Pros and cons of dexamethasone suppression test for screening of subclinical Cushing's syndrome in patients with adrenal incidentalomas.

Journal of Endocrinological Investigation
Giuseppe ReimondoMassimo Terzolo

Abstract

The results of dexamethasone suppression tests (DST) in the screening of subclinical hypercortisolism are not readily comparable. Aim of the present study was to review the effectiveness of overnight 1-mg DST and 8-mg DST to look for functional autonomy of clinically inapparent adrenal adenomas. Sixty-eight consecutive patients with clinically inapparent adrenal adenomas were enrolled. All patients underwent 1-mg DST. The 8-mg DST was performed in the 11 patients who had post 1-mg DST cortisol >138 nmol/l and in 11 patients who had post 1-mg DST cortisol between 50 and 138 nmol/l. The a priori probability to have autonomous cortisol secretion was defined by the presence of at least two alterations of the hypothalamic-pituitary-adrenal axis among reduced ACTH concentrations, elevated urinary free cortisol (UFC) or elevated midnight serum cortisol. Cortisol levels >138 nmol/l after the 1-mg DST increases the post-test probability of adrenal functional autonomy to 55%, whereas cortisol levels <50 nmol/l reduce the post-test probability to 8%. Cortisol levels recorded after the 8-mg DST were nonsignificantly lower than after the 1-mg DST and all the patients with cortisol >138 nmol/l after the 1-mg DST maintained cortisol above thi...Continue Reading

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Citations

Aug 7, 2012·Best Practice & Research. Clinical Endocrinology & Metabolism·Giorgio Arnaldi, Marco Boscaro
Oct 13, 2011·Clinical Endocrinology·M TerzoloG Reimondo
Dec 31, 2011·Neuroscience and Biobehavioral Reviews·Jian LiBerthold Hocher
May 2, 2013·The Journal of Clinical Endocrinology and Metabolism·Miguel DebonoJohn Newell-Price
Dec 7, 2014·The Journal of Physiology·Hershel Raff, Ty Carroll
Apr 15, 2015·Current Opinion in Endocrinology, Diabetes, and Obesity·Miguel Debono, John Newell-Price
Apr 11, 2013·Current Opinion in Endocrinology, Diabetes, and Obesity·Subramanian KannanAmir H Hamrahian

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