Využití stanovení vlasového kortizolu u pacientů s ektopickým Cushingovým syndromem
| Title in English | Hair cortisol potential in patients with ectopic Cushing's syndrome |
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| Authors | |
| Year of publication | 2025 |
| Type | Conference abstract |
| MU Faculty or unit | |
| Citation | |
| Description | Introduction Ectopic Cushing's syndrome (ECS) is a rare condition caused by the secretion of adrenocorticotropic hormone by tumors that are not of pituitary origin. Its most common causes include bronchial carcinoid, small cell lung carcinoma (SCLC), followed by gastrointestinal neuroendocrine tumors, medullary thyroid carcinoma, and pheochromocytoma. ECS represents a significant clinical problem requiring not only immediate diagnosis but also treatment due to the risk of life-threatening complications resulting from severe hypercortisolemia. Currently, monitoring of circadian variability of cortisol concentrations, determination of free urinary cortisol over 24 hours, dexamethasone suppression test, or morning basal ACTH plasma levels are used for the diagnosis of ECS. All of these methods are burdensome or stressful for the patient, but determination of segmented hair cortisol is minimally invasive for the patient - it only involves cutting a small strand of hair. Methodology Sample collection involves cutting a strand of hair from the vertex posterior region. The cut strand is placed in a dry, clean place where it is stored until the sample is delivered to the laboratory. In the laboratory, the hair strand is segmented 1 cm from the apical end, washed with isopropanol to remove exogenous contamination, and dried. Subsequently, the individual segments are weighed, an internal standard is added, and extraction is carried out overnight with methanol. After evaporation and reconstitution, it is determined using liquid chromatography with mass spectrometry and preliminary online solid-phase purification (online SPE LC-MS). Results Segmented hair cortisol was determined using online SPE LC-MS in 17 patients diagnosed with small cell lung cancer. Elevated cortisol values significantly exceeding the previously determined reference interval for the first segment were demonstrated in 80% of patients with SCLC. Conclusion Determination of hair cortisol in patients with ECS represents a suitable and inexpensive alternative to conventional ECS diagnostics. Given that ECS is part of a paraneoplastic syndrome, it is appropriate to determine hair cortisol levels in oncological patients before chemotherapy itself and possibly initiate early ECS treatment leading to increased survival time and improved response to chemotherapy. |
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