Methodological Considerations for Hair Cortisol Measurements in Children
Hair cortisol levels are used increasingly as a measure for chronic stress in young children. We propose modifications to the current methods used for hair cortisol analysis to more accurately determine reference ranges for hair cortisol across different populations and age groups.
The authors compared standard (finely cutting hair) vs. milled methods for hair processing (n=16), developed a 4-step extraction process for hair protein and cortisol (n=16), and compared liquid chromatography-mass spectrometry (LCMS) vs. ELISA assays for measuring hair cortisol (n=28). The extraction process included sequential incubations in methanol and acetone, repeated twice. Hair protein was measured via spectrophotometric ratios at 260/280 nm to indicate the hair dissolution state using a BioTek® plate reader and dedicated software. Hair cortisol was measured using an ELISA assay kit. Individual (n=13), pooled hair samples (n=12) with high, intermediate, and low cortisol values and the ELISA assay internal standards (n=3) were also evaluated by LCMS.
Milled and standard methods showed highly correlated hair cortisol (rs=0.951, p<0.0001) and protein values (rs=0.902, p=0.0002), although higher yields of cortisol and protein were obtained from the standard method in 13/16 and 14/16 samples respectively (p<0.05). Four sequential extractions yielded additional amounts of protein (36.5%, 27.5%, 30.5%, 3.1%) and cortisol (45.4%, 31.1%, 15.1%, 0.04%) from hair samples. Cortisol values measured by LCMS and ELISA were correlated (rs=0.737; p<0.0001), although cortisol levels (median [IQR]) detected in the same samples by LCMS (38.7 [14.4, 136] ng/ml) were lower than by ELISA (172.2 [67.9, 1051] ng/ml). LCMS also detected cortisone, which comprised 13.4% (3.7%, 25.9%) of the steroids detected.
Methodological studies suggest that finely cutting hair with sequential incubations in methanol and acetone, repeated twice, extracts greater yields of cortisol than does milled hair. Based on these findings, at least three incubations may be required to extract most of the cortisol in human hair samples. In addition, ELISA-based assays showed greater sensitivity for measuring hair cortisol levels than LCMS-based assays.
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