title: Scalp hair 17-hydroxyprogesterone and androstenedione as a long-term therapy monitoring tool in congenital adrenal hyperplasia.
abstract: BACKGROUND
  Glucocorticoid replacement therapy in congenital adrenal hyperplasia (CAH) is challenging, especially in children, because both over- and under-dosing may have profound and long-lasting adverse effects. Clinical follow-up parameters are largely nonspecific and slow to develop. Steroid concentrations in scalp hair may be a useful monitoring tool, as it provides information on both long-term steroid precursor and glucocorticoid exposure.
  
  
  OBJECTIVE
  We aimed to evaluate scalp hair steroid precursor concentrations as a monitoring tool for treatment follow-up in children with CAH.
  
  
  METHODS
  Scalp hair 17-hydroxyprogesterone (17-OHP) and androstenedione concentrations, measured by LC-MS/MS, of children with CAH (N = 26) were correlated with concentrations in serum and saliva, and compared to scalp hair concentrations in patient controls with adrenal insufficiency (AI) (N = 12) and healthy controls (N = 293).
  
  
  RESULTS
  Hair cortisol concentrations were higher in children with CAH, compared to both healthy controls (P < 0·001) and patient controls (P = 0·05), and did not differ significantly between patient controls with AI and healthy controls. Concentrations of androstenedione in scalp hair were strongly correlated with concentrations in serum (ρ = 0·72, P < 0·001) and saliva (ρ = 0·82, P = 0·002). This was also seen for 17-OHP in hair with serum (ρ = 0·94, P < 0·001) and saliva (ρ = 0·69, P = 0·009). Both hair 17-OHP and androstenedione were higher in CAH patients (mean concentration 17-OHP 2·9 pg/mg; androstenedione 1·3 pg/mg), when compared to healthy controls (17-OHP 0·44 pg/mg; androstenedione 0·65 pg/mg) and when compared to patients with AI (17-OHP 0·12 pg/mg; androstenedione 0·32 pg/mg).
  
  
  CONCLUSIONS
  This study shows that scalp hair 17-hydroxyprogesterone and androstenedione concentrations seem to be a promising parameter for treatment monitoring in patients with CAH.
authors.affiliation: Department of Pediatrics, Division of Endocrinology, Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Department of Internal Medicine, Division of Endocrinology, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Gerard
authors.initials: G
authors.lastname: Noppe
authors.affiliation: Department of Internal Medicine, Division of Endocrinology, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Yolanda B
authors.initials: YB
authors.lastname: de Rijke
authors.affiliation: Department of Internal Medicine, Division of Endocrinology, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Jan W
authors.initials: JW
authors.lastname: Koper
authors.affiliation: Department of Internal Medicine, Division of Endocrinology, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Elisabeth F C
authors.initials: EF
authors.lastname: van Rossum
authors.affiliation: Department of Pediatrics, Division of Endocrinology, Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands. E.L.T.vandenAkker@erasmusmc.nl.
authors.forename: Erica L T
authors.initials: EL
authors.lastname: van den Akker
mesh_terms: D019326:17-alpha-Hydroxyprogesterone / Q000032:analysis*; D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000188:drug therapy*; D000735:Androstenedione / Q000032:analysis*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002853:Chromatography, Liquid; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006197:Hair / Q000737:chemistry*; D006801:Humans; D006854:Hydrocortisone; D008297:Male; D012535:Scalp; D053719:Tandem Mass Spectrometry; D055815:Young Adult
chemical_list: D000735:Androstenedione; D019326:17-alpha-Hydroxyprogesterone; D006854:Hydrocortisone