Concomitant medication use can confound interpretation of the combined dexamethasone-corticotropin releasing hormone test in Cushing's syndrome.
Open accessAbstract
CONTEXT: The ability of combined dexamethasone-corticotropin releasing hormone (Dex-CRH) testing to distinguish pseudo-Cushing's syndrome (PCS) from Cushing's syndrome is controversial. One factor potentially impairing diagnostic efficacy is the concomitant use of commonly prescribed medications that may alter dexamethasone metabolism. OBJECTIVE: Our objective was to assess the diagnostic accuracy of the Dex-CRH test and evaluate the potential impact of concomitant drugs. DESIGN: The study was a retrospective one. PARTICIPANTS: Participants included 101 patients [60 Cushing's disease (CD); 41 PCS] who underwent 112 Dex-CRH tests. Patients were divided into two groups, depending on use of medications potentially interfering with dexamethasone metabolism: 58 tests were classified as No Meds (32 CD; 26 PCS) and 54 as Meds (34 CD; 20 PCS). The latter group was further subdivided into patients taking one medication vs. those taking multiple medications. MAIN OUTCOME MEASURES: Diagnostic accuracy of different serum cortisol and ACTH thresholds at baseline and 15 min after CRH injection was assessed. RESULTS: The specificity of a baseline post-low-dose-dexamethasone-suppressed test cortisol lower than 1.4 microg/dl (38 nmol/liter) was significantly higher in the No Meds vs. the Meds group (P = 0.014). Sensitivity and specificity using a post-CRH cortisol cutoff of 1.4 microg/dl (38 nmol/liter) were 93.1% (95% confidence interval = 88.4-97.8) and 92.3% (95% confidence interval = 87-97.6) in the No Meds group. The specificity of a cortisol lower than 1.4 microg/dl (38 nmol/l) at 15 min after CRH was significantly higher in patients taking only one medication vs. those on multidrug treatment (P < 0.05). CONCLUSIONS: Medications commonly prescribed in hypercortisolemic patients undergoing Dex-CRH testing may contribute to the variable diagnostic accuracy of this test. Prospective studies to address this issue are needed.
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Comorbidities such as type 2 diabetes and obesity, and concomitant medications, may affect dexamethasone suppression test results.
“several comorbidities (i.e.type 2 diabetes and obesity) and concomitant medications may affect the result of the dexamethasone suppression test (DST) (24).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [24]
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- Authors
- Valassi, E., Swearingen, B., Lee, H., Nachtigall, L. B., Donoho, D. A., Klibanski, A., & Biller, B. M. K.
- Affiliations
- Harvard University (US)
- Corresponding author
- Biller, Beverly M. K.
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2009-12-01
- Volume
- 94
- Issue
- 12
- Pages
- 4851-4859
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC2795659
- OpenAlex
- W1966949615
- Cited by
- 78
- References
- 14
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 4 · 2023: 5 · 2022: 3 · 2021: 9 · 2020: 10 · 2019: 2 · 2018: 9 · 2017: 5 · 2016: 4 · 2015: 5 · 2014: 4 · 2013: 1 · 2012: 2
- FWCI
- 2.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Massachusetts General Hospital
- National Institutes of Health
- National Center for Research Resources (UL1RR025758)
- 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, pseudo-Cushing's syndrome, Cushing's disease, dexamethasone/corticotropin-releasing hormone test, concomitant medications, diagnostic accuracy, serum cortisol, ACTH, hypercortisolism
- MeSH terms
- Adrenocorticotropic Hormone, Adult, Corticotropin-Releasing Hormone, Cushing Syndrome, Dexamethasone, Drug Interactions, Female, Humans, Hydrocortisone, Longitudinal Studies, Male, Middle Aged, Retrospective Studies, Reproducibility of Results
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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