Hair analysis reveals subtle HPA axis suppression associated with use of local corticosteroids: The Lifelines cohort study

Background and aims Scalp hair is increasingly used to measure the long-term exposure to endogenous glucocorticoids hormones. Long-term cortisone (HairE) and cortisol (HairF) have been associated with obesity, metabolic syndrome, cardiovascular disease and psychopathology. However, little is known about the influence of the use of local corticosteroids and major stressful life events on hair glucocorticoids. Materials and methods We determined HairE and HairF using liquid chromatography − tandem mass spectrometry in 295 adult participants of the population-based Lifelines cohort study (75% females, median age 42). We collected anthropometry and fasting metabolic laboratory values, questionnaires on hair characteristics, recent use of corticosteroids, and recent major stressful life events. Results After adjustment for covariates, hair glucocorticoids increased with age, male sex, black or brown hair color, and frequency of sweating on the scalp, and decreased with higher hair washing frequency (P < 0.05). HairE was decreased in participants who used systemic corticosteroids (5.4 vs. 8.5 pg/mg hair, P = 0.041), and in participants who only used local agents such as inhaled, topical and nasal corticosteroids (6.8 vs. 8.5 pg/mg, P = 0.005). Recent life events were positively associated with HairF after adjustment for age and sex (P = 0.026), but this association lost significance after adjustment for hair related characteristics (P > 0.05). Conclusions HairE can be a useful marker to detect mild adrenal suppression due to corticosteroid use in the general population, even when only inhaled, nasal or topical corticosteroids are used, which suggests that these commonly used agents induce systemic effects.

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