Vol 71, No 6 (2020)
Original paper
Published online: 2020-09-04

open access

Page views 2109
Article views/downloads 1611
Get Citation

Connect on Social Media

Connect on Social Media

Correlation analysis of cortisol concentration in hair versus concentrations in serum, saliva, and urine

Łukasz Cieszyński1, Jarosław Jendrzejewski1, Piotr Wiśniewski1, Przemysław Kłosowski1, Krzysztof Sworczak1
Pubmed: 32944922
Endokrynol Pol 2020;71(6):539-544.


Introduction: Cortisol concentration is measured in blood, urine, and saliva samples. It has been recently proven that cortisol could also be detected in hair samples. Cortisol measurements in different samples have their own individual characteristics and clinical utility. We aimed to investigate the correlation between hair cortisol concentration and standard cortisol measurements used in clinical practice.

Material and methods: Fifty adult volunteers with a negative history of endocrine disorders were enrolled in the study. Morning serum cortisol (MSC), evening serum cortisol (ESC), evening free salivary cortisol (EFSC), urine free cortisol (UFC), and hair cortisol concentration (HCC) were analysed in all participants. Eventually, 41 volunteers were included into the study, whose cortisol concentration in the 1 mg overnight dexamethasone suppression test (1 mg ONDST) were < 50 nmol/L, and cortisol levels in serum, saliva, and urine were within reference ranges. Hair cortisol concentration test was performed for 20 mg of hair strands of the proximal 1 cm hair segments.

Results: Hair cortisol concentration ranged from 0.3036 to 2.65 nmol/mg, and the average value was 0.8125 ± 0.4834 nmol/mg. No significant correlations were found between HCC and MSC (rho = 0.04419, p = 0.7838), HCC and ESC (rho = –0.2071, p = 0.1938), HCC and EFSC (rho = 0.1005, p = 0.532), or HCC and UFC (rho = 0.1793, p = 0.262).
Conclusions: This work is another step in the discussion on the application of HCC determinations in clinical practice. Our results have showed no correlations between HCC and single point cortisol assessment in blood, saliva, and urine in patients with reference cortisol levels.

Article available in PDF format

View PDF Download PDF file


  1. Haddad RA, Giacherio D, Barkan AL. Interpretation of common endocrine laboratory tests: technical pitfalls, their mechanisms and practical considerations. Clin Diabetes Endocrinol. 2019; 5: 12.
  2. Pasternak-Pietrzak K, Moszczyńska E, Jurkiewicz E, et al. Paediatric Cushing's disease - a literature review of epidemiology, pathogenesis, clinical symptoms, and diagnostics. Endokrynol Pol. 2020; 71(1): 87–95.
  3. Putignano P, Bertolini M, Losa M, et al. Screening for Cushing's syndrome in obese women with and without polycystic ovary syndrome. J Endocrinol Invest. 2003; 26(6): 539–544.
  4. Fichna M, Fichna P. Glucocorticoids and beta-cell function. Endokrynol Pol. 2017; 68(5): 568–573.
  5. Cyrańska-Chyrek E, Szczepanek-Parulska E, Stajgis P, et al. Distinct clinical picture of Cushing's syndrome in a patient with Morris' syndrome - first literature report. Endokrynol Pol. 2020; 71(1): 96–97.
  6. Levine A, Zagoory-Sharon O, Feldman R, et al. Measuring cortisol in human psychobiological studies. Physiol Behav. 2007; 90(1): 43–53.
  7. Gatti R, Antonelli G, Prearo M, et al. Cortisol assays and diagnostic laboratory procedures in human biological fluids. Clin Biochem. 2009; 42(12): 1205–1217.
  8. Abdulateef DS, Mahwi TO. Assessment of hair cortisol in euthyroid, hypothyroid, and subclinical hypothyroid subjects. Endocrine. 2019; 63(1): 131–139.
  9. Cieszyński Ł, Berendt-Obołończyk M, Szulc M, et al. Cushing's syndrome due to ectopic ACTH secretion. Endokrynol Pol. 2016; 67(4): 458–471.
  10. Meulenberg PM, Hofman JA. The effect of oral contraceptive use and pregnancy on the daily rhythm of cortisol and cortisone. Clin Chim Acta. 1990; 190(3): 211–221.
  11. Stalder T, Kirschbaum C, Kudielka BM, et al. Assessment of the cortisol awakening response: Expert consensus guidelines. Psychoneuroendocrinology. 2016; 63: 414–432.
  12. Fries E, Dettenborn L, Kirschbaum C. The cortisol awakening response (CAR): facts and future directions. Int J Psychophysiol. 2009; 72(1): 67–73.
  13. Hellman L, Nakada F, Zumoff B, et al. Renal capture and oxidation of cortisol in man. J Clin Endocrinol Metab. 1971; 33(1): 52–62.
  14. Viardot A, Huber P, Puder JJ, et al. Reproducibility of nighttime salivary cortisol and its use in the diagnosis of hypercortisolism compared with urinary free cortisol and overnight dexamethasone suppression test. J Clin Endocrinol Metab. 2005; 90(10): 5730–5736.
  15. Raul JS, Cirimele V, Ludes B, et al. Detection of physiological concentrations of cortisol and cortisone in human hair. Clin Biochem. 2004; 37(12): 1105–1111.
  16. Wennig R. Potential problems with the interpretation of hair analysis results. Forensic Sci Int. 2000; 107(1–3): 5–12.
  17. Gow R, Thomson S, Rieder M, et al. An assessment of cortisol analysis in hair and its clinical applications. Forensic Sci Int. 2010; 196(1-3): 32–37.
  18. Henderson GL. Mechanisms of drug incorporation into hair. Forensic Sci Int. 1993; 63(1–3): 19–29.
  19. Wosu AC, Valdimarsdóttir U, Shields AE, et al. Correlates of cortisol in human hair: implications for epidemiologic studies on health effects of chronic stress. Ann Epidemiol. 2013; 23(12): 797–811.e2.
  20. Stalder T, Steudte-Schmiedgen S, Alexander N, et al. Stress-related and basic determinants of hair cortisol in humans: A meta-analysis. Psychoneuroendocrinology. 2017; 77: 261–274.
  21. Staufenbiel SM, Penninx BW, Spijker AT, et al. Hair cortisol, stress exposure, and mental health in humans: a systematic review. Psychoneuroendocrinology. 2013; 38(8): 1220–1235.
  22. Dettenborn L, Tietze A, Kirschbaum C, et al. The assessment of cortisol in human hair: associations with sociodemographic variables and potential confounders. Stress. 2012; 15(6): 578–588.
  23. Gerber M, Jonsdottir IH, Kalak N, et al. Objectively assessed physical activity is associated with increased hair cortisol content in young adults. Stress. 2013; 16(6): 593–599.
  24. Garcia-Leon MA, Peralta-Ramirez MI, Arco-Garcia L, et al. Hair cortisol concentrations in a Spanish sample of healthy adults. PLoS One. 2018; 13(9): e0204807.
  25. Kristensen SK, Larsen SC, Olsen NJ, et al. Hair dyeing, hair washing and hair cortisol concentrations among women from the healthy start study. Psychoneuroendocrinology. 2017; 77: 182–185.
  26. Ito N, Ito T, Kromminga A, et al. Human hair follicles display a functional equivalent of the hypothalamic-pituitary-adrenal axis and synthesize cortisol. FASEB J. 2005; 19(10): 1332–1334.
  27. Slominski R, Rovnaghi CR, Anand KJS. Methodological Considerations for Hair Cortisol Measurements in Children. Ther Drug Monit. 2015; 37(6): 812–820.
  28. Russell E, Kirschbaum C, Laudenslager ML, et al. Toward standardization of hair cortisol measurement: results of the first international interlaboratory round robin. Ther Drug Monit. 2015; 37(1): 71–75.
  29. Cieszyński Ł, Jendrzejewski J, Wiśniewski P, et al. Hair cortisol concentration in a population without hypothalamic-pituitary-adrenal axis disorders. Adv Clin Exp Med. 2019; 28(3): 369–373.
  30. Umeda T, Hiramatsu R, Iwaoka T, et al. Use of saliva for monitoring unbound free cortisol levels in serum. Clin Chim Acta. 1981; 110(2–3): 245–253.
  31. Poll EM, Kreitschmann-Andermahr I, Langejuergen Y, et al. Saliva collection method affects predictability of serum cortisol. Clin Chim Acta. 2007; 382(1-2): 15–19.
  32. Hellhammer DH, Wüst S, Kudielka BM. Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology. 2009; 34(2): 163–171.
  33. Gozansky WS, Lynn JS, Laudenslager ML, et al. Salivary cortisol determined by enzyme immunoassay is preferable to serum total cortisol for assessment of dynamic hypothalamic–pituitary–adrenal axis activity. Clin Endocrinol (Oxf). 2005; 63(3): 336–341.
  34. Arafah BM, Nishiyama FJ, Tlaygeh H, et al. Measurement of salivary cortisol concentration in the assessment of adrenal function in critically ill subjects: a surrogate marker of the circulating free cortisol. J Clin Endocrinol Metab. 2007; 92(8): 2965–2971.
  35. Short SJ, Stalder T, Marceau K, et al. Correspondence between hair cortisol concentrations and 30-day integrated daily salivary and weekly urinary cortisol measures. Psychoneuroendocrinology. 2016; 71: 12–18.
  36. Sauvé B, Koren G, Walsh G, et al. Measurement of cortisol in human hair as a biomarker of systemic exposure. Clin Invest Med. 2007; 30(5): E183–E191.
  37. Xie Q, Gao W, Li J, et al. Correlation of cortisol in 1-cm hair segment with salivary cortisol in human: hair cortisol as an endogenous biomarker. Clin Chem Lab Med. 2011; 49(12): 2013–2019.
  38. Vanaelst B, Huybrechts I, Bammann K, et al. Intercorrelations between serum, salivary, and hair cortisol and child-reported estimates of stress in elementary school girls. Psychophysiology. 2012; 49(8): 1072–1081.
  39. Steudte S, Kolassa IT, Stalder T, et al. Increased cortisol concentrations in hair of severely traumatized Ugandan individuals with PTSD. Psychoneuroendocrinology. 2011; 36(8): 1193–1200.
  40. Davenport MD, Tiefenbacher S, Lutz CK, et al. Analysis of endogenous cortisol concentrations in the hair of rhesus macaques. Gen Comp Endocrinol. 2006; 147(3): 255–261.
  41. Iglesias S, Jacobsen D, Gonzalez D, et al. Hair cortisol: A new tool for evaluating stress in programs of stress management. Life Sci. 2015; 141: 188–192.
  42. Russell E, Koren G, Rieder M, et al. Hair cortisol as a biological marker of chronic stress: current status, future directions and unanswered questions. Psychoneuroendocrinology. 2012; 37(5): 589–601.
  43. Karlén J, Ludvigsson J, Frostell A, et al. Cortisol in hair measured in young adults — a biomarker of major life stressors? BMC Clin Pathol. 2011; 11: 12.
  44. Wosu AC, Gelaye B, Valdimarsdóttir U, et al. Hair cortisol in relation to sociodemographic and lifestyle characteristics in a multiethnic US sample. Ann Epidemiol. 2015; 25(2): 90–5, 95.e1.