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PubMed2004

The low-dose dexamethasone suppression test: a reevaluation in patients with Cushing's syndrome.

Low-dose dexamethasone suppression testing has been recommended for biochemical screening when Cushing's syndrome is suspected. The criterion for normal suppression of cortisol after dexamethasone is controversial. To assess diagnostic utility (sensitivity), we report the results of low-dose dexamethasone suppression testing in 103 patients with spontaneous Cushing's syndrome. There were 80 patients with Cushing's disease (78%), 13 with the ectopic ACTH syndrome (13%), and 10 with cortisol-producing adrenocortical adenomas (10%). Fourteen (18%) of 80 patients with Cushing's disease suppressed serum cortisol to less than 5 micro g/dl (<135 nmol/liter) after the overnight 1-mg test, whereas six patients (8%) actually showed suppression of serum cortisol to less than 2 micro g/dl (<54 nmol/liter). In addition, the 2-d, low-dose dexamethasone suppression test yielded false-negative results in 38% of patients when urine cortisol was used and 28% when urinary 17-hydroxycorticosteroids were used. Serum cortisol after the 1-mg test correlated with baseline urinary free cortisol (r = 0.705, P < 0.001), plasma ACTH level (r = 0.322, P = 0.001), and urinary free cortisol after the 2-d test (r = 0.709, P = 0.001). This study provides evidence that low-dose dexamethasone may suppress either plasma cortisol or urinary steroids to levels previously thought to exclude Cushing's syndrome and that these tests should not be used as the sole criterion to exclude the diagnosis of endogenous hypercortisolism.

17-Hydroxycorticosteroids↗

PubMed2002

The low dose dexamethasone suppression test: effect of time of administration and dose.

The dexamethasone suppression test (DST) is used to determine the sensitivity of the hypothalamic-pituitary-adrenal axis (HPA-axis) to negative feedback. Dexamethasone is usually administered at 23:00 h or at midnight but this is often not convenient. The aim of this study was to determine whether the administration of dexamethasone at 21:00 h as compared to 23:00 h would alter the degree to which 08:00 h plasma cortisol was suppressed the following morning. Three healthy males (mean+/-SE: 32+/-7 yr) and 3 healthy females (mean+/-SE: 35+/-7 yr) took part in the study. Each subject was orally administered 1 of 3 doses of dexamethasone (0.25 mg, 0.5 mg, or 1.0 mg) on 3 separate occasions in random order at least a week apart. Each dose of dexamethasone was taken at either 21:00 h or 23:00 h so that each subject underwent 6 tests. The differences in cortisol suppression between times and doses of dexamethasone were assessed using Analysis of Variance. Plasma cortisol was suppressed less in response to 0.25 mg dexamethasone at both 21:00 h and 23:00 h as compared with doses of dexamethasone of 0.5 mg or 1.0 mg (p=0.004). Suppression of plasma cortisol in response to each dose of dexamethasone was similar regardless of the timing of dexamethasone administration (p=0.5). We conclude that in healthy subjects 0.25 mg dexamethasone suppresses plasma cortisol less than either 0.5 mg or 1.0 mg and that 0.5 mg dexamethasone suppresses plasma cortisol to a similar extent as 1.0 mg dexamethasone. Moreover, changing the administration time of dexamethasone from 23:00 h to 21:00 h does not effect the degree to which cortisol is suppressed in healthy subjects.

Adult↗

PubMed1983

The dexamethasone suppression test in adolescent psychiatric inpatients.

The dexamethasone suppression test (DST) was administered to 120 adolescent psychiatric patients at the time of hospitalization, and cortisol levels were measured at 4:00 p.m. and 11:30 p.m. on the day after a 1-mg oral dose of dexamethasone was given. Failure to suppress serum cortisol (i.e., cortisol level less than 5 micrograms/dl) was noted in 25 patients: 7 of 17 patients who met DSM-III criteria for major depressive disorder, 7 of 38 patients with dysthymic disorder, 7 of 47 patients with conduct disorder, and 4 of 15 schizophreniform patients. The predictive value of the DST for major depressive disorder was only 28%. Although adolescent patients with abnormal DSTs may eventually develop affective symptoms consistent with a major depressive disorder, the DST did not discriminate between major depression and other psychiatric diagnoses in these hospitalized adolescents.

Adolescent↗

PubMed1986

The dexamethasone suppression test in generalised anxiety disorder.

The dexamethasone suppression test was performed on 79 patients with a diagnosis of generalised anxiety disorder. A non-suppression rate of 27% was obtained, comparable to that found in out-patient major depression but notably higher than previous reports in panic disorder. No good clinical predictors of non-suppression were discovered, nor was the co-occurrence of depression sufficient to account for the finding.

Anxiety Disorders↗

PubMed1988

Dexamethasone suppression test, schizophrenia and movement disorder.

The dexamethasone suppression test (DST) was administered to 20 patients with schizophrenic illness. Ten of these patients also had tardive dyskinesia (TD). The scores on TD and parkinsonism scales were significantly higher in DST nonsuppressors. There was also a significant positive correlation between the post-dexamethasone cortisol level and the movement disorder scales.

Adult↗

PubMed1988

The association of MHPG to dexamethasone suppression test status.

The results of the dexamethasone suppression test (DST) were compared to levels of 24-hour 3-methoxy-4-hydroxyphenylglycol (MHPG) in 60 patients with unipolar depression. DST nonsuppressors had significantly higher levels of MHPG than did DST suppressors. The possible implications of this finding are discussed.

Adult↗

PubMed1983

Dexamethasone suppression tests in patients with panic disorder.

Dexamethasone suppression tests were given to 10 patients with panic disorder and 22 depressed patients. All patients with panic disorder were normal suppressors, and nine depressed patients were nonsuppressors. The mean cortisol levels of the two groups differed significantly.

Adult↗

PubMed1983

Depression and the Newcastle Scale. Their relationship to the dexamethasone suppression test.

The results of 41 standardised dexamethasone suppression tests (DST) with the Newcastle Scale diagnostic weighting for endogenous depression correlated significantly (P less than .001). Specificity of the DST was found to be 89 per cent, sensitivity 82 per cent and the diagnostic confidence for endogenous depression 94 per cent. This strongly supports the validity of the Newcastle Scale diagnostic weighting for endogenous depression.

Adult↗

PubMed1987

Factors interfering with the 1 mg dexamethasone suppression test in depression.

The 1 mg dexamethasone suppression test (DST) was performed in 50 depressive inpatients in order to investigate factors which might interfere with its sensitivity and specificity for endogenous depression: improvement within one week after the test, recent admission to a psychiatric ward, and weight loss. Four out of five endogenous depressive patients whose depression improved within one week after the test had normal suppression, thus supporting the assumption that normalization of the DST may precede the improvement in depression. Nonendogenous depressive patients had an accumulation of pathologic test results on the day after admission that may be due to "admission stress". However, in endogenous depressives this effect was not observed. An influence of weight loss on the percentage of suppressors and nonsuppressors was not demonstrable. It is concluded that in the evaluation of DST results time parameters should be considered to a greater degree.

Adult↗

PubMed1989

Stress lymphocytes and the dexamethasone suppression test in major depressive disorders.

The Dexamethasone Suppression Test (DST) was administered to 12 patients with major depression and 4 normal controls. Peripheral blood smears were collected before and after the DST, and atypical lymphocytes were counted. Six patients who were nonsuppressors on the DST had a high percentage of so-called stress lymphocytes (Downey type II atypical lymphocytes). Five of six subjects with normal suppressor responses had low stress lymphocyte counts or no such cells (p less than 0.01). The findings suggest that the stress lymphocyte response might be related to nonsuppression on the DST in major depression.

Adolescent↗

PubMed1985

What does the dexamethasone suppression test identify?

The authors studied the Dexamethasone Suppression Test (DST) in chronic pain patients with and without major depression, using items from a modified version of the Hamilton Depression Scale, the Hamilton Anxiety Scale, and the Montgomery-Asberg Depression Rating Scale. The purpose of the study was to identify the factor or factors which discriminated DST suppressors from nonsuppressors. The data suggest that depression and its profile are efficient discriminators of suppressors and nonsuppressors. Anxiety-related items were not as good as discriminators. The items that identified nonsuppression were the items that are often seen in combination in endogenous depression.

Adult↗

PubMed1985

The dexamethasone suppression test in prepubertal depressed children.

The dexamethasone suppression test (DST) was performed in 50 hospitalized prepubertal children who met DSM-III criteria for major depressive episode, 18 hospitalized controls with a psychiatric disorder, and 18 nonhospitalized normal controls. Baseline and post-DST cortisol levels were measured at 8 a.m. and 4 p.m. The depressed children had consistently higher cortisol levels than the controls at baseline and post-DST. The DST was positive in 82% of depressed children, 28% of psychiatric controls, and 11% of normal controls. The results indicate that prepubertal depressed children may have abnormalities in the hypothalamic-pituitary-adrenal axis similar to those in adults with a major depressive illness.

Age Factors↗

PubMed1985

Depression after minor closed head injury: role of dexamethasone suppression test and antidepressants.

The results of dexamethasone suppression test (DST) and the effectiveness of amitriptyline and phenelzine in treating depression with melancholia after minor closed head injury in 10 patients were compared to those in 12 control patients with primary depression and melancholia. Prevalence of abnormal DST results was higher in the control group (91%) than in the closed head injury group (10%). Results of the DST corresponded with clinical improvement. Amitriptyline produced significant and consistent improvement in all control patients at the end of 4 weeks of treatment. No patient in the closed head injury group showed significant improvement with amitriptyline. The closed head injury patients were treated with phenelzine after a 3- to 7-day washout period. No statistical improvement after 4 weeks of treatment with phenelzine was seen in any of these patients. The DST may be useful as an adjunct to the diagnostic and monitoring process in primary depression with melancholia. Depression after minor closed head injury did not correlate with the DST. Amitriptyline and phenelzine have limited use (if any) in depression with melancholia after minor closed head injury.

Adult↗

PubMedDate not supplied

[The dexamethasone suppression test in affective disorders. A review].

The Dexamethasone Suppression Test (DST) is a new tool to help in the diagnosis of depression. The authors present the clinical methodology for in- and out-patients and review the current literature on the DST. Some show a correlation between cortisol non-suppression after dexamethasone and the diagnosis of endogenous or primary depression. The authors illustrate the interest of the DST by providing there personal experience of this test. The influence of clinical state, severity of depression and other variables, such as age, sex, menopause and family history, are reviewed in reference to the neuro-transmitters control of the DST.

Adrenocorticotropic Hormone↗

PubMed2006

An update on the overnight dexamethasone suppression test for the diagnosis of Cushing's syndrome: limitations in patients with mild and/or episodic hypercortisolism.

The overnight one-mg dexamethasone suppression test has been used for many years to screen for Cushing's syndrome. This test has usually been evaluated in controls versus patients with severe hypercortisolism. Under these conditions, the overnight dexamethasone suppression test has been reported to have high sensitivity and specificity. The objective of this study was to determine the sensitivity of the one mg overnight dexamethasone suppression test in patients with mild and/or periodic Cushing's syndrome. Therefore, an overnight dexamethasone suppression test was performed in 17 consecutive patients presenting to an endocrinology clinic with signs and symptoms of hypercortisolemia who were later proven to have Cushing's syndrome. The majority of patients were found to have both mild and periodic hypercortisolism. One mg of dexamethasone was given at midnight and a plasma cortisol was measured by radioimmunoassay at 08:00 the following morning. Using a cut-off for a morning cortisol following overnight dexamethasone of > 5 microg/dL, only three of 17 patients failed to suppress to a value less than this cut-off (sensitivity 18 %). A cut-off of > 2 microg/dL gave similar sensitivity. Even with a stringent cut-off point of > 1.8 microg/dL, only seven of 17 patients failed to suppress to a value less than this cut-off point (sensitivity of 41 %). These results demonstrate that the great majority of patients with mild and/or periodic Cushing's syndrome suppress to overnight dexamethasone. Since patients with mild and/or periodic Cushing's syndrome are the patients in whom the identification of hypercortisolism is difficult, our results from this relatively small study suggest that this test should no longer be used to exclude these patients from further workup for Cushing's syndrome.

Adolescent↗

PubMed1987

Dexamethasone suppression test in severe schizophrenic illness: effects of plasma dexamethasone and caffeine levels.

A dexamethasone suppression test (DST) was administered to 31 inpatients with a severe acute schizophrenic exacerbation 4 or 5 days following admission and repeated after 4 weeks or prior to discharge. We identified 15 patients (48%) who were nonsuppressors on the DST at the first test. To exclude major confounders of DST results we monitored weight constancy and plasma concentrations of dexamethasone. In a subgroup of patients also plasma caffeine contents were determined. Our results indicate that DST nonsuppression occurs frequently among patients with schizophrenic crisis. Since caffeine plasma levels were indistinguishable between suppressors and nonsuppressors we reject that excessive caffeine intake accounts for DST nonsuppression among individuals with schizophrenia. Nonsuppressors had lower plasma dexamethasone levels than suppressors and reversal of the DST status from nonsuppression to suppression was associated with an increase of plasma concentrations of the test drug.

Adult↗

PubMed1990

Plasma dexamethasone levels in children given the dexamethasone suppression test.

To determine whether children who demonstrate dexamethasone suppression test (DST) nonsuppression have lower plasma dexamethasone levels than DST suppressors, we administered the DST to 73 patients ranging in age from 5-14 years. Plasma dexamethasone levels and postdexamethasone cortisol levels were measured at 4:00 PM on day 2. We found: (1) DST nonsuppressors had significantly lower plasma dexamethasone levels (p less than 0.03) than suppressors; similar trends were observed when the population was divided into depressed and nondepressed patients; (2) mg/m2 dose of dexamethasone was directly correlated with plasma dexamethasone (p less than 0.003) and inversely correlated with postdexamethasone plasma cortisol levels (p less than 0.04); and (3) a statistically significant inverse correlation between plasma dexamethasone levels and postdexamethasone cortisol levels (p less than 0.04). Our findings show that plasma dexamethasone levels are important in evaluating DST results in psychiatrically disturbed children and suggest that dexamethasone dosage for use in the DST in children might be better calculated in terms of body surface area.

Adolescent↗

PubMed1985

Does the dexamethasone suppression test have clinical utility in psychiatry?

The dexamethasone suppression test (DST) has had unprecedented evaluation among biologic tests proposed for application to psychiatric patients. Several techniques for test administration have been devised, including the use of 1 mg of dexamethasone at bedtime, two plasma samples for assay of cortisol (ideally in the afternoon and evening of the following day), and a criterion of greater than 5 micrograms/dl to define nonsuppression. The DST has limited power in differentiating major depression from other acute, severe illnesses but may be useful in comparisons of selected patient populations with affective features or history, and may also have value in predicting and monitoring treatment response. Experience with the DST encourages the search for additional simple biologic tests to help evaluate psychiatric patients.

Acute Disease↗