title: Hair cortisol in the evaluation of Cushing syndrome.
abstract: OBJECTIVE
  Hair cortisol evaluation has been used to help detect patients with suspected Cushing syndrome. Our goal was to correlate segmental hair cortisol with biochemical testing in patients with Cushing syndrome and controls. This study was a prospective analysis of hair cortisol in confirmed Cushing syndrome cases over 16 months.
  
  
  METHODS
  Thirty-six subjects (26.5 ± 18.9 years, 75% female, and 75% Caucasian) were analyzed by diurnal serum cortisol, 24 h urinary free cortisol corrected for body surface area (UFC/BSA), and 24 h urinary 17-hydroxysteroids corrected for creatinine (17OHS/Cr). Thirty patients were diagnosed with Cushing syndrome, and six were defined as controls. 3-cm hair samples nearest to the scalp, cut into 1-cm segments (proximal, medial, and distal), were analyzed for cortisol by enzyme immunoassay and measured as pmol cortisol/g dry hair. Hair cortisol levels were compared with laboratory testing done within previous 2 months of the evaluation.
  
  
  RESULTS
  Proximal hair cortisol was higher in Cushing syndrome patients (266.6 ± 738.4 pmol/g) than control patients (38.9 ± 25.3 pmol/g) (p = 0.003). Proximal hair cortisol was highest of all segments in 25/36 (69%) patients. Among all subjects, proximal hair cortisol was strongly correlated with UFC/BSA (r = 0.5, p = 0.005), midnight serum cortisol (r = 0.4, p = 0.03), and 17OHS/Cr, which trended towards significance (r = 0.3, p = 0.06).
  
  
  CONCLUSIONS
  Among the three examined hair segments, proximal hair contained the highest cortisol levels and correlated the most with the initial biochemical tests for Cushing syndrome in our study. Further studies are needed to validate proximal hair cortisol in the diagnostic workup for Cushing syndrome.
authors.affiliation: Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA.|Albert Einstein College of Medicine, Department of Radiology, Jacobi Medical Center, Bronx, NY, 10461, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Hodes
authors.affiliation: Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA.
authors.forename: Maya B
authors.initials: MB
authors.lastname: Lodish
authors.affiliation: Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel.
authors.forename: Amit
authors.initials: A
authors.lastname: Tirosh
authors.affiliation: Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, 01003, USA.
authors.forename: Jerrold
authors.initials: J
authors.lastname: Meyer
authors.affiliation: Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA.
authors.forename: Elena
authors.initials: E
authors.lastname: Belyavskaya
authors.affiliation: Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Lyssikatos
authors.affiliation: Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, 01003, USA.
authors.forename: Kendra
authors.initials: K
authors.lastname: Rosenberg
authors.affiliation: Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Demidowich
authors.affiliation: Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Swan
authors.affiliation: Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA.
authors.forename: Nichole
authors.initials: N
authors.lastname: Jonas
authors.affiliation: Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA.
authors.forename: Constantine A
authors.initials: CA
authors.lastname: Stratakis
authors.affiliation: Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA. mihail.zilbermint@nih.gov.|Johns Hopkins University School of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Baltimore, MD, 21287, USA. mihail.zilbermint@nih.gov.|Suburban Hospital, Bethesda, MD, 20814, USA. mihail.zilbermint@nih.gov.
authors.forename: Mihail
authors.initials: M
authors.lastname: Zilbermint
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000378:metabolism; D005260:Female; D006197:Hair / Q000737:chemistry*; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D006914:Hydroxysteroids / Q000652:urine; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D006914:Hydroxysteroids; D006854:Hydrocortisone
keywords: Adolescence; Children; Cortisol; Cushing disease; Cushing syndrome; Hair; Hair cortisol