Clinical applications of cortisol measurements in hair
Abstract
Cortisol measurements in blood, saliva and urine are frequently used to examine the hypothalamus–pituitary–adrenal (HPA) axis in clinical practice and in research. However, cortisol levels are subject to variations due to acute stress, the diurnal rhythm and pulsatile secretion. Cortisol measurements in body fluids are not always a reflection of long-term cortisol exposure. The analysis of cortisol in scalp hair is a relatively novel method to measure cumulative cortisol exposure over months up to years. Over the past years, hair cortisol concentrations (HCC) have been examined in association with a large number of somatic and mental health conditions. HCC can be used to evaluate disturbances of the HPA axis, including Cushing's syndrome, and to evaluate hydrocortisone treatment. Using HCC, retrospective timelines of cortisol exposure can be created which can be of value in diagnosing cyclic hypercortisolism. HCC have also been shown to increase with psychological stressors, including major life events, as well as physical stressors, such as endurance exercise and shift work. Initial studies show that HCC may be increased in depression, but decreased in general anxiety disorder. In posttraumatic stress disorder, changes in HCC seem to be dependent on the type of traumatic experience and the time since traumatization. Increased hair cortisol is consistently linked to obesity, metabolic syndrome and cardiovascular disease. Potentially, HCC could form a future marker for cardiovascular risk stratification, as well as serve as a treatment target.
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Cortisol has been measured in human blood, serum, urine, saliva, hair, interstitial fluid, and most recently eccrine sweat.
“Cortisol has been measured in human blood,106 serum,107 urine,107 saliva,107,108 hair,109 interstitial fluid,110 and most recently eccrine sweat.111”
From Wearable sensors for monitoring the physiological and biochemical profile of the athlete (2019) · cites this paper as [109]
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Wester, V. L., Reincke, M., Koper, J. W., van den Akker, E. L. T., Manenschijn, L., Berr, C. M., Fazel, J., de Rijke, Y. B., Feelders, R. A., & van Rossum, E. F. C. (2017) · European Journal of Endocrinology · doi:10.1530/eje-16-0873 · Cited by 39 · see citing works
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Garcia-Leon, M. A., Peralta-Ramirez, M. I., Arco-Garcia, L., Romero-Gonzalez, B., Caparros-Gonzalez, R. A., Saez-Sanz, N., Santos-Ruiz, A. M., Montero-Lopez, E., Gonzalez, A., & Gonzalez-Perez, R. (2018) · PLOS ONE · doi:10.1371/journal.pone.0204807 · Cited by 35 · see citing works
Molecular Derangements and the Diagnosis of ACTH-Dependent Cushing’s Syndrome
Nieman, L. K. (2022) · Endocrine Reviews · doi:10.1210/endrev/bnab046 · Cited by 33 · see citing works
“Measurement of hair cortisol has shown to be useful to identify the association of mild hypercortisolism with potential comorbidities but has not yet been validated as a test to diagnose CS (50,94).”
BackgroundGlucocorticoid receptor haplotype and metabolic syndrome: the Lifelines cohort study
Wester, V. L., Koper, J. W., van den Akker, E. L. T., Franco, O. H., Stolk, R. P., & van Rossum, E. F. C. (2016) · European Journal of Endocrinology · doi:10.1530/eje-16-0534 · Cited by 24 · see citing works
Self-citation
- Authors
- Wester, V. L., & van Rossum, E. F. C.
- Affiliations
- Erasmus MC (NL)
- ORCID
- Wester, Vincent L
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-10
- Volume
- 173
- Issue
- 4
- Pages
- M1-M10
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2022718998
- Semantic Scholar
- 3a3d55895c37c354cb512ef11d7796509af1eb24
- Cited by
- 210
- References
- 75
- Citations by year
- 2026: 15 · 2025: 17 · 2024: 8 · 2023: 22 · 2022: 20 · 2021: 32 · 2020: 15 · 2019: 30 · 2018: 22 · 2017: 10 · 2016: 14 · 2015: 5
- FWCI
- 1.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Keywords
- hair cortisol, hypothalamic-pituitary-adrenal axis, Cushing's syndrome, psychological stress, major life events, endurance exercise, shift work, depression, generalized anxiety disorder, post-traumatic stress disorder, obesity, metabolic syndrome, cardiovascular disease, cardiovascular risk stratification
- MeSH terms
- Adrenal Insufficiency, Anxiety Disorders, Cardiovascular Diseases, Chromatography, Liquid, Circadian Rhythm, Cushing Syndrome, Depressive Disorder, Enzyme-Linked Immunosorbent Assay, Hair, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, Stress Disorders, Post-Traumatic, Biomarkers, Hormone Replacement Therapy, Tandem Mass Spectrometry
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