ArticleJournal of endocrinological investigation2020
Dexamethasone measurement during low-dose suppression test for suspected hypercortisolism: threshold development with and validation.
Article in Journal of endocrinological investigation, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers, 2 of them syntheses that pooled it.
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Who cites it
41 citing papers in PubMed, 2 syntheses or guidelines pooled it, 69 citations in OpenAlex.
- Who and how to screen for Cushing's syndrome: the position statement of the Italian Society of Endocrinology.Journal of endocrinological investigation · 2026Guideline
- Second-line tests in the differential diagnosis of neoplastic and non-neoplastic hypercortisolism: a systematic review and meta-analysis.Journal of endocrinological investigation · 2023Pooled it
- Adrenalectomy Improves Blood Pressure and Metabolic Control in Patients With Possible Autonomous Cortisol Secretion: Results of a RCT.Frontiers in endocrinology · 2022Trial
- 11-deoxycortisol, other hormones and pituitary function characteristics in the diagnosis of adrenal insufficiency in the overnight oral metyrapone test.Endocrine connections · 2026Article
- The Role of Cortisol Secretion in Pheochromocytomas and Paragangliomas: Clinical and Perioperative Implications.The Journal of clinical endocrinology and metabolism · 2026Article
- Time-dependent Increase in Cortisol after 1-mg Overnight Dexamethasone Suppression Test in Adrenal Incidentalomas.Journal of the Endocrine Society · 2026Article
- Plasma cortisol cut-off concentrations using the dexamethasone suppression test in patients with adrenal incidentalomas.Frontiers in endocrinology · 2026Observational
- Beyond cortisol: multiplex steroid profiling after overnight dexamethasone suppression to optimize Cushing's syndrome screening.Endocrine · 2025Article
- Prevalence of Hypercortisolism in Difficult-to-Control Type 2 Diabetes.Diabetes care · 2025Observational
- Review
- Hypertension and Cushing's syndrome: hunt for the red flag.Journal of endocrinological investigation · 2025Review
- Cardiometabolic complications after Cushing's disease remission.Journal of endocrinological investigation · 2025Observational
- Prevalence of Metabolic-Associated Steatotic Liver Disease in Patients With Primary Aldosteronism.Clinical endocrinology · 2025Article
- Who and how to screen for endogenous hypercortisolism in adrenal and pituitary incidentaloma.Journal of endocrinological investigation · 2025Review
- Screening for endogenous hypercortisolism in patients with osteoporosis and fractures: why, when and how.Journal of endocrinological investigation · 2025Review
- Unusual infections and thrombotic events in Cushing's syndrome.Journal of endocrinological investigation · 2025Review
- Who and how to screen for endogenous hypercortisolism in patients with mood disorders.Journal of endocrinological investigation · 2025Review
- Cushing syndrome in paediatric population: who and how to screen.Journal of endocrinological investigation · 2025Review
- Cushing syndrome.Nature reviews. Disease primers · 2025Review
- Long-term Remission in Functioning Pituitary Adenomas after Medical Therapy Withdrawal: A Chance for Cushing's Disease.Endocrine, metabolic & immune disorders drug targets · 2025Article
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Authors and funding
10 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
aimDexamethasone Suppression Test (DST), recommended for Cushing's Syndrome (CS) diagnosis, explores the pituitary feedback to glucocorticoids. Its diagnostic accuracy could be affected by dexamethasone bioavailability, and therefore, we have developed and validated a dexamethasone threshold after 1-mg DST. MATERIALS AND
methodsWe studied 200 subjects: 125 patients were considered retrospectively and 75 were enrolled prospectively as the validation cohort. Serum dexamethasone, Late Night Salivary Cortisol (LNSC), and Urinary Free Cortisol (UFC) were measured with LC-MS/MS. Normal LNSC and UFC levels were used to exclude CS. The lower 2.5th percentile of dexamethasone distribution in non-CS patients with cortisol ≤ 50 nmol/L after 1-mg DST was used as threshold.
results16 patients were CS and 184 non-CS (108 adrenal incidentaloma and 76 excluded CS); 4.5 nmol/L resulted the calculated threshold. Cortisol after 1-mg DST confirmed high sensitivity (100% at 50 nmol/L cut-off) and moderate-low specificity (63%, increased to 91% at 138 nmol/L) to diagnose CS in the whole cohort of patients. We could reduce the number of false-positive results (from 10 to 6 and from 7 to 4 in AI and excluded CS) considering adequate dexamethasone levels. Dexamethasone levels were not affected by hypercortisolism, age, gender, smoke, weight, and creatinine. 6% of non-CS patients did not achieve adequate dexamethasone levels (40% of tests with serum cortisol > 138 nmol/L after 1-mg DST).
conclusionsWe developed and validated the routine dexamethasone measurement during 1-mg DST: it is independent from patient's clinical presentation, and it should be used to increase the specificity of serum cortisol levels.
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