scholarly journals The Value of the Low-Dose Dexamethasone Suppression Test in the Differential Diagnosis of Hyperandrogenism in Women

2003 ◽  
Vol 88 (6) ◽  
pp. 2634-2643 ◽  
Author(s):  
Gregory A. Kaltsas ◽  
Andrea M. Isidori ◽  
Blerina P. Kola ◽  
Rob H. Skelly ◽  
Shern L. Chew ◽  
...  
Keyword(s):  
Low Dose ◽  
Clinical Presentation ◽  
Dexamethasone Suppression Test ◽  
Adrenal Tumors ◽  
Adrenal Androgen ◽  
Testosterone Levels ◽  
Small Series ◽  
Suppression Test ◽  
Dexamethasone Suppression ◽  
Androgen Levels

We studied 211 hyperandrogenic women with respect to clinical presentation, basal androgen levels, and the degree of cortisol and androgen suppression during a 48-h low-dose (2 mg) dexamethasone-suppression test (LDDST) to exclude ovarian and adrenal tumors. In 42 women with elevated testosterone levels, 21 of whom failed to suppress testosterone during the LDDST, the response of serum androgen levels during a 4-wk administration of 7.5 mg prednisolone in a reverse circadian regimen was also assessed. These results were compared with an additional 17 patients with histologically proven androgen-secreting tumors. Clinical presentation alone was suggestive of a virilizing tumor in 70% of patients with tumors. Serum testosterone, although occasionally only marginally elevated, was the sole androgen that was elevated in every patient with a tumor. After the LDDST, none of the patients with tumors obtained either a greater than 40% reduction or normalization of the previously elevated testosterone levels, whereas 88% of patients with nontumorous hyperandrogenism showed either normalization or suppression of more than 40%. With one exception, all of the patients with nontumorous hyperandrogenism who showed inadequate suppression of testosterone during the LDDST, and were treated with prednisolone, normalized the previously elevated androgens after 1 month of administration. In summary, in women presenting with hyperandrogenism, lack of testosterone suppression during the LDDST is associated with 100% sensitivity and 88% specificity in distinguishing patients with ovarian and adrenal androgen-secreting tumors from patients with nontumorous hyperandrogenism in this small series. The LDDST is an easy to perform screening test that can also identify causes of hyperandrogenism due to altered glucocorticoid secretion.

scholarly journals Elevated Testosterone Levels With Unclear Etiology- the Need for Longer Follow up and Role of Dexamethasone Suppression Test as a Useful Tool to Distinguish Tumorous vs Non Tumorous Etiology

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A757-A758
Author(s):  
Muhammad Ilyas Khan ◽  
Stuart Ruthven ◽  
Peter Smith ◽  
Monika Oktaba ◽  
Sumer A ◽  
...  
Keyword(s):  
Testosterone Level ◽  
Low Dose ◽  
Dexamethasone Suppression Test ◽  
Bilateral Oophorectomy ◽  
Testosterone Levels ◽  
Free Cortisol ◽  
Suppression Test ◽  
Unclear Etiology ◽  
Dexamethasone Suppression

Abstract Background: Severe hirsutism in women in conjunction with elevated testosterone level raises concern for androgen secreting tumors. When initial investigations and radiological imaging do not identify a tumorous pathology, clinicians are faced with a dilemma on whether to investigate further or to consider a benign cause such as PCOS or ovarian hyperthecosis. There is inadequate evidence on how long these patients need to be followed up before considering a benign cause for their symptoms. Clinical Case: 57 years-old female, with pertinent history including primary hypothyroidism and eczema, was referred to endocrine clinic in September-2011 for work-up of severe hirsutism and elevated testosterone levels of 4.1 nmol /L (n: 0 - 2.5). All other tests including androstenedione, DHEAS, baseline pituitary profile and 24-hours urinary free cortisol levels were unremarkable. MRI of adrenal glands and ovaries was also unremarkable. Patient was presumptively diagnosed with ovarian hyperthecosis and commenced on spironolactone. There was improvement in hirsutism and patient was discharged from clinic in Feb 2012. Patient was re-referred to endocrine clinic 7 years later in September-2019 for worsening of hirsutism, male pattern baldness. At this stage, patient had testosterone levels of 17– 23 nmol/L (n: 0 - 2.5). Free androgen index 76.6% (n:0–7), SHBG (35 nmol/L, n: 18 – 114). Androstenedione (4 nmol, n: 1 – 8.5) DHEAS (2.3 umol/L, n: 0.3 – 12), 24-hours urine free cortisol level (< 13 nmol, n: < 165 nmol), 17-hydroxyprogesterone, serum ACTH, TSH, LH and FSH and estradiol levels were all normal. On examination patient had signs of virilization which had developed over previous six months. Patient had a low dose dexamethasone suppression test (0.5 mg of dexamethasone 6 hourly for 48 hours). The androgen profile obtained pre and post test showed no suppression in testosterone but well suppressed cortisol. Patient had repeat MRI of the adrenals and ovaries which revealed focal enhancing mass in right ovary (3.3 x 2.5 x 2.6 cm). Patient had an urgent bilateral oophorectomy and histology confirmed a rare steroid cell tumour of the right ovary. Following surgery there has been a significant improvement in her symptoms. Conclusion: Patients with elevated testosterone level and unclear etiology need longer follow up and review of investigations when symptoms worsen as yet undiscovered sinister etiology could be the likely reason. Dexamethasone suppression can be considered as a useful tool to distinguish tumorous vs non tumorous etiology in early stage of investigations as poor suppression of androgens with dexamethasone increases the likelihood of tumorous etiology1References: 1. Kaltsas GA, Isidori AM, Kola BP, et al. The Value of the Low-Dose Dexamethasone Suppression Test in the Differential Diagnosis of Hyperandrogenism in Women. The Journal of Clinical Endocrinology & Metabolism 2003; 88(6): 2634-43.

scholarly journals Patterns of the low‐dose dexamethasone suppression test in canine hyperadrenocorticism revisited

2021 ◽  
Author(s):  
Florian K. Zeugswetter ◽  
Alejandra Carranza Valencia ◽  
Kerstin Glavassevich ◽  
Ilse Schwendenwein
Keyword(s):  
Low Dose ◽  
Dexamethasone Suppression Test ◽  
Suppression Test ◽  
Dexamethasone Suppression

Major Depressive Episode and Low Dose Dexamethasone Suppression Test

1982 ◽  
Vol 36 (2) ◽  
pp. 109-114
Author(s):  
Masakazu Sarai ◽  
Norio Taniguchi ◽  
Takao Kagomoto ◽  
Hideaki Kameda ◽  
Takeshi Uema ◽  
...  
Keyword(s):  
Depressive Episode ◽  
Low Dose ◽  
Major Depressive Episode ◽  
Dexamethasone Suppression Test ◽  
Major Depressive ◽  
Suppression Test ◽  
Dexamethasone Suppression

Low-Dose, Stand Overnight and Low-Dose Dexamethasone Suppression Test in Patients with Mild and/or Episodic Hypercortisolism

2011 ◽  
pp. P3-531-P3-531
Author(s):  
Nesyah Shayesteh ◽  
Michael Mangubat ◽  
Mastaneh Haykani ◽  
Martin L Lee ◽  
Ian E McCutcheon ◽  
...  
Keyword(s):  
Low Dose ◽  
Dexamethasone Suppression Test ◽  
Suppression Test ◽  
Dexamethasone Suppression

Two Day Low Dose Dexamethasone Suppression Test

2015 ◽  
pp. 19-22
Author(s):  
Ahmet Bahadir Ergin ◽  
Amir H. Hamrahian ◽  
A. Laurence Kennedy ◽  
Manjula K. Gupta
Keyword(s):  
Low Dose ◽  
Dexamethasone Suppression Test ◽  
Suppression Test ◽  
Dexamethasone Suppression

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

BMJ ◽  
1985 ◽  
Vol 290 (6462) ◽  
pp. 158-159
Author(s):  
L. Kennedy ◽  
D. Hadden ◽  
B. Atkinson ◽  
B Sheridan ◽  
H. Johnston
Keyword(s):  
Cushing’S Syndrome ◽  
Low Dose ◽  
Serum Cortisol ◽  
Cushing's Syndrome ◽  
Dexamethasone Suppression Test ◽  
Suppression Test ◽  
Dexamethasone Suppression

Suppression of cortisol secretion by low-dose dexamethasone testing in Cushing's disease

1983 ◽  
Vol 58 (1) ◽  
pp. 129-132 ◽  
Author(s):  
Lucille W. King ◽  
Kalmon D. Post ◽  
Israel Yust ◽  
Seymour Reichlin
Keyword(s):  
Cushing’S Disease ◽  
Low Dose ◽  
Dexamethasone Suppression Test ◽  
Cushing's Disease ◽  
Cortisol Secretion ◽  
Content Type ◽  
Normal Individuals ◽  
Suppression Test ◽  
Peripheral Clearance ◽  
Dexamethasone Suppression

✓ Pituitary-adrenal function in a patient with classical features of Cushing's disease, increased urinary excretion of cortisol, and documented pituitary adenoma was found to be suppressed by dexamethasone in doses even less than those required to inhibit secretion in normal individuals. This response was shown to be due to inappropriately high levels of dexamethasone in plasma, presumed to be the consequence of decreased peripheral clearance. Because the dexamethasone suppression test is so widely used for diagnosis of Cushing's disease, it is important to recognize that this situation can occasionally occur.

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