Comparison of efficacy between 1 mg overnight dexamethasone suppression test and 2-day low dose dexamethasone suppression test for diagnosis of Cushing's syndrome. 2010

Nuntakorn Kungpanichkul
Division ofEndocrinology and Metabolism, Faculty of Medicine, Siriraj Hospital, Mahidol University Bangkok, Thailand. nuntakorn@hotmail.com

OBJECTIVE To assess the sensitivity and specificity of 1 mg overnight dexamethasone suppression test (ODST) and the 2-day low dose dexamethasone suppression test (LDST) for diagnosis of Cushing's syndrome, and to compare the accuracy of both tests using cutoff value at below 5 microg/dl and at below 1.8 microg/dl. METHODS The present study is a retrospective study, from 1971-2007, in one academic center of 77 patients with clinical suspicion of Cushing's syndrome. Kappa statistical analysis was used to determine agreement between the two tests. Sensitivity and specificity of the tests were calculated. ROC curves were created to determine the best cutoff value of the two tests. RESULTS ODST has very good agreement with the more troublesome LDST and has comparable efficacy Lowering the cutoff value from 5 microg/dl to 1.8 microg/dl does not improve the accuracy of ODST but results in decreased specificity of LDST. The best cutoff value of ODST test is > or = 5.3 microg/dl and the best cutoff value of LDST is > or =5 micro/dl. CONCLUSIONS ODST is an efficient method for diagnosis of patients suspected of having Cushing's syndrome. The attempt to lowering cutoff value does not improve the efficacy of dexamethasone suppression test.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D011237 Predictive Value of Tests In screening and diagnostic tests, the probability that a person with a positive test is a true positive (i.e., has the disease), is referred to as the predictive value of a positive test; whereas, the predictive value of a negative test is the probability that the person with a negative test does not have the disease. Predictive value is related to the sensitivity and specificity of the test. Negative Predictive Value,Positive Predictive Value,Predictive Value Of Test,Predictive Values Of Tests,Negative Predictive Values,Positive Predictive Values,Predictive Value, Negative,Predictive Value, Positive
D011863 Radioimmunoassay Classic quantitative assay for detection of antigen-antibody reactions using a radioactively labeled substance (radioligand) either directly or indirectly to measure the binding of the unlabeled substance to a specific antibody or other receptor system. Non-immunogenic substances (e.g., haptens) can be measured if coupled to larger carrier proteins (e.g., bovine gamma-globulin or human serum albumin) capable of inducing antibody formation. Radioimmunoassays
D003480 Cushing Syndrome A condition caused by prolonged exposure to excess levels of cortisol (HYDROCORTISONE) or other GLUCOCORTICOIDS from endogenous or exogenous sources. It is characterized by upper body OBESITY; OSTEOPOROSIS; HYPERTENSION; DIABETES MELLITUS; HIRSUTISM; AMENORRHEA; and excess body fluid. Endogenous Cushing syndrome or spontaneous hypercortisolism is divided into two groups, those due to an excess of ADRENOCORTICOTROPIN and those that are ACTH-independent. Cushing's Syndrome,Hypercortisolism,Syndrome, Cushing,Syndrome, Cushing's
D003907 Dexamethasone An anti-inflammatory 9-fluoro-glucocorticoid. Hexadecadrol,Decaject,Decaject-L.A.,Decameth,Decaspray,Dexasone,Dexpak,Hexadrol,Maxidex,Methylfluorprednisolone,Millicorten,Oradexon,Decaject L.A.
D005260 Female Females
D005938 Glucocorticoids A group of CORTICOSTEROIDS that affect carbohydrate metabolism (GLUCONEOGENESIS, liver glycogen deposition, elevation of BLOOD SUGAR), inhibit ADRENOCORTICOTROPIC HORMONE secretion, and possess pronounced anti-inflammatory activity. They also play a role in fat and protein metabolism, maintenance of arterial blood pressure, alteration of the connective tissue response to injury, reduction in the number of circulating lymphocytes, and functioning of the central nervous system. Glucocorticoid,Glucocorticoid Effect,Glucorticoid Effects,Effect, Glucocorticoid,Effects, Glucorticoid
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D006854 Hydrocortisone The main glucocorticoid secreted by the ADRENAL CORTEX. Its synthetic counterpart is used, either as an injection or topically, in the treatment of inflammation, allergy, collagen diseases, asthma, adrenocortical deficiency, shock, and some neoplastic conditions. Cortef,Cortisol,Pregn-4-ene-3,20-dione, 11,17,21-trihydroxy-, (11beta)-,11-Epicortisol,Cortifair,Cortril,Epicortisol,Hydrocortisone, (11 alpha)-Isomer,Hydrocortisone, (9 beta,10 alpha,11 alpha)-Isomer,11 Epicortisol

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