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PubMed1988

Dexamethasone suppression test and coping behavior in psychosocial stress.

The dexamethasone suppression test (DST) and the Minnesota Multiphasic Personality Inventory (MMPI) were administered to 144 healthy inductees on day 2 of military service. One hundred and four of them completed a 120-item questionnaire describing their coping responses to this particular challenge. Thirty-six subjects (25%) failed to suppress plasma cortisol adequately. Their mean scores on the MMPI clinical standard scales were within the normal range. High postdexamethasone cortisol levels were associated with denial and passivity, and with low demand for social support. These results suggest that the DST might be more related to coping with a stressor than to a specific diagnosis. The authors speculate that high hypothalamic-pituitary-adrenal activity may have a primary role in psychological defense promoting inattention to the aversive aspects of stressful situations.

Adolescent↗
PubMed1999

The continuous 7-hour intravenous dexamethasone suppression test in the differential diagnosis of ACTH-dependent Cushing's syndrome.

OBJECTIVE: A recent report showing disappointingly low sensitivity and specificity for the oral high dose dexamethasone test in the differential diagnosis of Cushing's syndrome prompted us to re-evaluate the results obtained in our centre using the continuous 7-hour intravenous dexamethasone suppression test for this purpose. PATIENTS: 105 patients with ACTH-dependent Cushing's syndrome were included in this study; 78 with Cushing's disease, 8 with ectopic ACTH-secreting tumours and 19 were classified as 'of unknown aetiology'. RESULTS: In 74/78 (94.9%) of patients with Cushing's disease and in 3/8 (37.5%) patients with the ectopic ACTH syndrome, a plasma cortisol decrease > 190 nmol/l at 7 h as compared to baseline values was achieved in the continuous 7-hour intravenous dexamethasone suppression test. Using a plasma cortisol decrease > 190 nmol/l at 7 h as compared to baseline values as the cut-off value, the sensitivity and specificity of the continuous 7-hour intravenous dexamethasone suppression test for the diagnosis of Cushing's disease in patients with ACTH-dependent Cushing's syndrome were 94.9% and 62.5%, respectively. CONCLUSIONS: In patients with ACTH-dependent Cushing's syndrome with a plasma cortisol decrease > 190 nmol/l at 7 h in the continuous 7-hour intravenous dexamethasone suppression test, additional localizing investigations such as bilateral simultaneous inferior petrosal sinus sampling and/or pentetreotide scintigraphy should be performed when no clearly discernible pituitary adenoma is observed on MRI studies. Patients with ACTH-dependent Cushing's syndrome with a plasma cortisol decrease < 190 nmol/l at 7 h in the continuous 7-hour intravenous dexamethasone suppression test should also undergo bilateral simultaneous inferior petrosal sinus sampling and/or pentetreotide scintigraphy to demonstrate the presence of a nonpituitary source of ACTH overproduction.

ACTH Syndrome, Ectopic↗
PubMed1989

[Investigation of Cushing's syndrome. The diagnostic value of the dexamethasone suppression test, the metopirone test and the CRF test].

We describe thirty-one patients with Cushing's syndrome, with the object of evaluating the relative merit of the Dexamethasone suppression test, Metyrapone test and Corticotrophin Releasing Factor (CRF) test in classifying the syndrome. Bilateral adrenocortical hyperplasia (Cushing's disease) was present in sixteen patients. Three had bilateral macrodular hyperplasia of the adrenal cortex, six had adrenocortical adenoma, four had adrenocortical carcinoma, and two patients presented ectopic ACTH-syndrome. The diagnosis was surgically verified in every case. The Metyrapone test was found to give the safest classification in patients with Cushing's syndrome. The Dexamethasone test will diagnose Mb. Cushing reliably when suppression of serum cortisol is present following the large dose of Dexamethasone, but failure to suppress does not exclude the diagnosis. The CRF test is easy to perform and distinguished reliably between Mb. Cushing and other causes of the syndrome in eight out of ten patients in whom it was performed. Outpatient examination including the CRF test and CT-scanning of the pituitary and adrenal glands is advocated as a preliminary step in the classification of biochemically and clinically suspected cases of Cushing's syndrome.

17-Hydroxycorticosteroids↗
PubMed1983

Thirty-four hour dexamethasone suppression test in depression.

The utility of extending the dexamethasone suppression test past its usual 24 hr period to include a cortisol determination at 34 hr was investigated in 18 depressed patients. Conventional suppressors and non-suppressors differed significantly on their 34 hr cortisol values. However, this difference was small. Furthermore, 34 hr values generally returned close to baseline values, so that the 34 hr DST cannot now be recommended in the assessment of depressed patients without further study.

Adult↗
PubMed1990

Dexamethasone suppression test in patients with Parkinson's disease.

The Dexamethasone Suppression Test (DST), supposed to effectively distinguish between endogenous and nonendogenous depression, was performed in a group of 34 patients with Parkinson's disease. Abnormal DST results were observed in 50% of the patients. The patients were clinically divided into subgroups of depressed and nondepressed parkinsonians. Abnormal DST results were significantly more frequent in depressed (75%) than in nondepressed parkinsonians (27.7%).

Depression↗
PubMed1985

Dexamethasone suppression test and sleep deprivation in endogenous depression.

The dexamethasone suppression test (DST) was carried out in 24 endogenously depressed and 15 non-endogenously depressed patients before and on the day after therapeutic sleep deprivation (SD) for one night. The diagnostic selectivity of DST results was not improved by combination with SD. The alteration of DST cortisol levels after SD, irrespective of the direction of change (so-called cortisol response) was significantly higher in endogenous depressives than in neurotic depressives. No unequivocal statement was possible on (a) the predictive value of DST data for the SD effect and (b) the relationship between neuroendocrine changes and the antidepressive effect of SD.

Bipolar Disorder↗
PubMed1986

Body weight and reported versus measured weight loss as confounders of the dexamethasone suppression test.

We examined the association between post-dexamethasone suppression test (DST) serum cortisol and body weight, self-report of weight loss during the episode, and measured weight loss during the first week of admission in a series of 245 depressed inpatients. Data on measured weight loss between two successive admissions was available in a group of 57 depressed inpatients. Reported weight loss during the episode and measured weight loss during the first week of admission were not related to DST nonsuppression. In contrast, DST nonsuppression was significantly more frequent in patients with measured weight loss between two successive admissions. This association was particularly strong in patients with below-average body weight and was practically nonexistent in patients with above-average body weight. Multivariate analysis indicates that a significant association between DST results and weight loss may be missed if self-report is substituted for direct measurement of weight loss and if potential confounders, such as total body weight, age, and sex, are ignored.

Adult↗
PubMed1992

Abnormal overnight dexamethasone suppression test in subjects receiving rifampicin therapy.

We have studied the effects of rifampicin on the overnight 1-mg dexamethasone suppression test usually employed to exclude suspected Cushing's syndrome. Previous observations indicate that in humans, rifampicin profoundly attenuates the biological effects of hydrocortisol and prednisolone, probably by increasing the metabolism of these drugs in the liver. The study was carried out in 16 normal volunteers. All subjects had a normal overnight 1-mg dexamethasone suppression test (468 +/- 86 vs. 32 +/- 21 nmol/L; mean +/- SD). In 8 subjects treated with rifampicin (600 mg) for 10 days, the inhibitory effect of dexamethasone on serum cortisol was completely prevented (575 +/- 114 vs. 434 +/- 82). In the remaining 8 rifampicin-treated subjects, the inhibitory effect of 1, 2, or 3 mg dexamethasone on serum cortisol was not observed. When 4 mg dexamethasone were administered, the serum cortisol level was 193 nmol/L, above the expected normal suppression value. The plasma dexamethasone concentration was very low after rifampicin treatment (range, 1.2-4.8 nmol/L). We conclude that when patients are treated with rifampicin, the standard overnight dexamethasone suppression test not only has no diagnostic value, but can be very misleading.

Adult↗
PubMed1984

Endocrine changes and clinical profiles in depression: I. The dexamethasone suppression test.

Hypothalamic-pituitary-adrenal axis function was investigated in 72 patients with primary depression. Forty-four per cent of the patients demonstrated abnormal suppression of their cortisol levels after a 1 mg overnight dexamethasone suppression test. Patients with abnormal suppression ('non-suppressors') were not clearly distinguished from 'suppressors' by the commonly used diagnostic classifications. They did not appear to be more severely depressed, but they were more likely than the 'suppressors' to be in-patients. Multivariate analysis of the data suggested that two clinical features were independently associated with non-suppression: the PSE syndromes of Slowness and General Anxiety. However, the association of these syndromes with non-suppression was relatively weak, indicating that the clinical significance of the dexamethasone suppression test is, as yet, unclear. The results raise doubts about the validity of using the dexamethasone suppression test as a diagnostic marker for a specific depressive syndrome.

Adult↗
PubMed2002

Overnight dexamethasone suppression test: a reliable screen for Cushing's syndrome in the obese.

OBJECTIVE: Reevaluation of the validity of the 1-mg overnight dexamethasone suppression test (ODST) as a screening test for Cushing's syndrome in obese patients. RESEARCH METHODS AND PROCEDURES: Eighty-six obese patients (body mass index, 30 to 53 kg/m(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 <80 nM (3 micro g/dL) was chosen as the cut-off point for normal suppression. Patients with serum cortisol levels > or =80 nM were evaluated for Cushing's syndrome. RESULTS: Suppression of morning cortisol levels to <80 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.

Adult↗
PubMed1986

An overnight high-dose dexamethasone suppression test for rapid differential diagnosis of Cushing's syndrome.

We have developed a high-dose dexamethasone suppression test that can be administered overnight with a single 8-mg dose and used the new procedure in the differential diagnosis of 83 patients with Cushing's syndrome. In 76 patients with surgically or pathologically proven cause--60 with Cushing's disease, 7 with the ectopic adrenocorticotrophic hormone syndrome, and 9 with adrenal tumors--suppression of plasma cortisol levels to less than 50% of baseline indicated a diagnosis of Cushing's disease. The test had a sensitivity of 92%, a specificity of 100%, and a diagnostic accuracy of 93%. These values equal or exceed those of the standard 2-day test whether based on suppression of urinary 17-hydroxycorticosteroids or plasma cortisol. We conclude that this overnight, high-dose dexamethasone suppression test is practical and reliable in the differential diagnosis of Cushing's syndrome.

17-Hydroxycorticosteroids↗
PubMed2004

Effects of antidepressant treatment on thyrotropin-releasing hormone stimulation, growth hormone response to L-DOPA, and dexamethasone suppression tests in major depressive patients.

Dexamethasone suppression (DST), thyroid-stimulating hormone (TSH) and prolactin (PRL) responses to thyrotropin-releasing hormone (TRH) and growth hormone (GH) response to L-DOPA tests were evaluated in 19 depressed inpatients before the commencement of the antidepressant treatment and after the clinical response to examine: (i) the functional relationships among the hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-thyroid (HPT) axis and dopaminergic system in depression, (ii) any alterations in these hormonal functions with the antidepressant treatment. TSH responses to TRH showed a tendency to increase from pre- to posttreatment period, while TRH-induced PRL and L-DOPA-induced GH responses did not change with treatment in depressed patients who responded to the treatment. Females showed significantly higher TSH and PRL responses to TRH compared to males. No interconnections were found among the responses in DST, TRH stimulation test and L-DOPA-induced GH test in the patients. The results do not support the interrelations between the abnormalities in the HPT and HPA axes and central dopaminergic activity in depression.

Adult↗
PubMed1986

Dexamethasone suppression test in schizophrenic patients before and during neuroleptic treatment.

The dexamethasone suppression test (DST) was performed in 21 drug-free schizophrenic patients. The patients satisfied DSM-III and Research Diagnostic Criteria for schizophrenia and were in an acute phase of the disease. In 15 of the patients the DST was repeated after about 5 weeks of treatment with neuroleptics. DST compliance was checked by analysis of dexamethasone concentrations in plasma. In the acute phase 71% (at 04 p.m.) of the patients were nonsuppressors. After neuroleptic treatment the frequency of abnormal responders had decreased to 20%. The decrease in nonsuppressors was not due to alteration of the dexamethasone concentration between the two test occasions. Prolactin levels were markedly increased at the second test occasion compared with the first. There were no significant relationships between cortisol levels, cortisol suppression and prolactin levels. The high frequency of nonsuppressors among schizophrenic patients in the acute phase of the disease indicates that acute stress may be a confounding factor in the outcome of DST.

Adult↗
PubMedDate not supplied

The use of the dexamethasone suppression test in the differential diagnosis of catatonic stupor.

Catatonic stupor is a cluster of symptoms and not necessarily a disease entity. It may be seen not only in schizophrenia, but in major affective disorders, conversion disorders, organic brain syndromes, and atypical psychoses. The dexamethasone suppression test is a valuable tool in the diagnosis of major affective disorders, differentiating them from other types of psychopathology. In a twelve month retrospective study, five patients admitted to Psychiatric Institute of Atlanta were identified as meeting the criteria for catatonic schizophrenia. A dexamethasone suppression test was performed shortly after admission. Four of the five had patterns of inadequate suppression, indicative of a major affective disorder rather than a schizophrenic disorder. The dexamethasone suppression test is simple to administer, relatively painless, free from hazards, easy to interpret, readily available, and reliable. Not only can the dexamethasone suppression test be used in diagnosis, but also as a valuable aid in following the therapeutic progress in resolution of a major affective disorder.

Adult↗
PubMed1983

The dexamethasone suppression test in mixed bipolar disorder.

The authors administered the dexamethasone suppression test to 10 patients who met DSM-III criteria for bipolar disorder. All 7 patients with bipolar disorder, mixed type, failed to suppress cortisol; however, the 3 patients with bipolar disorder, manic type, were normal suppressors.

Adult↗
PubMed1990

Comorbidity in the interpretation of dexamethasone suppression test results in children: a review and report.

The dexamethasone suppression test (DST) was administered as part of the initial clinical assessment to 83 children and adolescents who were consecutively referred for outpatient evaluation. All diagnoses were made clinically by a child psychiatrist according to DSM-III criteria. A weight-corrected dose of dexamethasone of 17 micrograms/kg was used. DSM-III diagnoses were made independent of DST results. Patients were stratified into four main diagnostic groups: major depressive disorder (MDD) (N = 27); attention deficit disorder with hyperactivity (ADDH) (N = 22); major depressive disorder plus attention deficit disorder with hyperactivity (MDD + ADDH) (N = 29); and psychiatric controls (PC) (N = 5). Rates of dexamethasone nonsuppression were found to be similarly elevated in children with MDD (29.6%), ADDH (22.7%), and MDD + ADDH (37.9%). All 5 psychiatric control patients had a normal postdexamethasone suppression (0%). A similar pattern of results emerged in a reexamination of the literature on available studies of DST in juveniles which revealed that children with major affective disorders, attention deficit disorder (ADDH), and anxiety disorders had comparable DST results that were significantly higher than the 5.6% rate found in normal controls. These findings provide further support for similarities in DST results between ADDH and MDD in outpatients. Although these results suggest a lack of specificity of the DST as a laboratory aid for the diagnosis of juvenile affective disorders, they are also consistent with findings indicating that the DST may be an index of clinical severity and other findings suggesting a possible association between ADDH and MDD. Despite its limitations, the DST may provide potentially useful clinical and research information regarding the pathophysiology of psychiatric disorders and in alerting clinicians to the presence of serious psychiatric disorders. The findings also stress the relevance of assessing comorbidity in interpreting DST results.

Adolescent↗
PubMed1989

The predictive value of the dexamethasone suppression test. A placebo-controlled study.

We evaluated the dexamethasone suppression test (DST) as a predictor of response to drugs and placebo in 105 patients, in a large double-blind placebo-controlled out-patient trial to determine the efficacy of paroxetine HCl, a selective serotonin reuptake inhibitor, compared with that of imipramine HCl and placebo. The presence of a positive or negative DST did not predict response to either paroxetine or imipramine. However, a positive DST predicted a poorer response to placebo: only 3 out of 18 patients who showed DST non-suppression responded to placebo, as opposed to 11 out of 21 who exhibited DST suppression (P less than 0.05). A positive DST was associated with a 61% response to drugs and a 16% response to placebo. This finding suggests that the presence of a positive DST implies the need for active somatic treatment.

Adult↗