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Cited by 67Pituitary Gland Disorders and TreatmentsAdrenal Hormones and DisordersAdrenal and Paraganglionic Tumors

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

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Kennedy, L, Atkinson, A B, Johnston, H, Sheridan, B, Hadden, D R·1984·BMJ
DOI 10.1136/bmj.289.6453.1188
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Abstract

Forty four subjects (23 obese controls, 11 patients with possible Cushing's syndrome, and 10 patients with definite Cushing's syndrome) underwent low dose (0 X 5 mg every six hours for two days) dexamethasone suppression tests during which serum cortisol concentration at 0800 and excretion of urinary free cortisol over 24 hours were measured. Serum cortisol concentration fell to below 60 nmol/1 (2 X 2 micrograms/100 ml) in 31 subjects and remained above 250 nmol/1 (9 X 1 micrograms/100 ml) in the 13 others. Excretion of urinary free cortisol showed a similar response, falling to below 110 nmol (40 micrograms)/24 h in 31 and remaining above 180 nmol (65 micrograms)/24 h in the 13 others. There was complete concordance between the two variables in terms of the pattern of response. Serum cortisol concentration fell to below 60 nmol/1 (2 X 2 micrograms/100 ml) in at least 97% (31 of a possible 32) of subjects without Cushing's syndrome. On the other hand, a serum cortisol concentration of above 250 nmol/1 (9 X 1 micrograms/100 ml) after low dose dexamethasone gave a false positive diagnosis of Cushing's syndrome in at most only one of 13 patients (7 X 7%). Measurement of serum cortisol concentration during the low dose dexamethasone test is simpler than, and as accurate and reliable as, measurements of urinary steroids.

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  • With a cutoff of 50 nmol/liter (1.8 g/dl), the initially reported sensitivity of the LDDST was greater than 95% for adult patients.

    “With a cutoff value for suppression of 50 nmol/liter (1.8 g/ dl), the initially reported sensitivity was greater than 95% for adult patients (86).”

    From The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. (2008) · cites this paper as [86]

    The Discussion reports that all 12 patients with Cushing’s syndrome had cortisol concentrations above 250 nmol/l after the low-dose test, consistent with sensitivity greater than 95% in this sample. But the paper uses a suppression cutoff of 60 nmol/l, not 50 nmol/l; its reported 97% figure concerns subjects without Cushing’s syndrome. Page numbers were not supplied for these passages. (LLM, conf=0.88)

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Authors
Kennedy, L., Atkinson, A. B., Johnston, H., Sheridan, B., & Hadden, D. R.
Affiliations
Royal Victoria Hospital (GB)
Venue
BMJ
Publisher
BMJ
Published
1984-11-03
Volume
289
Issue
6453
Pages
1188-1191
ISSN
  • 0007-1447 (ISSN-L)
  • 1468-5833
DOI
10.1136/bmj.289.6453.1188
OpenAlex
W2040950362
Cited by
67
References
25
Citations by year
2023: 2 · 2022: 1 · 2021: 1 · 2020: 2 · 2018: 1 · 2017: 3 · 2015: 5 · 2014: 1 · 2013: 3 · 2012: 1
FWCI
0.68
Type
journal article
Language
en
Open access
Licence
www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
Locations
  • BMJ (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
Keywords
Cushing's syndrome, low-dose dexamethasone suppression test, serum cortisol, urinary free cortisol, false-positive diagnosis, obesity, cortisol measurement, diagnostic accuracy
MeSH terms
Adolescent, Adult, Aged, Cushing Syndrome, Dexamethasone, Female, Humans, Hydrocortisone, Male, Middle Aged, Pituitary-Adrenal Function Tests

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