Review of hair cortisol to detect patients with Cushing syndrome.

What is it about?

Hair cortisol has been studied in recent years to detect patients with persistently elevated blood levels of a major stress hormone, cortisol, caused by several cancers that cause increased production of this hormone. We review recent studies on its ability to detect these cases, specifics of how to sample and measure hair cortisol, and delineate areas of further investigation.

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Why is it important?

Cases of persistently elevated cortisol from overproduction by specific types of cancers, called endogenous Cushing syndrome—indicating the cause is from within the patient— are, fortunately, extremely rare but are associated with many health risks, such as hypertension, diabetes mellitus, heart attacks and stroke, if left untreated. However, detection of these cases by current standards at best detect up to 24 hour exposure of elevated blood cortisol, and some of these cancers can have intermittent secretion of cortisol, not uncommonly causing normal results. Hair cortisol detects long term exposure to cortisol similar to HbA1c detects months of exposure to elevated blood sugar and may improve clinicians’ confidence in pursuit of the diagnosis.

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