Erasmus MC, Department of Internal Medicine, Rotterdam, The Netherlands.
Psychoneuroendocrinology. 2012 Dec;37(12):1960-8. doi: 10.1016/j.psyneuen.2012.04.010. Epub 2012 May 24.
Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is hypothesized to play a role in the pathogenesis of bipolar disorder (BD). Conflicting results have been reported when saliva or serum was used to measure cortisol levels. A recently developed method is to measure cortisol in scalp hair, with 1cm of scalp hair representing 1 month. We studied whether there are differences in long-term hair cortisol levels between BD patients and healthy individuals and whether there are associations between hair cortisol and disease characteristics.
Hair samples were collected in 100 BD patients and 195 healthy controls. Long-term cortisol levels were determined in 3 cm hair segments. Saliva samples were collected on two consecutive evenings. Documented disease characteristics were disease state, age of onset and psychiatric co-morbidity.
Hair cortisol levels were not statistically different in BD patients compared to healthy controls (p=0.233) and were not associated with the disease state at the moment of sample collection (p=0.978). In the subgroup of patients with age of onset ≥ 30 years, hair cortisol levels were significantly elevated compared to the subgroup with age of onset <30 years and to healthy controls (p=0.004). Psychiatric co-morbidity was associated with elevated cortisol levels (44.87 versus 31.41 pg/mg hair; p=0.021), with the exclusion of panic disorder, which was associated with decreased cortisol levels (22.13 versus 34.67 pg/mg hair; p=0.019).
Elevated long-term cortisol levels might play a role in a subgroup of patients with BD. There may be differences in pathogenesis of younger and older onset BD suggesting two different disease entities.
下丘脑-垂体-肾上腺（HPA）轴的失调被认为在双相情感障碍（BD）的发病机制中起作用。当使用唾液或血清测量皮质醇水平时，报告了相互矛盾的结果。最近开发的方法是测量头皮头发中的皮质醇，1 厘米头皮头发代表 1 个月。我们研究了 BD 患者和健康个体之间长期头发皮质醇水平是否存在差异，以及头发皮质醇与疾病特征之间是否存在关联。
在 100 名 BD 患者和 195 名健康对照者中采集头发样本。在 3 cm 头发段中确定长期皮质醇水平。采集两个连续晚上的唾液样本。记录的疾病特征包括疾病状态、发病年龄和精神共病。
BD 患者与健康对照组相比，头发皮质醇水平无统计学差异（p=0.233），与样本采集时的疾病状态无关（p=0.978）。在发病年龄≥30 岁的患者亚组中，与发病年龄<30 岁的患者亚组和健康对照组相比，头发皮质醇水平显著升高（p=0.004）。精神共病与皮质醇水平升高有关（44.87 与 31.41 pg/mg 头发；p=0.021），不包括惊恐障碍，惊恐障碍与皮质醇水平降低有关（22.13 与 34.67 pg/mg 头发；p=0.019）。
长期皮质醇水平升高可能在 BD 的亚组患者中起作用。年轻和发病年龄较大的 BD 发病机制可能存在差异，提示存在两种不同的疾病实体。
