title: Hair analysis reveals subtle HPA axis suppression associated with use of local corticosteroids: The Lifelines cohort study.
abstract: OBJECTIVE
  Scalp hair is increasingly used to measure the long-term exposure to endogenous glucocorticoids hormones. Long-term cortisone (HairE) and cortisol (HairF) have been associated with obesity, metabolic syndrome, cardiovascular disease and psychopathology. However, little is known about the influence of the use of local corticosteroids and major stressful life events on hair glucocorticoids.
  
  
  METHODS
  We determined HairE and HairF using liquid chromatography - tandem mass spectrometry in 295 adult participants of the population-based Lifelines cohort study (75% females, median age 42). We collected anthropometry and fasting metabolic laboratory values, questionnaires on hair characteristics, recent use of corticosteroids, and recent major stressful life events.
  
  
  RESULTS
  After adjustment for covariates, hair glucocorticoids increased with age, male sex, black or brown hair color, and frequency of sweating on the scalp, and decreased with higher hair washing frequency (P<0.05). HairE was decreased in participants who used systemic corticosteroids (5.4 vs. 8.5pg/mg hair, P=0.041), and in participants who only used local agents such as inhaled, topical and nasal corticosteroids (6.8 vs. 8.5pg/mg, P=0.005). Recent life events were positively associated with HairF after adjustment for age and sex (P=0.026), but this association lost significance after adjustment for hair related characteristics (P>0.05).
  
  
  CONCLUSIONS
  HairE can be a useful marker to detect mild adrenal suppression due to corticosteroid use in the general population, even when only inhaled, nasal or topical corticosteroids are used, which suggests that these commonly used agents induce systemic effects.
authors.affiliation: Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Wester
authors.affiliation: Department of Internal Medicine, Division of Endocrinology, Erasmus MC, 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, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Mesut
authors.initials: M
authors.lastname: Savas
authors.affiliation: Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Erica L T
authors.initials: ELT
authors.lastname: van den Akker
authors.affiliation: 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, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Lifelines Cohort Study and Biobank, Groningen, The Netherlands. Electronic address: e.vanrossum@erasmusmc.nl.
authors.forename: Elisabeth F C
authors.initials: EFC
authors.lastname: van Rossum
mesh_terms: D000305:Adrenal Cortex Hormones / Q000378:metabolism; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003348:Cortisone / Q000032:analysis; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D005938:Glucocorticoids / Q000032:analysis* / Q000378:metabolism; D006197:Hair / Q000737:chemistry*; D006200:Hair Color; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010913:Pituitary-Adrenal System / Q000378:metabolism; D013315:Stress, Psychological / Q000378:metabolism
chemical_list: D000305:Adrenal Cortex Hormones; D005938:Glucocorticoids; D003348:Cortisone; D006854:Hydrocortisone
keywords: Corticosteroids; Glucocorticoids; Hair cortisol; Hair cortisone; Life events