Scalp hair cortisol and testosterone levels in patients with sarcoidosis.

M J G Van Manen,K Y Dorst,Y B De Rijke,M S Wijsenbeek,V L Wester,E F C Van Rossum,L M Van Den Toorn

doi:10.1371/journal.pone.0215763

Abstract

BackgroundPatients with sarcoidosis often experience fatigue and psychological distress, but little is known about the etiology of these conditions. While serum and saliva steroid hormones are used to monitor acute steroid levels, scalp hair analysis is a relatively new method enabling measurement of long-term steroid levels, including hair cortisol reflecting chronic stress. We investigated whether scalp hair cortisol and testosterone levels differ between sarcoidosis patients both with and without fatigue and general population controls. Additionally, we studied if these hormones could serve as objective biomarkers for psychological distress in patients with sarcoidosis.MethodsWe measured hair steroid levels using liquid chromatography–tandem mass spectrometry in glucocorticoid naïve sarcoidosis patients. Patients completed the Perceived Stress Scale, Fatigue Assessment Scale, Hospital Anxiety and Depression Scale and Short Form 36 (SF-36). Hair steroid levels from 293 participants of the population-based Lifelines cohort study served as controls.ResultsThirty-two patients (14 males) were included. Hair cortisol, but not testosterone, concentrations were significantly higher in patients with sarcoidosis than in general population controls (mean 6.6 versus 2.7 pg/mg, p<0.001). No differences were found in hair cortisol and testosterone levels between fatigued and non-fatigued patients with sarcoidosis. Hair cortisol of sarcoidosis patients correlated significantly with anxiety (r = 0.47, p = 0.01), depression (r = 0.46, p = 0.01), and SF-36 mental domain (r = -0.38, p = 0.03), but not with fatigue.ConclusionsPatients with sarcoidosis have chronically higher levels of the stress hormone cortisol than the normal population, while testosterone levels in hair did not differ. Hair cortisol levels were positively related to subjective measures of psychological distress, but not to fatigue. Our study shows that hair cortisol is a promising non-invasive biomarker for psychological distress in patients with sarcoidosis.Trial registrationClinicalTrials.gov: NCT03108547. Registered 31 March 2017, retrospectively registered.

Highlights

Sarcoidosis is a multi-organ disease of unknown etiology, characterized by non-caseating granulomas, which commonly occur in the lymph nodes, lungs, skin and eyes [1]
We investigated whether scalp hair cortisol and testosterone levels differ between sarcoidosis patients both with and without fatigue and general population controls
Hair cortisol levels were positively related to subjective measures of psychological distress, but not to fatigue

Summary

Introduction

Sarcoidosis is a multi-organ disease of unknown etiology, characterized by non-caseating granulomas, which commonly occur in the lymph nodes, lungs, skin and eyes [1]. Fatigue and psychological distress are frequently reported problems [2,3,4,5]. Chronic fatigue in sarcoidosis patients has been associated with increased levels of perceived stress and psychological stressors such as depression and anxiety [4,5,6]. While stress and inflammation are both associated with increased levels of cortisol, there are studies that show evidence of hypocortisolism in relation to chronic fatigue, [13, 14] thereby leaving the relationship between cortisol and fatigue in sarcoidosis unclear. Patients with sarcoidosis often experience fatigue and psychological distress, but little is known about the etiology of these conditions. We studied if these hormones could serve as objective biomarkers for psychological distress in patients with sarcoidosis.

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