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Cited by 58Pituitary Gland Disorders and TreatmentsAdrenal and Paraganglionic TumorsAdrenal Hormones and Disorders

Overnight dexamethasone suppression test: a reliable screen for Cushing's syndrome in the obese.

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Ness‐Abramof, Rosane, Nabriski, Dan, Apovian, Caroline M., Niven, Mark, Weiss, Eliahu, Shapiro, Menachem S., Shenkman, Louis·2002·Obesity Research
DOI 10.1038/oby.2002.166
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Abstract

Objective: Reevaluation of the validity of the 1‐mg overnight dexamethasone suppression test (ODST) as a screening test for Cushing's syndrome in obese patients. Research Methods and Procedures: Eighty‐six obese patients (body mass index, 30 to 53 kg/m 2 ) that were referred to a general endocrine outpatient clinic for evaluation of simple obesity, diabetes mellitus, hypertension, polycystic ovary disease, or pituitary tumor. One milligram dexamethasone was administered orally at 11:00 pm , and serum cortisol levels were measured the following morning between 8:00 am and 9:00 am . Suppression of serum cortisol to <80 nM (3 μg/dL) was chosen as the cut‐off point for normal suppression. Patients with serum cortisol levels ≥80 nM were evaluated for Cushing's syndrome. Results: Suppression of morning cortisol levels to <80 nM occurred in 79 of the 86 obese patients. Seven patients had serum cortisol levels higher than 80 nM; five were eventually diagnosed with Cushing's syndrome and two were considered false positive results in view of normal 24‐hour free urinary cortisol and normal suppression on a low dose dexamethasone suppression test (0.5 mg of dexamethasone every 6 hours for 2 days). We found a false positive rate of 2.3% for the ODST using a cut‐off serum cortisol of 80 nM. Discussion: The ODST is a valid screening test for Cushing's syndrome in the obese population. The false positive rate was 2.3%, even when using a strict cut‐off serum cortisol of 80 nM. Abnormal cortisol suppression in obese patients should be investigated and not be considered false positive results.

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  • A study of 86 consecutive obese subjects referred to an endocrine clinic with diabetes mellitus, hypertension, and/or polycystic ovary syndrome found a 5.8% incidence of Cushing's syndrome.

    “Another study of 86 consecutive obese subjects referred to an endocrine clinic with diabetes mellitus, hypertension, and/or the polycystic ovary syndrome found a 5.8% incidence of Cushing's syndrome (35).”

    From The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. (2008) · cites this paper as [35]

    The Patients section describes 86 obese patients referred to an endocrine clinic, and the Results report five Cushing’s syndrome diagnoses—5/86, or approximately 5.8%, though the paper prints 5.7%. The copy does not say the patients were consecutive. It also reports that 51 had obesity alone, so diabetes, hypertension, and polycystic ovary disease do not describe the whole group. (LLM, conf=0.87)

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Research works printed but not linked: 4

  1. Tsagarakis S, Roboti C, Kokkoris P, Vasiliu V, Aleviazaki C, Thalassinos N. Elevated post-dexamethasone suppression test in patients with adrenal incidentalomas: comparisons with clinical euadrenal subjects and patients with Cushing's syn- drome. Clin Endocrinol. 1998;49:165-71.
  2. Leibovitz G, Tzur A, Chayen SO, et al. Pre-clinical Cushing's syndrome: an unexpected frequent cause of poor glycemic con- trol in obese patients. Clin Endocrinol. 1996;44:717-22.
  3. Shapiro MS, Shenkman L. Variable hormogenesis in Cush- ing's syndrome. Q J Med. 1991;79:351-63.
  4. ODST in Obese Patients, Ness-Abramof et al. OBESITY RESEARCH Vol. 10 No. 12 December 2002 1221 15508528, 2002, 12, Downloaded from https://onlinelibrary.wiley.com/doi/10.1038/oby.2002.166, Wiley Online Library on [25/08/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

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Authors
Ness‐Abramof, R., Nabriski, D., Apovian, C. M., Niven, M., Weiss, E., Shapiro, M. S., & Shenkman, L.
Affiliations
  • Tel Aviv University (IL)
  • Boston University (US)
ORCID
Venue
Obesity Research
Publisher
Wiley
Published
2002-12
Volume
10
Issue
12
Pages
1217-1221
ISSN
  • 1071-7323 (ISSN-L)
  • 1550-8528
DOI
10.1038/oby.2002.166
OpenAlex
W2063923957
Cited by
58
References
28
Citations by year
2026: 1 · 2025: 1 · 2024: 2 · 2023: 2 · 2021: 1 · 2020: 2 · 2019: 2 · 2017: 5 · 2016: 4 · 2015: 6 · 2014: 3 · 2013: 5 · 2012: 3
FWCI
1.33
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 3567 d)
Locations
  • Obesity Research (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords
Cushing's syndrome, dexamethasone suppression test, obesity, screening validity, false positive rate, serum cortisol, cortisol suppression, low-dose dexamethasone suppression test, 24-hour urinary free cortisol
MeSH terms
Adult, Cushing Syndrome, Dexamethasone, False Positive Reactions, Female, Glucocorticoids, Humans, Hydrocortisone, Male, Middle Aged, Obesity, Body Mass Index

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