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Cited by 24Adrenal and Paraganglionic TumorsPituitary Gland Disorders and TreatmentsAdrenal Hormones and Disorders

Discrepancies in results of low- and high-dose dexamethasone suppression tests for diagnosing preclinical Cushing's syndrome.

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KATABAMI, Takuyuki, OBI, Ryusei, SHIRAI, Naoko, NAITO, Satoru, SAITO, Nobuhiko·2005·Endocrine Journal
DOI 10.1507/endocrj.52.463
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Abstract

According to the diagnostic criteria for adrenal preclinical Cushing's syndrome (PreCS) established by a group headed by the Ministry of Health, Labor and Welfare (MHLW), low- and high-dose dexamethasone suppression tests (DSTs) must be performed to prove autonomous cortisol secretion, i.e., > or =3 microg/dL serum cortisol following 1-mg DST administration, and > or =1 microg/dL serum cortisol following 8-mg DST administration. However, discrepancies have been documented in the results of low-and high-dose DSTs. We therefore investigated the validity of the DST for diagnosing PreCS by performing 1-mg and 8-mg DSTs in 39 patients with adrenal incidentaloma, but no characteristic Cushingoid symptoms. In about half of these patients (20/39, 51.3%), high-dose DST was positive but low-dose was negative, and one or more of the other abnormalities of hypothalamus-pituitary-adrenal axis dysfunction was seen in 75% of these patients. Furthermore, no significant difference in incidence of glucose intolerance and hypertension was noted in patients with positive high-dose DST and negative low-dose DST compared with patients with positive low- and high-dose DST. Under the current MHLW diagnostic criteria, patients with positive high-dose DST and negative low-dose DST are not diagnosed with PreCS, but some of these patients should be. Discrepancies in the results of low- and high-dose DSTs appear attributable to the current cutoff values, and further investigations are necessary to resolve these discrepancies.

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  • In more than 25% of patients with adrenal incidentalomas, cortisol is not suppressed after 1-mg or 3-mg overnight dexamethasone suppression testing or 2-day low-dose dexamethasone suppression testing.

    “In more than 25% of AI subjects, the lack of cortisol suppression after 1-or 3-mg overnight DST or 2-d low-dose DST (LDDST) (19,34,41,44,46,48,53,55,56,60,61)”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [56]

  • Higher dexamethasone doses of 3 or 8 mg did not show better performance for diagnosing subclinical hypercortisolism.

    “some authors have proposed higher (3 or 8 mg) dexamethasone doses (40,46,54,56), which however did not show a better performance (14,23,66).”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [56]

  • Low serum ACTH levels are frequently found in patients with adrenal incidentalomas.

    “Low serum ACTH levels are frequently found in AI patients (19,21,32,36,40,43,44,48,49,56,60,61).”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [56]

  • With lower 1-mg dexamethasone suppression test cutoffs of 1.8 and 2.2 g/dl, specificity decreased to 67-72% and sensitivity increased to 75-100%.

    “However, if the lowest cutoffs were used [1.8 and 2.2 g/dl (50 and 60.6 nmol/liter), respectively], specificity decreased to 67-72%, whereas sensitivity increased to 75-100% (48 -62, 64 -67).”

    From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [56]

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Research works printed but not linked: 1

  1. Aron DC (2001) Diagnostic implications of adrenal physiology and clinical epidemiology for evaluation of glucocorticoid excess and deficiency. In: DeGroot LJ, Jameson JL (eds) Endocrinology (Fourth edition). WB Saunders Company, Philadelphia, vol 3: 1655-1667.

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Authors
KATABAMI, T., OBI, R., SHIRAI, N., NAITO, S., & SAITO, N.
Affiliations
St. Marianna University School of Medicine (JP)
ORCID
KATABAMI, Takuyuki
Venue
Endocrine Journal
Publisher
Japan Endocrine Society
Published
2005
Volume
52
Issue
4
Pages
463-469
ISSN
  • 0918-8959 (ISSN-L)
  • 1348-4540
DOI
10.1507/endocrj.52.463
OpenAlex
W1986043443
Cited by
24
References
11
Citations by year
2023: 1 · 2020: 1 · 2019: 1 · 2018: 3 · 2017: 1 · 2014: 3 · 2013: 3 · 2012: 1
FWCI
0.63
Type
journal article
Language
en
Open access
Locations
  • Endocrine Journal (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords
preclinical Cushing's syndrome, dexamethasone suppression test, low-dose dexamethasone, high-dose dexamethasone, adrenal incidentaloma, autonomous cortisol secretion, HPA axis dysregulation, diagnostic criteria, serum cortisol, impaired glucose tolerance, hypertension
MeSH terms
Adrenal Gland Neoplasms, Adult, Aged, Anti-Inflammatory Agents, Cushing Syndrome, Dexamethasone, Diagnostic Techniques, Endocrine, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Male, Middle Aged, Pituitary-Adrenal System, Reproducibility of Results, Incidental Findings, Early Diagnosis

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