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Low Diagnostic Utility of Overnight High-Dose Dexamethasone Suppression Test in ACTH-Dependent Cushing's Syndrome

Anand Kumar1, Jayabhanu Kanwar1, Niharika Bharti2

  • 1Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh.

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
|July 12, 2021
PubMed

Insights

The overnight high-dose dexamethasone suppression test (ON-HDDST) shows poor diagnostic value for distinguishing Cushing's disease from ectopic ACTH syndrome. This test is not reliable for localizing ACTH sources in patients with ACTH-dependent Cushing's syndrome.

Area of Science:

  • Endocrinology
  • Diagnostic Testing
  • Hormone Disorders

Background:

  • The overnight high-dose dexamethasone suppression test (ON-HDDST) is used to localize ACTH sources in ACTH-dependent Cushing's syndrome (CS).
  • Previous studies report variable accuracy for the ON-HDDST in differentiating Cushing's disease (CD) from ectopic ACTH syndrome (EAS).

Purpose of the Study:

  • To evaluate the diagnostic utility of the ON-HDDST in distinguishing CD from EAS.
  • To assess the accuracy of ON-HDDST in a series of patients with confirmed ACTH-dependent CS.

Main Methods:

  • Retrospective analysis of 88 patients with ACTH-dependent CS undergoing ON-HDDST.
  • Patients diagnosed with CD (n=68) or EAS (n=20).
  • Diagnostic workup included MRI, CT, Gallium-68-DOTANOC PET scans, and bilateral inferior petrosal sinus sampling.

Main Results:

  • Patients with EAS showed significantly higher post-ON-HDDST serum cortisol levels compared to CD patients (19.9 vs 9.9 μg/dL, P <.01).
  • ON-HDDST suppression (≥50% fall) occurred in 65% of CD patients versus 15% of EAS patients (P <.0001).
  • ROC analysis yielded an AUC of 0.72 (P=.01), with 65% sensitivity and 85% specificity at a 50% cortisol suppression cutoff.

Conclusions:

  • The ON-HDDST demonstrates poor diagnostic value in differentiating CD from EAS.
  • The test's accuracy is limited, making it unreliable for precise localization of ACTH sources in ACTH-dependent CS.
Abstract

Keywords:
ACTHCushing’s diseasedexamethasone suppressionectopic Cushing’s syndrome

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