A Rapid Screening Test for Cushing's Syndrome

Pavlatos, Fotios Ch.; Smilo, Renata P.; Forsham, Peter H.

doi:10.1001/jama.1965.03090090026005

Cited by 101 publications

(14 citation statements)

References 14 publications

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“…Dexamethasone suppression tests, metyrapone tests, TRH, gonadotropin-releasing hormone (LHRH), and insulin tolerance tests were performed as previously reported (10,21,(22)(23)(24).…”

Section: Methodsmentioning

confidence: 99%

Cushing' Disease: Management by Transsphenoidal Pituitary Microsurgery*

Bigos

Somma

Rasio

et al. 1980

The Journal of Clinical Endocrinology & Metabolism

152

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Over 15 yr, 24 patients underwent transsphenoidal pituitary surgery for Cushing's disease with a median follow-up of 12 months. Cures included 7 patients with normal sella turcicas (6 microadenomas), 6 patients with focal depressions (6 microadenomas) of the sella (grade I), and 3 patients (3 adenomas) with enlarged sellas (grade II). Three patients with sella destruction (grades III and IV), 2 with normal sellas, and 1 with focal sella depression (grade I) were not cured. Two apparent cures (microadenomas) recurred. Tumor histology revealed 19 basophilic adenomas; electron microscopy (14 tumors) and immunochemical studies (10 tumors) revealed only ACTH cells. Circadian rhythm returned in 6 cured patients. Impotence (in 2), amenorrhea (in 7), and galactorrhea (in 3) resolved in affected cured patients. The major surgical complication was hemorrhage at the operative site (3 patients). Transsphenoidal pituitary surgery is a valuable method for managing Cushing's disease in many patients.

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“…Dexamethasone suppression tests, metyrapone tests, TRH, gonadotropin-releasing hormone (LHRH), and insulin tolerance tests were performed as previously reported (10,21,(22)(23)(24).…”

Section: Methodsmentioning

confidence: 99%

Cushing' Disease: Management by Transsphenoidal Pituitary Microsurgery*

Bigos

Somma

Rasio

et al. 1980

The Journal of Clinical Endocrinology & Metabolism

152

View full text Add to dashboard Cite

show abstract

“…Nugent and coworkers 24 and Pavlatos, et al, 26 initially described the low-dose overnight dexamethasone suppression test for the rapid diagnosis of Cushing syndrome. When used in the diagnostic setting, there are relatively high falsepositive and false-negative rates, 9,13,32 especially when used in patients in whom concurrent illness may lead to a reduction in the suppressibility of the adrenal axis.…”

Section: Prognostic Factors For Recurrence and The Role Of Serum Cortmentioning

confidence: 99%

Transsphenoidal microsurgical treatment of Cushing disease: postoperative assessment of surgical efficacy by application of an overnight low-dose dexamethasone suppression test

Chen¹,

Amar²,

Choi³

et al. 2003

Journal of Neurosurgery

153

118

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Transsphenoidal microsurgery is an effective means of control for patients with adrenocorticotrophic hormone-producing microadenomas. Clinical outcome correlated well with the size of the tumor, as measured on preoperative imaging studies, and with postoperative morning cortisol levels following an overnight dexamethasone suppression test. Postoperative cortisol levels can be used as a useful prognostic indicator of the likelihood of future recurrence following transsphenoidal adenomectomy in CD.

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“…The overnight 1‐mg dexamethasone suppression test (ODST) is used as a screening test for Cushing's syndrome. Most normal persons suppress cortisol levels to <80 nM after ODST (1, 2). One possible pitfall of the test has been obesity because of the reported failure of obese adults who do not have Cushing's syndrome to suppress serum cortisol after ODST in 13% to 53% of the cases (3, 4).…”

Section: Introductionmentioning

confidence: 99%

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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A Rapid Screening Test for Cushing's Syndrome

Cited by 101 publications

References 14 publications

Cushing' Disease: Management by Transsphenoidal Pituitary Microsurgery*

Cushing' Disease: Management by Transsphenoidal Pituitary Microsurgery*

Transsphenoidal microsurgical treatment of Cushing disease: postoperative assessment of surgical efficacy by application of an overnight low-dose dexamethasone suppression test

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

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