The Dexamethasone Suppression Test as a Discriminator among Subtypes of Psychotic Patients

1982 ◽  
Vol 141 (5) ◽  
pp. 471-474 ◽  
Author(s):  
Anthony J. Rothschild ◽  
Alan F. Schatzberg ◽  
Alan H. Rosenbaum ◽  
Julie B. Stahl ◽  
Jonathan O. Cole
Keyword(s):  
Plasma Cortisol ◽  
Bipolar Depression ◽  
Depressive Illness ◽  
Dexamethasone Suppression Test ◽  
Control Subjects ◽  
Distribution Of Values ◽  
Suppression Test ◽  
Cortisol Levels ◽  
Dexamethasone Suppression

SummaryPlasma Cortisol levels examined at 16.00 hours after dexamethasone in 31 controls and in 34 psychotic patients with various diagnoses, suggests that the ranges of such levels may help to discriminate among subtypes of psychotic patients. They were significantly higher in the unipolar depressed psychotic group than in control subjects or in psychotic patients with bipolar depression or schizophrenia. Moreover, the distribution of values differed between groups. Whereas 8 of 14 psychotic patients with unipolar depressive illness had post-dexamethasone Cortisol values ≥ 14 μg/dl, none of the remaining psychotic patients had similarly high values. Implications of these data are discussed.

scholarly journals Association between posttest dexamethasone and cortisol concentrations in the 1 mg overnight dexamethasone suppression test

2012 ◽  
Vol 1 (2) ◽  
pp. 62-67 ◽  
Author(s):  
Bjørn O Åsvold ◽  
Valdemar Grill ◽  
Ketil Thorstensen ◽  
Marit R Bjørgaas
Keyword(s):  
Cushing’S Syndrome ◽  
Plasma Cortisol ◽  
Polynomial Regression ◽  
Regression Line ◽  
Cushing's Syndrome ◽  
Dexamethasone Suppression Test ◽  
Strong Negative Association ◽  
Suppression Test ◽  
Cortisol Levels ◽  
Dexamethasone Suppression

It has been suggested that comparison of posttest dexamethasone and cortisol concentrations may improve the evaluation of the dexamethasone suppression test (DST) for Cushing's syndrome. In particular, this would be reasonable if posttest cortisol differs by dexamethasone levels within the range that is usually attained in the DST. Using fractional polynomial regression, we therefore studied the association between posttest 0800 h dexamethasone and cortisol levels in 53 subjects without Cushing's syndrome who were tested with the 1 mg overnight DST. Plasma dexamethasone was associated with plasma cortisol (P<0.001), and the regression line suggested a strong negative association related to dexamethasone levels <5 nmol/l. However, among the 94% of subjects with plasma dexamethasone >5.0 nmol/l, there was no association between dexamethasone and cortisol levels (P=0.55). In conclusion, subjects tested with the 1 mg overnight DST usually attain an 0800 h plasma dexamethasone >5 nmol/l, and plasma cortisol does not differ by plasma dexamethasone in these subjects. This suggests that routine comparison of dexamethasone and cortisol levels may not be a useful approach to improve the performance of the 1 mg DST. However, dexamethasone measurements may identify subjects with inadequately low plasma dexamethasone and may therefore be of value when retesting subjects with possibly false-positive DST results.

Dexamethasone Suppression Test in Depressive Illness: Its Relation to Anxiety Symptoms

1984 ◽  
Vol 144 (2) ◽  
pp. 181-184 ◽  
Author(s):  
P. T. Saleem
Keyword(s):  
Depressive Symptoms ◽  
Plasma Cortisol ◽  
Rating Scales ◽  
Depressive Illness ◽  
Dexamethasone Suppression Test ◽  
Anxiety Symptoms ◽  
Negative Finding ◽  
Single Item ◽  
Suppression Test ◽  
Dexamethasone Suppression

SummaryFifty-nine depressed inpatients who satisfied Feighner's criteria for depression were separated into two groups by the response of their plasma Cortisol (1600 hours) to a dose of 1 mg of dexamethasone given at 2100 hours. No statistically significant differences were found between suppressors and non-suppressors as regards severity of anxiety or depressive symptoms in the Leeds and the MADRS rating scales. No single item either in the Leeds or the MADRS scale was associated with a positive DST. The reason for this negative finding is discussed.

The Dexamethasone Suppression Test for Melancholia

1982 ◽  
Vol 140 (3) ◽  
pp. 292-304 ◽  
Author(s):  
Bernard J. Carroll
Keyword(s):  
Differential Diagnosis ◽  
Adrenal Cortex ◽  
Depressive Illness ◽  
Dexamethasone Suppression Test ◽  
Neuroendocrine System ◽  
Biological Research ◽  
Biological Basis ◽  
Suppression Test ◽  
Dexamethasone Suppression

SummaryMelancholia is thought by many investigators to have a biological basis, and biological research, particularly on abnormalities of the neuroendocrine system and of the sleep electroencephalogram, is now beginning to yield results which can help in the differential diagnosis of depressive illness. This review will focus on the most widely studied neuroendocrine disturbance: disinhibition of the hypothalamus-pituitary-adrenal cortex (HPA) system as revealed by the dexamethasone suppression test (DST).

How early can one diagnose Cushing’s disease? An early diagnosis in a case of prepubertal Cushing’s disease

2014 ◽  
Vol 27 (11-12) ◽  
pp. 1043-1047 ◽  
Author(s):  
Julia Hoppmann ◽  
Isabel V. Wagner ◽  
Gudrun Junghans ◽  
Stefan A. Wudy ◽  
Michael Buchfelder ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Cushing’S Disease ◽  
Dexamethasone Suppression Test ◽  
Cushing's Disease ◽  
High Dose ◽  
Thyroid Function Tests ◽  
Free Cortisol ◽  
Suppression Test ◽  
Cortisol Levels ◽  
Dexamethasone Suppression

Abstract Background: Cushing’s disease is very rare in children, and the diagnosis is frequently delayed by several years. Objective: We report a case of prepubertal Cushing’s disease with a medical history of only 9 months. This case illustrates the difficulties involved in diagnosing children at the early stage of the disease. Case presentation: An 8-year-old prepubertal boy presented with rapid weight gain accompanied by a decreasing growth velocity and hirsutism. Thyroid function tests and growth factor levels were normal, thus excluding hypothyroidism and growth hormone deficiency. Cushing’s syndrome was confirmed by elevated 24-h urinary free cortisol levels, increased diurnal cortisol levels, and a lack of cortisol suppression in the low-dose dexamethasone suppression test. Further tests to investigate the source of the hypercortisolism showed the following results: Basal morning adrenocorticotropic hormone (ACTH) was normal. The high-dose dexamethasone suppression test led to a 51% decrease in cortisol level. In the corticotropin-releasing hormone (CRH) test, ACTH and cortisol increased only by 28%. Repeated magnetic resonance imaging (MRI) finally revealed a microadenoma in the anterior pituitary, thus establishng the diagnosis of Cushing’s disease. Upon diagnosis, the patient underwent transsphenoidal surgery. Histological analysis confirmed an ACTH-secreting pituitary adenoma. Conclusion: This case illustrates the difficulties associated with the clinical, biochemical, and radiological diagnoses of Cushing’s disease in children. Early diagnosis remains a challenge because test results often do not match standard diagnostic criteria.

Postdexamethason intact and multisequentia ACTH in melancholia

1991 ◽  
Vol 3 (1) ◽  
pp. 8-13
Author(s):  
M. Maes ◽  
C. Vandervorst ◽  
E. Suy ◽  
M. Martin ◽  
B. Minner ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Plasma Levels ◽  
Clinical Relevance ◽  
Plasma Cortisol ◽  
Adrenocorticotropic Hormone ◽  
Severity Of Illness ◽  
Dexamethasone Suppression Test ◽  
Before And After ◽  
Suppression Test ◽  
Dexamethasone Suppression

SummaryThe dexamethasone suppression test has been carried out in 111 depressed inpatients. Fasting, 8 a.m. plasma levels of Cortisol and adrenocorticotropic hormone (ACTH) were determined before and after administration of 1 mg dexamethasone. In 64 subjects multisequential (1-17,1-24,1-39) ACTH, and in 47 subjects intact (1-39) ACTH has been determined. Patients with melancholia exhibited significantly higher postdexamethasone Cortisol and intact ACTH values as compared with minor and simple major depressives. Severity of illness was significantly and positively related to postdexamethasone intact ACTH - but not to multisequential ACTH. Cortisol nonsuppressors showed higher postdexamethasone (only intact) ACTH values than Cortisol suppressors. Both postdexamethasone ACTH values were significantly and positively related with the postdexamethasone Cortisol values. We have established that Cortisol nonsuppression during melancholia is determined by an augmented escape of ACTH from suppression by dexamethasone. Intact ACTH showed the most significant clinical relevance for depression and Cortisol nonsuppression. In the clinical practice we advize the use of postdexamethasone intact ACTH in stead of plasma Cortisol or multisequential ACTH.

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