Hair Cortisol Analysis
Cortisol is released by the adrenal gland following the stimulation by ACTH (adrenocorticotropic hormone) which is produced by the anterior pituitary gland. This gland is itself triggered by corticotropin-releasing hormone produced by the hypothalamus. The process is called the hypothalamus-pituitary-adrenal (HPA) axis.
Measurement of cortisol can be done in saliva, blood and urine. These matrices reflect current levels in the body. Long term levels as measured in hair may allow assessments relating to causation of chronic diseases based on a continuous activation of the HPA axis.
Hair analysis for cortisol is seen as a new tool for the diagnosis of these diseases.1 Hair cortisol measurements have been validated by repeated measurements of saliva and urine.2 Hair cortisol has also been linked to chronic stress and mental health disorders.3
The hair matrix allows the measurement of free cortisol for periods up to six months.4 Beyond this time the cortisol levels are lower due to the amount of washing the hair has been submitted to.5
General observations relating to cortisol levels in hair the Whitehall II Study:
- In general women have lower levels than men
- Higher levels seen with diabetes
- Higher in blacks than other ethnic groups - possibly because of hair being coarser seems to increase cortisol levels (in-house study)
- Depressive symptoms were associated with elevated levels although prolonged depression like PTSD showed lower levels
- Age did not show differences in levels when corrected for diseases
- Taking corticosteroids generated lower hair levels of cortisol
- High BMI individuals had higher cortisol levels5
- Dyed hair had lower cortisol levels
- Lower cortisol levels seen in seasons other than winter
- l. Manenschijn et al., Endocrine Abstracts, 11, V29, 2012
- E Russell et al., J Psychoneuroendocronoloy, V37, 589, 2012, and Gow et al., Forensic Sci International,196, 32 2010
- l Manenschijn, et al., J Psychoneuroendocrinology, V37, 1960,2012, A V Herane J Psychiatr Res V70,38,2015
- Dettenborn et al,J Psychoneuroendocrinology V9,1404, 2010
- J G Abell et al., J Psychoneuroendocrinology 73,148,2016
The Importance of Testing
Chronic high circulating cortisol levels have negative effects on the body, such as slowed wound healing and cognitive impairments to name a few. Hence this stress response through the HPA axis is sought to be the major physiological mechanism through which stress influences disease states. (Karlén et al. BMC Clinical Pathology 2011, 11:12)
A study by Lucia et al. demonstrated an increase in hair cortisol in depressed patients versus healthy controls. (Lucia et al. Stress, 2011 1-6) A study by Karlen et al., concluded that hair cortisol serves as a retrospective biomarker of increased cortisol reflecting exposure to major life stresses in young adults. (Karlén et al. BMC Clinical Pathology 2011, 11:12) Another study from Karen et al. studied expecting mothers’ hair cortisol levels as well as their babies. The study concluded that there was a correlation between hair cortisol levels in mothers and their children, suggesting a maternal calibration to the child’s HPA axis. (Karlen et.al Pediatrics. 2013)
The research is promising and the versatile use in helping so many different types of patients makes this test an asset in your practice. In addition to using Hair Cortisol with your patients, valuable information regarding the adrenal glands can also be taken from the Hair Tissue Mineral Analysis.
Currently, measuring cortisol is the best way to biologically understand the stress response through the HPA axis. Cortisol is most often measured in urine, saliva and blood. Although these methods can be insightful they only cover a spot time interval (24 hours) and are not good at predicting chronic or longitudinal stress. Because of these drawbacks, a better procedure for determining long term exposure to stress was devised. Using hair tissue has become a viable and widely studied means to look at one’s stress response over months vs. hours.
Results You and Your Clients Can Understand
Cortisol reports are a measurement of the picograms of cortisol per milligram as analyzed in the hair sample provided.
The results presented in the report are applied to a scale determined by CanAlt research and several notable publications. Scales of cortisol concentrations are dependent on the analytical procedures used in the laboratory. Variations in distribution may occur based on processes performed in the laboratory like washing the hair prior to extraction. These processes may not be part of all laboratory procedures as there is no regulatory procedure.
Note: The assay for cortisol is performed using antibodies for cortisol following the hair extraction. As with any antibody cross-reactivity may occur. The principal cross-reactivity with the assay antibody is Prednisolone/Prednisone. The cortisol readings may be elevated if the patient is taking these steroids.
Very high cortisol is also an indicator of “Cushing Syndrome“ and very low cortisol is an indicator of “Addison Syndrome”, both serious conditions. Very high or very low cortisol can indicate metabolic disorders.