Scalp hair cortisol: A promising new biomarker for psychological wellbeing in patients with sarcoidosis?

Introduction: Stress, depression, anxiety and fatigue are major problems in sarcoidosis. Little is known about the etiology of psychological distress in sarcoidosis. Serum and saliva cortisol tests are commonly used to monitor acute stress. Scalp hair cortisol is a novel biomarker of long-term cortisol levels, and may reveal biological stress and its relationship with psychopathology in sarcoidosis patients. Aim: To study the relationships between hair cortisol concentrations (HCC) and psychological and fatigue measures in patients with sarcoidosis. Methods: We measured HCC using liquid chromatography–tandem mass spectrometry in glucocorticoid naive sarcoidosis patients. All patients completed the Hospital Anxiety and Depression Scale (HADS), Fatigue Assessment Scale (FAS), Perceived Stress Scale (PSS) and Short Form 36 (SF-36). Results: We included 32 patients with sarcoidosis (14 male). Mean (ranges) questionnaire scores were respectively PSS 26 (4-55), FAS 29 (10-46), HADS anxiety 6 (0-19), HADS depression 7 (0-21) and SF-36 mental field 60 (36-75); no significant sex differences were observed. In women, elevated HCC were associated with decreased psychological wellbeing, as measured by PSS (r=0.588, p=0.01), SF-36 mental (r=-0.553, p=0.017) and HADS anxiety (r=0.716, p=0.001), HADS depression (r=0.655,p=0.003). No significant correlations were found in men. HCC did not correlate with the FAS. Conclusion: Long-term increased cortisol measured in scalp hair is associated with decreased psychological wellbeing in women with sarcoidosis, but not with fatigue. Hair cortisol analysis seems a promising non-invasive biomarker of distress in sarcoidosis. Sex differences need further evaluation.