The overnight dexamethasone test is the procedure of choice in screening for Cushing's syndrome

Montwill, J.; Igoe, Derval; McKenna, T. J.

doi:10.1016/0039-128x(94)90116-3

Cited by 28 publications

(12 citation statements)

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“…We found a very low false positive rate (2.3%) for the overnight 1‐mg dexamethasone suppression test in our obese population, using a strict cut‐off of 80 nM, a rate close to the 1% false positive rate in a normal non‐obese population (17). Similar data has been recently published by Pasquali et al (18), in which the suppressibility of the hypothalamic‐pituitary‐adrenal axis was evaluated in 34 healthy normal‐weight individuals and 87 healthy obese subjects using a standard dexamethasone dose (1 mg) and three different weight‐adjusted dexamethasone doses.…”

Section: Discussionsupporting

confidence: 64%

Overnight Dexamethasone Suppression Test: A Reliable Screen for Cushing's Syndrome in the Obese

et al. 2002

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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 Ͻ80 nM (3 g/dL) was chosen as the cut-off point for normal suppression. Patients with serum cortisol levels Ն80 nM were evaluated for Cushing's syndrome. Results: Suppression of morning cortisol levels to Ͻ80 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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Section: Discussionsupporting

confidence: 64%

Overnight Dexamethasone Suppression Test: A Reliable Screen for Cushing's Syndrome in the Obese

et al. 2002

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“…Além disso parece haver uma diferença de excreção urinária de cortisol entre os dois sexos, sendo pouco mais elevada em homens do que em mulheres (22); nossos dados não permitiram este estudo por incluírem um numero pequeno de indivíduos do sexo masculino. Apesar de todos estes senões, e uma série de controvérsias (23)(24)(25)(26), a medida de cortisol livre na urina de 24hs vem sendo considerado por muitos autores como o método mais adequado para a investigação inicial de pacientes suspeitos de serem portadores de síndrome de Cushing.…”

Section: Discussionunclassified

Desenvolvimento e caracterização de método para a dosagem de cortisol livre urinário

Vieira

Noguti

Rayol

et al. 2000

Arq Bras Endocrinol Metab

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A dosagem de cortisol livre na urina de 24 horas é considerada por muitos como a dosagem mais útil na pesquisa da presença de síndrome de Cushing. Os resultados publicados são, no entanto, pouco comparáveis entre si em função de diferenças metodológicas importantes, relacionadas principalmente aos processos preparativos, sendo que a especificidade é diretamente proporcional à complexidade dos mesmos. Neste trabalho descrevemos a adaptação de um ensaio de rotina, desenvolvido originalmente para a medida de cortisol sérico, para a medida de cortisol urinário. O antisoro empregado, F-79-1, foi estudado quanto à especificidade em relação aos principais metabólitos urinários de cortisol, sendo os resultados obtidos comparáveis aos dos melhores antisoros descritos na literatura. O método preparativo utilizado faz uso de extração de alíquota de urina com diclorometano, seguida de cromatografia em coluna de Sep-Pak Diol. A recuperação média do processo foi de 63,3%; a sensibilidade do ensaio é da ordem de 1,6 mg/L e os coeficientes de variação intra e inter-ensaio da ordem de 7,2 e 15,6%, respectivamente. Os resultados obtidos em 40 amostras de indiví-duos normais foram de 21,9 a 74,1 mg/24hs (média de 47,8); a comparação com método semelhante de laboratório de referência internacional mostrou alta correlação (R= 0,9286, n= 74, p<0,001). Em quatro pacientes com doença de Cushing comprovada os valores foram significativamente elevados. O presente método, empregando antisoro próprio e processo preparativo simples, vai permitir uma aplicação mais ampla do teste e uma melhor avaliação de sua utilidade clínica. ABSTRACTThe measurement of 24-hours free urinary cortisol is considered by many authors as the best screening test for Cushing's syndrome. However, the published results are not comparable due to methodological differences between the various available techniques. These differences are related mainly to the preparative process employed, and in general there is a direct relation between the complexity of the process and the degree of specificity achieved. In this publication we describe the adaptation for free urinary cortisol measurement of a routine assay, developed originally for the measurement of serum cortisol. The specificity of the antiserum employed, F-79-1, was studied against the major urinary cortisol metabolites, and the results comparable to the best antisera described in the literature. The preparative method utilized includes dichloromethane extraction followed by a Sep-Pak Diol column chromatography. The mean recovery of the preparative process was 63.3%; the sensitivity of the assay is in the order of 1.6 mg/L and the intra and inter-assay CVs in the order of 7.2 and 15.6%, respectively. The results obtained in 40 samples from normal adults ranged betwen 21.9 and 74.1 mg/24hs (mean 47.8); the comparison with a similar method from an international refer-

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“…In contrast, in our hands false positivity of the test proved to be very low, thus obviating the need for unnecessary in-patient investigations. The sensitivity of the overnight dexamethasone suppression test in screening for Cushing's syndrome was emphasized in recent studies (Cronin et al, 1990, Montwill et al, 1994. However, the rates of false positives were 7 .…”

Section: Discussionmentioning

confidence: 99%

Pre‐clinical Cushing's syndrome: an unexpected frequent cause of poor glycaemic control in obese diabetic patients

Leibowitz

Tsur²,

Chayen³

et al. 1996

Clinical Endocrinology

177

108

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The overnight dexamethasone test is the procedure of choice in screening for Cushing's syndrome

Cited by 28 publications

References 10 publications

Overnight Dexamethasone Suppression Test: A Reliable Screen for Cushing's Syndrome in the Obese

Overnight Dexamethasone Suppression Test: A Reliable Screen for Cushing's Syndrome in the Obese

Desenvolvimento e caracterização de método para a dosagem de cortisol livre urinário

Pre‐clinical Cushing's syndrome: an unexpected frequent cause of poor glycaemic control in obese diabetic patients

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