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In the PWS group large variations in hair cortisol was seen. Mean hair cortisol was 12.8 ± 25.4 pg/mg compared to 3.8 ± 7.3 pg/mg in controls (p= 0.001). The linear regression model similarly showed higher cortisol levels in patients with PWS, which remained consistent after adjusting for BMI and stress (p= 0.023). Furthermore, hair cortisol increased with BMI (p= 0.012) and reported stress (p= 0.014). Long-term cortisol concentrations were higher in patients with PWS compared to controls and increased with BMI and stress, suggesting a