Serum cortisol level after low dose dexamethasone suppression test may be predictive for diabetes mellitus and hypertension presence in obese patients: A retrospective study

AbstractIn this study, we compared the 2 mg dexamethasone suppression test (DST) with the gold-standard 1 mg DST in obese patients in order to reduce the false-positive rate for Cushing’s syndrome (CS). The primary endpoint was the comparison of serum cortisol levels after 1 mg versus 2 mg DST in patients with a BMI >30 kg/m2 and at least one additional feature of the metabolic syndrome. Secondary endpoints were comparison of salivary cortisol and ACTH levels, respectively. Fifty-four obese patients were included. Median serum cortisol levels after 1 mg DST and 2 mg DST were similar [28 nmol/l (20; 36) vs. 28 nmol/l (20; 38), p=0.53]. Salivary cortisol was 8.2 nmol/l (4.7; 11.7) after the 1 mg DST vs. 6.7 nmol/l (4.2; 9.5) after the 2 mg test, p=0.09. ACTH levels were higher after the 1 mg DST compared to the 2 mg DST [10.0 pg/ml (7.6; 10.7) vs. 5.0 pg/ml (5.0; 5.1), p<0.0001]. The false positive rate after the 1 mg DST was 14.8% (n=8) and was reduced to 11.1% (n=6) after the 2 mg DST. All non-suppressors (n=8) had type 2 diabetes and most of them took a medication interacting with cytochrome P450 3A4 (CYP3A4). In individuals with obesity, the 2 mg DST was not superior to the 1 mg DST in regard to serum cortisol levels. However, in some patients, particularly with poorly controlled diabetes or medication interacting with CYP3A4 and without adequate suppression after the 1 mg DST, the 2 mg DST might prove helpful to reduce the false-positive rate for CS. ClinicalTrials.gov Number: NCT02227420

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An Optimized Pathway for the Differential Diagnosis of ACTH-Dependent Cushing’s Syndrome Based on Low-Dose Dexamethasone Suppression Test

Frontiers in Endocrinology ◽

10.3389/fendo.2021.720823 ◽

2021 ◽

Vol 12 ◽

Author(s):

Kang Chen ◽

Shi Chen ◽

Lin Lu ◽

Huijuan Zhu ◽

Xiaobo Zhang ◽

...

Keyword(s):

Differential Diagnosis ◽

Cushing’S Syndrome ◽

Low Dose ◽

Serum Cortisol ◽

Cushing's Syndrome ◽

Dexamethasone Suppression Test ◽

High Dose ◽

Free Cortisol ◽

Suppression Test ◽

Dexamethasone Suppression

ContextTraditionally, low-dose dexamethasone suppression test (LDDST) was used to confirm the diagnosis of Cushing’s syndrome (CS), and high-dose dexamethasone suppression test (HDDST) was used to differentiate Cushing’s disease (CD) and ectopic adrenocorticotropin (ACTH) syndrome (EAS), but some studies suggested that HDDST might be replaced by LDDST. For the differential diagnosis of CS, dexamethasone suppression test was usually combined with other tests such as bilateral petrosal sinus sampling (BIPSS) and pituitary magnetic resonance imaging, but the optimal pathway to incorporate these tests is still controversial.ObjectivesTo develop an optimized pathway for the differential diagnosis of CD and EAS based on LDDST.Design and SettingSingle-center retrospective study (2011–2019).PatientsTwo hundred sixty-nine CD and 29 EAS patients with pathological diagnosis who underwent consecutive low- and high-dose DST.ResultsFor the differential diagnosis of CD and EAS, the area under curve (AUC) of LDDST using urine free cortisol (0.881) was higher than that using serum cortisol (0.685) (p < 0.001) in head-to-head comparison among a subgroup of 108 CD and 10 EAS. The AUC of LDDST (0.883) was higher than that of HDDST (0.834) among all the included patients. With the cutoff of <26%, the sensitivity and specificity of LDDST were 39.4% and 100%. We designed a new pathway in which BIPSS was only reserved for those patients with unsuppressed LDDST and adenoma <6mm, yielding an overall sensitivity of 97.7% and specificity of 86.7%.ConclusionLDDST had similar value to HDDST in differentiating CD and EAS using the specific cutoff point. The pathway that combined LDDST and BIPSS could differentiate CD and EAS accurately.

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Serum cortisol concentrations during low dose dexamethasone suppression test to screen for Cushing's syndrome.

BMJ ◽

10.1136/bmj.289.6453.1188 ◽

1984 ◽

Vol 289 (6453) ◽

pp. 1188-1191 ◽

Cited By ~ 50

Author(s):

L Kennedy ◽

A B Atkinson ◽

H Johnston ◽

B Sheridan ◽

D R Hadden

Keyword(s):

Cushing’S Syndrome ◽

Low Dose ◽

Serum Cortisol ◽

Cushing's Syndrome ◽

Dexamethasone Suppression Test ◽

Suppression Test ◽

Dexamethasone Suppression

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Adrenocorticotrophin-dependent hypercortisolism: Imaging versus laboratory diagnosis

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1208500t ◽

2012 ◽

Vol 140 (7-8) ◽

pp. 500-504

Author(s):

Milina Tancic-Gajic ◽

Svetlana Vujovic ◽

Miomira Ivovic ◽

Milos Stojanovic ◽

Ljiljana Marina ◽

...

Keyword(s):

Cortisol Level ◽

Correct Diagnosis ◽

Diagnostic Testing ◽

Serum Cortisol ◽

Laboratory Diagnosis ◽

Serum Cortisol Level ◽

Inferior Petrosal Sinus ◽

Mortality Case ◽

Suppression Test ◽

Dexamethasone Suppression

Introduction. Cushing?s syndrome results from inappropriate exposure to excessive glucocorticoids. Untreated, it has significant morbidity and mortality. Case Outline. A 38-year-old woman with a typical appearance of Cushing?s syndrome was admitted for further evaluation of hypercortisolism. The serum cortisol level was elevated without diurnal rhythm, without adequate suppression of cortisol after 1 mg dexamethasone suppression test. 24-hour urinaryfree cortisol level was elevated. Differential diagnostic testing indicated adrenocorticotrophin (ACTH)- dependent lesion of the pituitary origin. Pituitary abnormalities were not observed during repeated MRI scanning. Inferior petrosal sinus sampling (IPSS) was performed: 1) Baseline ratio ACTH inferior petrosal sinus/peripheral was <2; 2) Corticotropin-releasing hormone (CRH) stimulated ratio ACTH inferior petrosal sinus/peripheral was <3; 3) Baseline intersinus ratio of ACTH was <1.4; 4) Increase in inferior petrosal sinus and peripheral ACTH of more than 50 percent above basal level after CRH; 5) Baseline ratio ACTH vena jugularis interna/peripheral was >1.7. Transsphenoidal exploration and removal of the pituitary tumor was performed inducing iatrogenic hypopituitarism. Postoperative morning serum cortisol level was less than 50 nmol/l on adequate replacement therapy with hydrocortisone, levothyroxine and estro-progestagen. Conclusion. No single test provides absolute distinction, but the combined results of several tests generally provide a correct diagnosis of Cushing?s syndrome.

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Elevated Cortisol Level and Cortisol/DHEAS Ratio in Schizophrenia as Revealed by Low-Dose Dexamethasone Suppression Test

The Open Neuropsychopharmacology Journal ◽

10.2174/1876523801205010018 ◽

2012 ◽

Vol 5 (1) ◽

pp. 18-24 ◽

Cited By ~ 4

Author(s):

Hiroaki Hori

Keyword(s):

Cortisol Level ◽

Low Dose ◽

Dexamethasone Suppression Test ◽

Suppression Test ◽

Dexamethasone Suppression

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Low-Dose and Standard Overnight and Low Dose-Two Day Dexamethasone Suppression Tests in Patients with Mild and/or Episodic Hypercortisolism

Hormone and Metabolic Research ◽

10.1055/a-0603-3868 ◽

2018 ◽

Vol 50 (06) ◽

pp. 453-461 ◽

Cited By ~ 1

Author(s):

Mona Mojtahedzadeh ◽

Nesyah Shaesteh ◽

Mastaneh Haykani ◽

Jennifer Tran ◽

Michael Mangubat ◽

...

Keyword(s):

Cushing’S Syndrome ◽

Low Dose ◽

Serum Cortisol ◽

Cushing's Syndrome ◽

Dexamethasone Suppression Test ◽

Morning Cortisol ◽

Morning Serum Cortisol ◽

Suppression Test ◽

Biochemical Testing ◽

Dexamethasone Suppression

AbstractWe previously reported on the lack of utility of the 1 mg overnight dexamethasone (DEX) test in mild and/or periodic Cushing’s syndrome, as most patients with the condition suppressed to 1 mg DEX. It is possible that a lower dose of DEX as part of an overnight DEX test might be able to distinguish between mild and/or periodic Cushing’s syndrome and those without the condition. The objective of the current study is to determine the sensitivity and specificity of a 0.25 mg overnight DEX suppression test, the standard 1 mg overnight DEX suppression test, and the two-day low-dose (Liddle test) DEX suppression test with and without correction for DEX levels in patients evaluated for mild and/or periodic Cushing’s syndrome. Thirty patients determined to have Cushing’s syndrome by biochemical testing and 14 patients determined not to have the condition had the 0.25 mg and standard 1 mg overnight DEX suppression test and the two-day low-dose DEX suppression tests. Our results show that morning serum cortisol and cortisol/DEX ratios following an overnight dexamethasone suppression test were similar in patients with Cushing’s syndrome and those not having Cushing’s syndrome. However, a morning cortisol value above 7.6 μg/dl following a dose of DEX of 0.25 mg was found in 12 patients with Cushing’s syndrome and none in those not having Cushing’s syndrome, suggesting that a high cortisol value after this low dose of dexamethasone can indicate that further testing for Cushing’s syndrome is warranted. Our data suggest that the traditional 1 mg overnight or the 2 mg/2 day DEX suppression testing should no longer be used as a screening test in patients who could have mild and/or periodic Cushing’s syndrome, while the 0.25 mg dose of DEX may pick up some patients with mild Cushing’s syndrome.

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