Horm Metab Res 2018; 50(06): 453-461
DOI: 10.1055/a-0603-3868
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

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

Mona Mojtahedzadeh
1   Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
,
Nesyah Shaesteh
1   Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
,
Mastaneh Haykani
1   Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
,
Jennifer L. A. Tran
1   Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
,
Michael Mangubat
1   Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
,
Hraya K. Shahinian
2   Skull Base Institute, Los Angeles, CA, USA
,
Rahul Nachnani
1   Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
,
Mohan Zopey
1   Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
,
Jason Saidian
1   Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
,
Antolice Thomas
1   Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
,
Martin L. Lee
1   Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
,
Ian E. McCutcheon
3   Department of Neurosurgery, MD Anderson Medical Center, Houston TX, USA
,
Theodore C. Friedman
1   Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
› Author Affiliations
Further Information

Publication History

received 26 December 2017

accepted 29 March 2018

Publication Date:
02 May 2018 (online)

Abstract

We 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.

Supplementary Material

 
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