Developed by Schulich School of Medicine & Dentistry professor Stan Van Uum, a new hair analysis may shed light on up to three years of the body’s production of the hormone cortisol. And what that ‘time machine’ reveals may just save the lives of patients struggling with adrenal imbalance.
“I compare (the test) to the rings of a tree that you can go back and see things that have happened in the past,” said Van Uum, who works in the divisions of Clinical Pharmacology and Endocrinology and Metabolism.
Cortisol, produced by the adrenal glands, is normally released during stressful situations and controls the body’s use of carbohydrates, fats and proteins. By doing so, it helps reduce the immune system’s response to swelling or inflammation.
Known as the ‘stress hormone,’ cortisol reveals itself during ‘fight or flight’ moments and is responsible for positive effects, such as quick bursts of energy or immunity, lower sensitivity to pain, even heightened memory functions.
Problems occur when this hormone swings wildly one way or another and doctors need to formulate a plan to treat the imbalance.
“With any hormone, too much is not good and too little is not good,” Van Uum said.
For cortisol, low levels can cause gastrointestinal symptoms, such as nausea, vomiting, diarrhea, weight loss. Extremely low levels can cause severe sickness or even death. On the flip side, high levels can lead to Cushing’s Disease, whose symptoms include high blood pressure, decreased peripheral vision and impaired immunological function. These could require surgery.
An accurate picture of the problem, and what role cortisol played in it, is key to proper treatment for patients. But until now, there was no way to look into the symptoms’ past.
“Any test you do – blood, urine, saliva – only tells you what’s happening now, and not what happened in the past,” Van Uum said. “When a patient says the symptoms started earlier, there was never a way for us to verify the symptoms, and if the disease started earlier. You had to go on their word.”
Van Uum’s test uses hair to measure cortisone levels and diagnose patients struggling with adrenal imbalance before they need to start treatment.
On average, hair grows around one centimetre a month. Therefore, a 12-centimetre strand would provide a year’s worth of information on cortisol levels. Having results that go back as far as three years – depending on the length of the hair – will support physicians in making a proper diagnosis, Van Uum said.
One patient Van Uum looked at was a 19-year-old woman admitted to hospital with nausea, vomiting, a urinary tract infection and severe hypotension that necessitated a five-day stay in the intensive care unit (ICU). Her test showed an acute adrenal insufficiency crisis. Aldosterone and renin levels (expected to be low and high, respectively) were not measured, and the patient was prescribed hydrocortisone and fludrocortisone.
A more detailed history, using the hair test, suggested the adrenal insufficiency developed much earlier than detected. The patient provided a hair sample (about 36 cm in length), and it showed a decline in cortisol production started almost three years before her admission to the ICU and coincided with the onset of symptoms of her adrenal insufficiency.
Should diagnosis require a patient need treatment, such as hydrocortisone, this method could also be used as a way to determine the effectiveness of the treatment – too much or not enough – and whether it should be continued or another form of treatment sought.