scholarly journals MON-165 Utility of Salivary Cortisol After 1 Mg Oral Dexamethasone in the Evaluation of Incidental Adrenal Tumors

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Alejandro L Arregger ◽  
Liliana N Contreras ◽  
Estela M L Cardoso ◽  
María E Céspedes
Keyword(s):  
Salivary Cortisol ◽  
Dexamethasone Suppression Test ◽  
Adrenal Tumors ◽  
Functional Evaluation ◽  
Adrenocortical Adenoma ◽  
Oral Dexamethasone ◽  
Free Cortisol ◽  
Suppression Test ◽  
Dexamethasone Suppression ◽  
Rule Out

Abstract The subclinical Cushing′s syndrome (SCS) is found in 20% of incidental adrenal tumors (AI). The overnight 1 mg oral dexamethasone suppression test (DST) with the measurement of circulating cortisol (F) is a sensitive method to rule out SCS. The assessment of salivary cortisol (SAF) as a surrogate of F became a non-invasive methodological advance. There are few data on the functional evaluation of AI through SAF in DST (SAFdex). The aim of this retrospective study was to investigate the utility of SAFdex for the detection of SCS in patients with AI. Subjects and Methods: 20 subjects with AI (7 male and 13 women; 65.0 ± 11.0 y/o; BMI: 26.5 ± 1.4) were studied. Sixteen had unilateral and 4 bilateral tumors (size: 10.0 - 90.0 mm; density (UH) was <10.0 in 17 cases and ≥ 10.0 in 3). They were not on drugs that may affect the HPA axis. Eight patients (1 male and 7 women; 20.0–60.0 y/o; BMI: 27.0 ± 3.0) with overt non ACTH dependent Cushing Syndrome (CS) were included as the reference group of active hypercortisolism. CS had unilateral adrenal tumors in 6 cases and bilateral in 2 (size: 11.0 -200.0 mm; density (UH) <10.0: n= 7 and >10.0: n=1).All subjects collected 24-hour urine for urinary free cortisol (UFC). After the urine collection, they obtained whole saliva samples at 23 h for cortisol (SAF23). Subsequently, they received 1 mg oral dexamethasone. The following day at 8 h, simultaneous blood (Fdex) and saliva (SAFdex) samples were obtained. F, SAF and UFC were determined by RIA and ACTH by IRMA. Reference values ​​from our laboratory (n= 100): UFC ≤90.0 µg / 24hs; ACTH: 10.0–50.0 pg / ml, SAF23: 0.5–3.8 nM / l; SAFdex: 0.5–2.0 nM; Fdex: 13.8–50.0 nM. Statistics were performed by Mann-Whitney and Spearman tests, p <0.05 was considered significant. In AI: ACTH 22.0 ± 11.0 pg /ml; UF:C 47.0 ± 20.0 µg / 24hs; SAF23: 1.5 ± 0.9 nM); SAFdex: 1.0 ± 0.5 nM and Fdex: 35.6 ± 10.0 nM were normal and significantly different from CS: 5.6±1.8 pg /ml; 391.0 ± 406.0 µg / 24hs; 20.0 ± 32.0 nM; 27.0 ± 24.0 nM and 674.0 ± 339.0 nM, respectively; p <0.05 in all cases. A positive and significant correlation was demonstrated between SAFdex and Fdex in AI (r = 0.830) and CS (r = 0.905); p <0.05 in both. Interestingly, a woman with overt CS and moderate signs of hypercortisolism, had normal SAF23 (1.5 nM) and UFC (76.0 µg / 24hs), while SAFdex (3.0 nM) and Fdex (69.0 nM) showed absence of suppression. Surgical resection of the adrenal tumor (an adrenocortical adenoma) and postoperative hypocorticism confirmed the diagnosis of CS. Conclusion: SCS was excluded in all AI. The dexamethasone suppression test using saliva as a diagnostic fluid was a sensitive and practical method to rule out hypercortisolism in these patients.

Abstract #130 Diagnostic Accuracy of Dexamethasone Suppression Test: Additive Value of Free Cortisol and Dexamethasone Measurements

2019 ◽  
Vol 25 ◽  
pp. 19
Author(s):  
Ravinder Jeet Kaur ◽  
Shobana Athimulam ◽  
Molly Van Norman ◽  
Melinda Thomas ◽  
Stefan K. Grebe ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Dexamethasone Suppression Test ◽  
Free Cortisol ◽  
Suppression Test ◽  
Dexamethasone Suppression

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.

Interpretation of Abnormal Dexamethasone Suppression Test is Enhanced With Use of Synchronous Free Cortisol Assessment

2021 ◽  
Author(s):  
Natalia Genere ◽  
Ravinder Jeet Kaur ◽  
Shobana Athimulam ◽  
Melinda A Thomas ◽  
Todd Nippoldt ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
False Positive ◽  
Medical Center ◽  
Dexamethasone Suppression Test ◽  
Total Cortisol ◽  
Normal Ranges ◽  
Free Cortisol ◽  
Suppression Test ◽  
Dexamethasone Suppression ◽  
Positive Results

Abstract Context Interpretation of dexamethasone suppression test (DST) may be influenced by dexamethasone absorption and metabolism and by the altered cortisol binding Objective We aimed to determine the normal ranges of free cortisol during DST in participants without adrenal disorders, and to identify the population of patients where post-DST free cortisol measurements add value to the diagnostic work up. Design and Setting Cross-sectional study conducted in a tertiary medical center Participants Adult volunteers without adrenal disorders (n=168; 47 women on oral contraceptive therapy (OCP), 66 women not on OCP, 55 men) and patients undergoing evaluation for hypercortisolism (n=196; 16 women on OCP) Measurements Post-DST dexamethasone and free cortisol (mass spectrometry) and total cortisol (immunoassay). Main Outcome Measures Reference range for post-DST free cortisol, diagnostic accuracy of post-DST total cortisol. Results Adequate dexamethasone concentrations (≥0.1 mcg/dL) were seen in 97.6% volunteers and 96.3% patients. Only 25.5% of women volunteers on OCP had abnormal post-DST total cortisol (>1.8 mcg/dL). In volunteers, the upper post-DST free cortisol range was 48 ng/dL in men and women not on OCP, and 79 ng/dL in women on OCP. When compared to post-DST free cortisol, diagnostic accuracy of post-DST total cortisol was 87.3% (95%CI 81.7-91.7); all false positive results occurred in patients with post-DST cortisol between 1.8 and 5 mcg/dL. OCP use was the only factor associated with false positive results (21.1% vs 4.9%, p=0.02). Conclusions Post-DST free cortisol measurements are valuable in patients with optimal dexamethasone concentrations and post-DST total cortisol between 1.8 and 5 mcg/dL.

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.

Childhood traumata, Dexamethasone Suppression Test and psychiatric symptoms: a trans-diagnostic approach

2010 ◽  
Vol 40 (12) ◽  
pp. 2037-2048 ◽  
Author(s):  
C. Faravelli ◽  
S. Gorini Amedei ◽  
F. Rotella ◽  
L. Faravelli ◽  
A. Palla ◽  
...  
Keyword(s):  
Life Events ◽  
Hpa Axis ◽  
Salivary Cortisol ◽  
Psychiatric Symptoms ◽  
Dexamethasone Suppression Test ◽  
Diagnostic Approach ◽  
Stressful Event ◽  
Suppression Test ◽  
Hpa Response ◽  
Dexamethasone Suppression

BackgroundChildhood traumatic events and functional abnormalities of the hypothalamus–pituitary–adrenal (HPA) axis have been widely reported in psychiatric patients, although neither is specific for any diagnosis. Among the limited number of studies that have evaluated these topics, none has adopted a trans-diagnostic approach. The aim of the present research is to explore the relationship between childhood stressors, HPA axis function and psychiatric symptoms, independent of the diagnosis.MethodA total of 93 moderate to severely ill psychiatric out-patients of Florence and Pisa University Psychiatric Units and 33 healthy control subjects were recruited. The assessment consisted of salivary cortisol pre- and post-low dose (0.5 mg) Dexamethasone, early and recent life events, 121 psychiatric symptoms independent of diagnosis, SCID, BPRS.ResultsIn total, 33.5% of patients were Dexamethasone Suppression Test (DST) non-suppressors, compared with 6.1% of controls (p=0.001). Among patients, non-suppression was associated with particular symptoms (i.e. depressive and psychotic), but not to any specific diagnosis. Early stressful life events were significantly associated with higher salivary cortisol levels, with DST non-suppression and with approximately the same subset of symptoms. A recent stressful event seemed to be associated to the HPA response only in those subjects who were exposed to early traumata.ConclusionsOur report suggests a relationship between life stress, HPA axis and psychopathology. A cluster of specific psychiatric symptoms seems to be stress related. Moreover, it seems that an abnormal HPA response is possibly triggered by an excessive pressure in vulnerable individuals.

scholarly journals Clinical Characteristics of Endogenous Cushing’s Syndrome at a Medical Center in Southern Taiwan

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Shih-Chen Tung ◽  
Pei-Wen Wang ◽  
Rue-Tsuan Liu ◽  
Jung-Fu Chen ◽  
Ching-Jung Hsieh ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Cushing’S Syndrome ◽  
Plasma Cortisol ◽  
Medical Center ◽  
Cushing's Syndrome ◽  
Dexamethasone Suppression Test ◽  
Adrenocortical Adenoma ◽  
Suppression Test ◽  
Southern Taiwan ◽  
Dexamethasone Suppression

From January 1987 to December 2011, over a total of 25 years, 84 patients with Cushing’s syndrome (CS) were identified at a medical center in southern Taiwan. We observed a higher incidence of ACTH-independent CS (75%) than ACTH-dependent CS (25%). A higher incidence of adrenocortical adenoma (58.3%) than Cushing’s disease (CD, 21.4%) was also found. The sensitivity of the definitive diagnostic tests for CS, including loss of plasma cortisol circadian rhythm, a baseline 24 h urinary free cortisol (UFC) value >80 μg, and overnight and 2-day low-dose dexamethasone suppression test, was between 94.4% and 100%. For the 2-day high-dose dexamethasone suppression test for the differential diagnosis of CD, the sensitivity of 0800 h plasma cortisol and 24 h UFC was 44.4% and 85.7%, respectively. For the differential diagnosis of adrenal CS, the sensitivities of the 0800 h plasma cortisol and 24 h UFC were 95.5% and 88.9%, respectively. In patients with ACTH-independent CS and ACTH-dependent CS, the baseline plasma ACTH levels were all below 29 pg/mL and above 37 pg/mL, respectively. The postsurgical hospitalization stay following retroperitoneoscopic adrenalectomy was shorter than that observed for transabdominal adrenalectomy (4.3 ± 1.6 versus 8.8 ± 3.7 days,P<0.001). It was easy to develop retroperitoneal and peritoneal seeding of adrenocortical carcinoma via laparoscopic adrenalectomy.

Comparison of 1 mg versus 2 mg Dexamethasone Suppression Test in Patients with Obesity

2017 ◽  
Vol 49 (11) ◽  
pp. 854-859
Author(s):  
Sandrine Urwyler ◽  
Nina Cupa ◽  
Mirjam Christ-Crain
Keyword(s):  
Salivary Cortisol ◽  
False Positive ◽  
False Positive Rate ◽  
Serum Cortisol ◽  
Dexamethasone Suppression Test ◽  
Obese Patients ◽  
Positive Rate ◽  
Suppression Test ◽  
Cortisol Levels ◽  
Dexamethasone Suppression

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

scholarly journals Salivary cortisol after overnight dexamethasone suppression test in different patient groups

2015 ◽  
Author(s):  
Meral Mert ◽  
Refik Tanakol ◽  
Hande Karpuzoglu ◽  
Semra Dogru Abbasoglu ◽  
Ozlem Soyluk ◽  
...  
Keyword(s):  
Salivary Cortisol ◽  
Dexamethasone Suppression Test ◽  
Patient Groups ◽  
Suppression Test ◽  
Dexamethasone Suppression
Sign in / Sign up

Export Citation Format

Share Document