Hair cortisol as a complementary marker of chronic glucocorticoid exposure in mild autonomous cortisol secretion.
- 1Department of Endocrinology and Metabolism, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
- 2Department of Medical Biochemistry, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
- 3Department of Endocrinology and Metabolism, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey. [email protected].
Abstract
Background
Mild autonomous cortisol secretion is a subtle yet clinically relevant form of cortisol excess linked to increased cardiometabolic risk. Conventional biochemical tests capture short-term hypothalamic-pituitary-adrenal axis activity and may not reflect cumulative exposure. Hair cortisol concentration has been proposed as a long-term biomarker, but evidence in mild autonomous cortisol secretion is limited.Objective
To compare hair cortisol concentration between patients with mild autonomous cortisol secretion and healthy controls, assess diagnostic performance, and examine associations with hormonal and metabolic parameters.Methods
In this cross-sectional study, 73 patients with mild autonomous cortisol secretion and 60 rigorously screened controls were included. Mild autonomous cortisol secretion was defined according to European Society of Endocrinology guidelines. Hair cortisol concentration was measured from the proximal 3-cm hair segment. Assessments included the 1-mg overnight dexamethasone suppression test, 2-day 2 mg dexamethasone suppression test, 24-hour urinary free cortisol, and late-night salivary cortisol. Correlation and receiver operating characteristic analyses were performed.Results
Hair cortisol concentration was significantly higher in patients with mild autonomous cortisol secretion than in controls (median 3.6 vs. 1.75 ng/g; p < 0.01). In patients with mild autonomous cortisol secretion, hair cortisol concentration correlated with waist circumference (ρ = 0.27; p = 0.02) and late-night salivary cortisol (ρ = 0.25; p = 0.03), but not with dexamethasone suppression test-based measures or urinary cortisol. Receiver operating characteristic analysis showed modest discrimination (AUC = 0.60, 95% CI 0.51-0.70, p = 0.025); the 2.7-ng/g cut-off yielded limited sensitivity and specificity. In multivariable logistic regression adjusted for age, sex, and body mass index, hair cortisol concentration was not independently associated with mild autonomous cortisol secretion.Conclusions
Hair cortisol concentrations were higher in patients with mild autonomous cortisol secretion than in healthy controls, suggesting that hair cortisol concentration may capture some aspects of chronic glucocorticoid exposure in this population. However, its diagnostic performance was modest, and hair cortisol concentration was not independently associated with mild autonomous cortisol secretion after adjustment for age, sex, and body mass index. Therefore, hair cortisol concentration should be regarded as a complementary rather than a standalone biomarker, and further prospective studies are needed to clarify its clinical utility.
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BibTeX
@article{yilmaz2026hair,
title = {{Hair cortisol as a complementary marker of chronic glucocorticoid exposure in mild autonomous cortisol secretion.}},
author = {Merve Korkmaz Yilmaz and Semih Tek and Aslihan Pekmezci and Mutlu Niyazoglu and Esra Hatipoglu},
journal = {BMC endocrine disorders},
year = {2026},
month = sep,
doi = {10.1186/s12902-026-02607-1},
url = {https://europepmc.org/article/MED/42897569},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Hair cortisol as a complementary marker of chronic glucocorticoid exposure in mild autonomous cortisol secretion.
AU - Merve Korkmaz Yilmaz
AU - Semih Tek
AU - Aslihan Pekmezci
AU - Mutlu Niyazoglu
AU - Esra Hatipoglu
PY - 2026
DA - 2026/09/01
JO - BMC endocrine disorders
DO - 10.1186/s12902-026-02607-1
UR - https://europepmc.org/article/MED/42897569
AB - Background Mild autonomous cortisol secretion is a subtle yet clinically relevant form of cortisol excess linked to increased cardiometabolic risk. Conventional biochemical tests capture short-term hypothalamic-pituitary-adrenal axis activity and may not reflect cumulative exposure. Hair cortisol concentration has been proposed as a long-term biomarker, but evidence in mild autonomous cortisol secretion is limited.Objective To compare hair cortisol concentration between patients with mild autonomous cortisol secretion and healthy controls, assess diagnostic performance, and examine associations with hormonal and metabolic parameters.Methods In this cross-sectional study, 73 patients with mild autonomous cortisol secretion and 60 rigorously screened controls were included. Mild autonomous cortisol secretion was defined according to European Society of Endocrinology guidelines. Hair cortisol concentration was measured from the proximal 3-cm hair segment. Assessments included the 1-mg overnight dexamethasone suppression test, 2-day 2 mg dexamethasone suppression test, 24-hour urinary free cortisol, and late-night salivary cortisol. Correlation and receiver operating characteristic analyses were performed.Results Hair cortisol concentration was significantly higher in patients with mild autonomous cortisol secretion than in controls (median 3.6 vs. 1.75 ng/g; p < 0.01). In patients with mild autonomous cortisol secretion, hair cortisol concentration correlated with waist circumference (ρ = 0.27; p = 0.02) and late-night salivary cortisol (ρ = 0.25; p = 0.03), but not with dexamethasone suppression test-based measures or urinary cortisol. Receiver operating characteristic analysis showed modest discrimination (AUC = 0.60, 95% CI 0.51-0.70, p = 0.025); the 2.7-ng/g cut-off yielded limited sensitivity and specificity. In multivariable logistic regression adjusted for age, sex, and body mass index, hair cortisol concentration was not independently associated with mild autonomous cortisol secretion.Conclusions Hair cortisol concentrations were higher in patients with mild autonomous cortisol secretion than in healthy controls, suggesting that hair cortisol concentration may capture some aspects of chronic glucocorticoid exposure in this population. However, its diagnostic performance was modest, and hair cortisol concentration was not independently associated with mild autonomous cortisol secretion after adjustment for age, sex, and body mass index. Therefore, hair cortisol concentration should be regarded as a complementary rather than a standalone biomarker, and further prospective studies are needed to clarify its clinical utility.
SN - 1472-6823
ER -