Hair cortisol and endocannabinoids measurement in patients with adrenal incidentalomas: A case-control study

Abstract

Abstract Purpose The role of endocannabinoids (ECs) in the regulation of the hypothalamo-pituitary-adrenocortical axis has been already studied; however, data are scarce in humans. The aim of our study was to analyse the ECs [anandamide (AEA) and 2-arachidonoylglycerol (2-AG)] and cortisol (F) levels in the hair samples of patients with adrenal incidentalomas (AIs) in comparison with controls and assess their association with the hormone profile. Methods Forty-four patients with AIs [32 with non-functioning AIs (NFAIs) and 12 with possible autonomous secretion (PACS)] and 44 controls were recruited. Basal and post-1mg overnight dexamethasone suppression test (ODST) F, adrenocorticotropic hormone, dehydroepiandrosterone sulfate and 24-h urinary free cortisol were analysed. After hair collection, EC and F levels were measured by liquid chromatography tandem-mass spectrometry. Results There was no difference between the groups regarding the age, sex and metabolic status. Significantly decreased hair AEA and 2-AG levels were found in patients with AIs compared to controls (p < 0.001 and p = 0.002 respectively) as well as between NFAI or PACS and controls (p < 0.001 or p = 0.002 and p = 0.038 or p = 0.02 respectively). Among the AI patients, EC levels tended to be lower in PACS group. AEA hair levels were negatively correlated with F levels post-1mg ODST (rs=-0.257, p = 0.033). We did not find any significant difference comparing hair F between the groups. Conclusion Our findings suggest that hair ECs measurement could be a potential biomarker in the evaluation of patients with AIs, while hair F analysis is not a useful diagnostic test for mild hypercortisolemia.