is shown by the adverse metabolic profile and doubled mortality rates in treated adrenal insufficiency patients. Measurement of cortisol concentrations in hair reflect the long-term systemic cortisol exposure and may be of use in refinement of hydrocortisone treatment.
  
  
  OBJECTIVE
  We aimed to study whether long-term cortisol (hydrocortisone) levels, as measured in scalp hair, are similar in children with adrenal insufficiency and healthy children.
  
  
  METHODS
  We set up a case control study, measuring anthropometric characteristics and hair cortisol concentrations (HCC) in 54 hydrocortisone substituted children with adrenal insufficiency (AI patients) in the age of 4-18 years and 54 healthy children matched for gender and age.
  
  
  RESULTS
  Mean HCC were significantly higher in AI patients compared with healthy controls (mean 13·3 vs 8·2 pg/mg, P = 0·02). AI patients also had a higher BMI (P < 0·001) and waist circumference (WC) (P = 0·02). HCC was significantly associated with BMI (P = 0·002) and WC (P = 0·002). HCC explained 13% of the difference in BMI and 29% of the difference in WC between AI patients and controls.
  
  
  CONCLUSIONS
  Hydrocortisone-treated AI patients have increased HCC and adverse anthropometric characteristics compared with healthy controls. HCC measurement may be of value in identifying overtreatment and thereby improve hydrocortisone replacement therapy.
authors.affiliation: Division of Endocrinology, Department of Paediatrics, Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands; Division of Endocrinology, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Noppe
authors.forename: E F C
authors.initials: EF
authors.lastname: van Rossum
authors.forename: J
authors.initials: J
authors.lastname: Vliegenthart
authors.forename: J W
authors.initials: JW
authors.lastname: Koper
authors.forename: E L T
authors.initials: EL
authors.lastname: van den Akker
mesh_terms: D000224:Addison Disease / Q000150:complications; D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000150:complications; D000309:Adrenal Insufficiency / Q000188:drug therapy* / Q000209:etiology; D015992:Body Mass Index; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016903:Drug Monitoring; D005260:Female; D005938:Glucocorticoids / Q000032:analysis / Q000627:therapeutic use*; D006197:Hair / Q000737:chemistry*; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000627:therapeutic use*; D007018:Hypopituitarism / Q000150:complications; D008297:Male; D050177:Overweight; D055105:Waist Circumference
chemical_list: D005938:Glucocorticoids; D006854:Hydrocortisone