Hair Glucocorticoids as a Biomarker for Endogenous Cushing's Syndrome: Validation in Two Independent Cohorts.

Abstract

BACKGROUND/AIMS:

The current diagnostic workup of Cushing's syndrome (CS) requires various tests which only capture short-term cortisol exposure, whereas patients with endogenous CS generally have elevated cortisol levels over longer periods of time. Scalp hair assessment has emerged as a convenient test in capturing glucocorticoid concentrations over long periods of time. The aim of this multicenter, multinational, prospective, case-control study was to evaluate the diagnostic efficacy of scalp hair glucocorticoids in screening of endogenous CS.

METHODS:

We assessed the diagnostic performances of hair cortisol (HairF), hair cortisone (HairE), and the sum of both (sumHairF+E), as measured by a state-of-the-art LC-MS/MS technique, in untreated patients with confirmed endogenous CS (n = 89) as well as in community controls (n = 295) from the population-based Lifelines cohort study.

RESULTS:

Both glucocorticoids were significantly elevated in CS patients when compared to controls. A high diagnostic efficacy was found for HairF (area under the curve 0.87 [95% CI: 0.83-0.92]), HairE (0.93 [0.89-0.96]), and sumHairF+E (0.92 [0.88-0.96]) (all p < 0.001). The participants were accurately classified at the optimal cutoff threshold in 86% of the cases (81% sensitivity, 88% specificity, and 94% negative predictive value [NPV]) by HairF, in 90% of the cases (87% sensitivity, 90% specificity, and 96% NPV) by HairE, and in 87% of the cases (86% sensitivity, 88% specificity, and 95% NPV) by the sumHairF+E. HairE was shown to be the most accurate in differentiating CS patients from controls.

CONCLUSION:

Scalp hair glucocorticoids, especially hair cortisone, can be seen as a promising biomarker in screening for CS. Its convenience in collection and workup additionally makes it feasible for first-line screening.

• Authors: Mesut Savas, Vincent L Wester, Yolanda B de Rijke, German Rubinstein, Stephanie Zopp, Kristien Dorst, Sjoerd A A van den Berg, Felix Beuschlein, Richard A Feelders, Martin Reincke, Elisabeth F C van Rossum
• Journal: Neuroendocrinology (Neuroendocrinology) Vol. 109 Issue 2 Pg. 171-178 ( 2019) ISSN: 1423-0194 [Electronic] Switzerland
• PMID: 30759443 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't, Validation Study)
• Copyright: © 2019 The Author(s) Published by S. Karger AG, Basel.

Chemical References

• Biomarkers
• Glucocorticoids

Topics

• Adult
• Aged
• Biomarkers (analysis, metabolism)
• Case-Control Studies
• Chromatography, Liquid
• Cohort Studies
• Cushing Syndrome (diagnosis, metabolism)
• Female
• Germany
• Glucocorticoids (analysis, metabolism)
• Hair (chemistry, metabolism)
• Humans
• Male
• Middle Aged
• Netherlands
• Predictive Value of Tests
• Prospective Studies
• Sensitivity and Specificity
• Tandem Mass Spectrometry