Low-Dose and Standard Overnight and Low Dose-Two Day Dexamethasone Suppression Tests in Patients with Mild and/or Episodic Hypercortisolism
| Autor: | Mastaneh Haykani, Jennifer L. A. Tran, Jason Saidian, Theodore C. Friedman, Hraya K. Shahinian, Ian E. McCutcheon, Michael Mangubat, Mohan Zopey, Antolice Thomas, Martin Lee, Rahul Nachnani, Nesyah Shaesteh, Mona Mojtahedzadeh |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Hydrocortisone Endocrinology Diabetes and Metabolism Clinical Biochemistry Cushing's syndrome 030204 cardiovascular system & hematology Biochemistry Dexamethasone 0302 clinical medicine Endocrinology polycyclic compounds Cushing Syndrome Morning Pediatric Low dose periodic General Medicine Middle Aged 6.1 Pharmaceuticals Dexamethasone suppression test Female episodic Drug hormones hormone substitutes and hormone antagonists medicine.drug Adult endocrine system medicine.medical_specialty Cortisol awakening response Adolescent Clinical Trials and Supportive Activities Clinical Sciences 030209 endocrinology & metabolism cortisol Article Dose-Response Relationship Young Adult Endocrinology & Metabolism 03 medical and health sciences Rare Diseases Clinical Research Internal medicine medicine Humans In patient Dose-Response Relationship Drug hypercortisolism business.industry Biochemistry (medical) Evaluation of treatments and therapeutic interventions Dexamethasone suppression business Serum cortisol |
| Zdroj: | Hormone and metabolic research = Hormon-und Stoffwechselforschung = Hormones et metabolisme, vol 50, iss 6 |
| ISSN: | 1439-4286 0018-5043 |
| DOI: | 10.1055/a-0603-3868 |
| Popis: | We previously reported on the lack of utility of the 1 mg overnight dexamethasone (DEX) test in mild and/or periodic Cushing’s syndrome, as most patients with the condition suppressed to 1 mg DEX. It is possible that a lower dose of DEX as part of an overnight DEX test might be able to distinguish between mild and/or periodic Cushing’s syndrome and those without the condition. The objective of the current study is to determine the sensitivity and specificity of a 0.25 mg overnight DEX suppression test, the standard 1 mg overnight DEX suppression test, and the two-day low-dose (Liddle test) DEX suppression test with and without correction for DEX levels in patients evaluated for mild and/or periodic Cushing’s syndrome. Thirty patients determined to have Cushing’s syndrome by biochemical testing and 14 patients determined not to have the condition had the 0.25 mg and standard 1 mg overnight DEX suppression test and the two-day low-dose DEX suppression tests. Our results show that morning serum cortisol and cortisol/DEX ratios following an overnight dexamethasone suppression test were similar in patients with Cushing’s syndrome and those not having Cushing’s syndrome. However, a morning cortisol value above 7.6 μg/dl following a dose of DEX of 0.25 mg was found in 12 patients with Cushing’s syndrome and none in those not having Cushing’s syndrome, suggesting that a high cortisol value after this low dose of dexamethasone can indicate that further testing for Cushing’s syndrome is warranted. Our data suggest that the traditional 1 mg overnight or the 2 mg/2 day DEX suppression testing should no longer be used as a screening test in patients who could have mild and/or periodic Cushing’s syndrome, while the 0.25 mg dose of DEX may pick up some patients with mild Cushing’s syndrome. |
| Databáze: | OpenAIRE |
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