title: Increased Hair Cortisol Concentrations and BMI in Patients With Pituitary-Adrenal Disease on Hydrocortisone Replacement.
abstract: BACKGROUND
  Intrinsic imperfections and lack of reliable biomarkers preclude optimal individual dosing of hydrocortisone replacement in adrenal insufficiency (AI). However, the clinical relevance of optimal dosing is exemplified by frequently occurring side effects of overreplacement and the dangers of underreplacement. Cortisol in scalp hair has been identified as a retrospective biomarker for long-term cortisol exposure. We compared hair cortisol concentrations (CORT(hair)) of patients with primary or secondary AI on replacement therapy with those of patient controls with a pituitary disease without AI (PCs) and of healthy controls (HCs).
  
  
  METHODS
  In this cross-sectional study, hair samples and anthropometric data were collected in 132 AI patients (52 males), 42 PCs (11 males), and 195 HCs (90 males). The proximal 3 cm of hair were used. CORT(hair) were measured using an ELISA.
  
  
  RESULTS
  CORT(hair) were higher in AI patients than in HCs and PCs (P < .001), and hydrocortisone dose correlated with CORT(hair) (P = .04). Male AI patients demonstrated higher CORT(hair) than female patients (P < .001). AI patients had higher body mass index (BMI) than HCs (P < .001), and BMI correlated with CORT(hair) in the whole sample (P < .001).
  
  
  CONCLUSIONS
  Physiological hydrocortisone replacement is associated with increased CORT(hair). The association between CORT(hair) and BMI could suggest a mild overtreatment that may lead to adverse anthropomorphic side effects, especially in males. CORT(hair) measurements may be a promising additional tool to monitor cumulative hydrocortisone replacement in AI.
authors: Department of Internal Medicine (S.M.S., L.M., E.F.C.v.R.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Endocrinology and Metabolic Diseases and Center for Endocrine Tumors (C.D.A., A.M.P., N.R.B.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
authors: Sabine M
authors: SM
authors: Staufenbiel
authors: Department of Internal Medicine (S.M.S., L.M., E.F.C.v.R.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Endocrinology and Metabolic Diseases and Center for Endocrine Tumors (C.D.A., A.M.P., N.R.B.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
authors: Cornelie D
authors: CD
authors: Andela
authors: Department of Internal Medicine (S.M.S., L.M., E.F.C.v.R.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Endocrinology and Metabolic Diseases and Center for Endocrine Tumors (C.D.A., A.M.P., N.R.B.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
authors: Laura
authors: L
authors: Manenschijn
authors: Department of Internal Medicine (S.M.S., L.M., E.F.C.v.R.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Endocrinology and Metabolic Diseases and Center for Endocrine Tumors (C.D.A., A.M.P., N.R.B.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
authors: Alberto M
authors: AM
authors: Pereira
authors: Department of Internal Medicine (S.M.S., L.M., E.F.C.v.R.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Endocrinology and Metabolic Diseases and Center for Endocrine Tumors (C.D.A., A.M.P., N.R.B.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
authors: Elisabeth F C
authors: EF
authors: van Rossum
authors: Department of Internal Medicine (S.M.S., L.M., E.F.C.v.R.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; and Department of Endocrinology and Metabolic Diseases and Center for Endocrine Tumors (C.D.A., A.M.P., N.R.B.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
authors: Nienke R
authors: NR
authors: Biermasz
mesh_terms: D000307:Adrenal Gland Diseases / Q000188:drug therapy* / Q000378:metabolism; D000309:Adrenal Insufficiency / Q000188:drug therapy / Q000378:metabolism; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006197:Hair / Q000737:chemistry* / Q000378:metabolism; D020249:Hormone Replacement Therapy; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis* / Q000378:metabolism / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010900:Pituitary Diseases / Q000188:drug therapy* / Q000378:metabolism; D055815:Young Adult
chemical_list: D006854:Hydrocortisone