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Purpose <p>Hair cortisol concentration (HCC) is effective in the identification of Cushing’s syndrome (CS), yet current guidelines have not incorporated its utilization. The limited use of HCC is a significant factor here, underscoring the need for additional data to validate the test. Earlier studies on HCC did not compare it with urinary free cortisol (UFC) and late-night salivary cortisol (LNSC) in cases with CS. We aimed to evaluate HCC’s effectiveness in identifying hypercortisolemia in patients with endogenous Cushing’s syndrome, comparing it to UFC and LNSC.</p> Methods <p>The study involved 23 individuals with active endogenous CS and 21 age- and gender-matched participants with non-functioning pituitary adenomas (NFA). HCC was evaluated through the ECLIA method. Cortisol and ACTH levels, dexamethasone suppression tests (DST), bedtime serum cortisol (BSC), UFC, and LNSC, all related to the hair collection period, were also included.</p> Results <p>Cases with CS had increased HCC relative to the control cases (24.2[IQR: 8.3–48.8] vs. 2.2[IQR: 0.7–5.7]ng/gr, <i>p</i> &lt; 0.001). The optimal HCC cut-off value, 6.15 ng/g, had 87% sensitivity and 91% specificity. In cases with CS, HCC was correlated with BSC, LNSC, and 1&#xa0;mg-DST results (rho = 0.5, <i>p</i> = 0.03; rho = 0.5, <i>p</i> = 0.01; and rho = 0.5, <i>p</i> = 0.03). In cases with CS, the false negative rates were 13% with HCC, 24% with LNSC, and 54.5% with UFC (HCC vs. LNSC, <i>p</i> = 0.4; HCC vs. UFC, <i>p</i> = 0.01).</p> Conclusion <p>HCC demonstrated high diagnostic accuracy in patients with Cushing’s syndrome and showed superior performance compared to urinary-free cortisol. Given its non-invasive nature and ability to reflect long-term cortisol exposure, HCC offers meaningful clinical implications as a complementary diagnostic tool, particularly in patients with discordant or borderline biochemical test results.</p>

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Hair cortisol outperforms urinary free cortisol in diagnosing Cushing’s syndrome: a cross-sectional study

  • 期刊论文

  • 发表日期：

    2026年1月16日

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  • Hilal Yildirim Deryol,
  • Semih Tek,
  • Ebubekir Akpinar,
  • Buruc Erkan,
  • Umran Keskin,
  • Mazhar Tuna,
  • Mutlu Niyazoglu,
  • Esra Suheda Hatipoglu

摘要

Purpose

Hair cortisol concentration (HCC) is effective in the identification of Cushing’s syndrome (CS), yet current guidelines have not incorporated its utilization. The limited use of HCC is a significant factor here, underscoring the need for additional data to validate the test. Earlier studies on HCC did not compare it with urinary free cortisol (UFC) and late-night salivary cortisol (LNSC) in cases with CS. We aimed to evaluate HCC’s effectiveness in identifying hypercortisolemia in patients with endogenous Cushing’s syndrome, comparing it to UFC and LNSC.

Methods

The study involved 23 individuals with active endogenous CS and 21 age- and gender-matched participants with non-functioning pituitary adenomas (NFA). HCC was evaluated through the ECLIA method. Cortisol and ACTH levels, dexamethasone suppression tests (DST), bedtime serum cortisol (BSC), UFC, and LNSC, all related to the hair collection period, were also included.

Results

Cases with CS had increased HCC relative to the control cases (24.2[IQR: 8.3–48.8] vs. 2.2[IQR: 0.7–5.7]ng/gr, p < 0.001). The optimal HCC cut-off value, 6.15 ng/g, had 87% sensitivity and 91% specificity. In cases with CS, HCC was correlated with BSC, LNSC, and 1 mg-DST results (rho = 0.5, p = 0.03; rho = 0.5, p = 0.01; and rho = 0.5, p = 0.03). In cases with CS, the false negative rates were 13% with HCC, 24% with LNSC, and 54.5% with UFC (HCC vs. LNSC, p = 0.4; HCC vs. UFC, p = 0.01).

Conclusion

HCC demonstrated high diagnostic accuracy in patients with Cushing’s syndrome and showed superior performance compared to urinary-free cortisol. Given its non-invasive nature and ability to reflect long-term cortisol exposure, HCC offers meaningful clinical implications as a complementary diagnostic tool, particularly in patients with discordant or borderline biochemical test results.