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At least 19 recordsLinked to original sources
PubMed1979

The 24-hour dexamethasone suppression test in a clinical setting: relationship to diagnosis, symptoms, and response to treatment.

Of 54 male psychiatric patients undergoing dexamethasone suppression tests in a clinical setting, 40% of those with a major depressive disorder showed escape from suppression over the 24 hours after dexamethasone administration, while all of the patients with schizophrenia, neurosis, alcoholism,and drug abuse showed normal pituitary-adrenal suppression. Only 10% of the depressed patients showed resistance to suppression 8 hours after dexamethasone administration. There was no difference between depressed patients who did and did not show escape from suppression in type of previous episodes, family history, symptoms, or medication. However, those who showed escape tended to respond better to treatment and to be rated as having a more severe depression. The theoretical and clinical implications of these findings are not yet clear.

Adult↗
PubMed1977

Conjugated estrogens and the overnight dexamethasone suppression test.

Basal (8:00 AM) serum cortisol levels in peri- or postmenopausal women treated with 0.625 mg daily of conjugated equine estrogens were only slightly higher than pretreatment levels. A 1.25 mg/day dosage resulted in a significant increase in basal serum cortisol levels. In women treated with either dosage, 8:00 AM serum cortisol levels 8 to 10 hours after 1 mg of oral dexamethasone were suppressed to below 5 microgram/100 ml, although there was a significant rise in post-dexamethasone serum cortisol levels in those treated with the higher dosage. It is concluded that while replacement dosages of estrogens increase circulating total serum cortisol levels, they do not interfere with the interpretation of the overnight dexamethasone suppression test.

Adult↗
PubMedDate not supplied

Clinical experience with a simple screening test for Cushing's syndrome combining the determination of plasma cortisol circadian rhythm with the overnight dexamethasone suppression test.

In 17 normal subjects and 126 patients with various endocrine disorders, including 13 patients with Cushing's syndrome, plasma levels of fluorogenic corticosteroid were measured at 9 AM and midnight, and again at 9 AM the following morning, after the patient had received 1 mg of dexamethasone by mouth immediately after the midnight sampling. Basal morning levels of plasma corticosteroids were of little diagnostic value in differentiating between Cushing's syndrome and non-Cushing's states because of the wide overlap of values observed. At midnight the overlap almost completely disappeared. After overnight suppression, only one patient with a mild form of Cushing's disease had normal (false-negative) results in two of four instances. There were virtually no false-positive results, except for two patients with anorexia nervosa showing minor abnormalities of the test. The results were in general agreement with those of the classic Liddle test. However, one patient with Cushing's disease had repeatedly abnormal responses to overnight suppression and normal responses to the Liddle test. When the inhibitory tests gave equivocal results in the differential diagnosis between exogenous obesity and Cushing's disease due to adrenal hyperplasia, the response of plasma corticosteroids to hypoglycemia, normal in obesity and absent in Cushing's disease, proved to be an excellent ancillary test in differentiating between the two conditions.

Adrenal Cortex Hormones↗
PubMed1977

A two-dose dexamethasone suppression test in patients with psychiatric illness.

After exposure to a low and high dose dexamethasone regime, 11 of 34 acute psychiatric inpatients demonstrated abnormal dexamethasone suppression characterized by morning and/or mid-afternoon escape from suppression. This abnormality of suppression was found in primary depression, in mania, and in acute schizophrenia. In primary depression, the presence of abnormal dexamethasone suppression failed to discriminate "endogenous" depressed from "other depressed" subjects. Because nonsuppression to a high dose of dexamethasone is also found in patients with ectopic ACTH secretion and in patients with autonomous adrenal tumors, caution is necessary in the interpretation of nonsuppression which persists after recovery from psychiatric illness. As patients with Cushing's syndrome of uncertain etiology may be referred to a psychiatrist for a diagnostic evaluation, the psychological correlates of abnormal dexamethasone suppression need to be established with greater certainty.

Bipolar Disorder↗
PubMed1976

Single-dose four hour dexamethasone suppression test in normal men and its application for the diagnosis of Cushing's syndrome.

As a four hour morning test, plasma cortisol levels were radioimmunoassayed before and at two and four hours after dexamethasone (0, 0.5 mg, 1.0 mg or 2.0 mg) was administered at 8-9 a.m. in 20 normal subjects. The 1.0 mg four hour test was most effective in suppression of cortisol and it showed the same suppressibility as the widely used single-dose overnight test. With the 1.0 mg four hour test, 2 patients with Cushing's syndrome due to adrenal hyperplasia could be differentiated from normal and obese subjects. The four hour morning test would be more useful than the widely used overnight test from the reasons; i) it shows the same suppressibility as the overnight test, ii) it obviates the need for bothersome midnight administration of dexamethasone, iii) because it takes only one morning to perform, it can save a day, iv) and it might be applicable for the differential diagnosis of Cushing's syndrome because 4.0 mg morning test resulted in complete suppression of plasma cortisol in a tested Cushing's syndrome, whereas with even 8.0 mg, plasma cortisol was not suppressed in the overnight test in 2 such patients examined.

Adult↗
PubMed1978

Canine plasma cortisol (hydrocortisone) measured by radioimmunoassay: clinical absence of diurnal variation and results of ACTH stimulation and dexamethasone suppression tests.

A radioimmunoassay for plasma cortisol (hydrocortisone) was developed and validated for sensitivity, specificity, accuracy, precision, and parallelism. Steroids were extracted with ethyl ether, and cortisol was purified by gel column chromatography prior to assay. [1,2-3H] cortisol and a commercially available sheep antibody to cortisol-21-hemisuccinate were used. Free steriods were separated from bound steroids by centrifugation after adsorption to dextran-coated charcoal. Plasma cortisol was measured by this technique in 6 normal dogs. Circadian rhythm of cortisol secretion was not detected in samples obtained by venipuncture at 8 different hours on 3 separate days, suggesting that adrenal function tests may be started in clinical patients at any time of day. Resting plasma cortisol concentrations averaged 19.4+/-3.0 (SD) ng/ml and ranged from nondetectable (less than 3 ng/ml) to 77.5 ng/ml. Of 144 canine plasma samples, 95% contained less than 50 ng of cortisol/ml. Intramuscular injection of 2.2 units of adrenocorticotropic hormone/kg of body weight caused detectable increase in plasma cortisol concentrations; maximum response (68.3 to 111.6 ng/ml) occurred 1 to 2 hours after injection. Oral administration of dexamethasone suppressed plasma cortisol to nondetectable concentrations for 32 hours in all 6 dogs.

Adrenocorticotropic Hormone↗
PubMed1976

[Hypothalamic-hypophyseal-adrenocortical dysfunction in patients with anorexia nervosa (author's transl)].

Hypothalamic-pituitary-adrenocortical function was investigated in 14 patients with anorexia nervosa. Impaired suppression of plasma cortisol by dexamethasone was revealed. In 14 patients with anorexia nervosa, circadian rhythm of plasma cortisol, insulin tolerance test, rapid ACTH test and overnight dexamethasone suppression test were examined. Levels of plasma cortisol were higher than those in control subjects throughout the day, and normal circadian rhythm of plasma cortisol was not observed. Basal levels of plasma ACTH were within normal range. tthe response of plasma cortisol to insulin-induced hypoglycemia was lower than that in control subjects, while the response of plasma cortisol in rapid Acth test was normal. In overnight suppression tests, in which one mg dexamethasone was administered orally, 11 of 14 patients showed no suppression of plasma cortisol and 3 other patients showed incomplete suppression. Elevated levels of plasma cortisol and the absence of normal circadian rhythm in patients with anorexia nervosa and malnutrition have already been reported by other investigators, and these abnormalities were ascribed to the delayed half life of plasma cortisol due to impaired cortisol metabolism. However, according to our investigation, it is difficult to explain the failure of dexamethasone to suppress cortisol only by the delayed half life of plasma cortisol, and it is supposed that some kind of abnormal hypothalamic control is also involved.

17-Ketosteroids↗
PubMed1977

Dexamethasone suppressibility of plasma dehydroepiandrosterone (3beta-hydroxy-5-androsten-17-one) in normal men.

9 AM and overnight dexamethasone suppression tests were performed in normal adult subjects and plasma dehydroepiandrosterone (DHA) levels were radioimmunoassayed. The results were as follows: 1) In the 9 AM test, plasma DHA was suppressed to the lowest level at the time between 4 hours and 6 hours after dexamethasone; 2) 2 mg (overnight test) or 3 mg (9AM test) of dexamethasone induced the maximum DHA suppression; 3) after dexamethasone administration in both the tests, plasma DHA was not suppressed below 30% of the basal level, nor below 2 ng/ml; and 4) there was no significant difference in dexamethasone suppressibility of plasma DHA between 9 AM test and overnight test.

Adult↗
PubMed1975

The diagnostic value of hypothalamic-pituitary-adrenocortical function tests in patients with Cushing's syndrome.

The following examinations, including the estimation of urinary neutral steroid metabolites, plasma cortisol, the percentage of unbound-cortisol, cortisol production rate, plasma adrenocorticotrophin (ACTH), dexamethasone suppression test, ACTH stimulation test, metopirone test, lysine-vasopressin (LVP) test and insulin tolerance test, were conducted in 16 patients with Cushing's syndrome for the presence of hypercoticism and for identifying the cause of this syndrome. Of these tests, the measurements of plasma cortisol late in the day and single dose dexamethasone suppression test were most useful for the diagnosis of hypercorticism because of their reliability and simplicity. Urinary 17-KGS, THF/THE ratio, cortisol production rate and low dose dexamethasone suppression test were also useful, whereas insulin test and LVP test were less valuable for this purpose. For the identification of the causes of this syndrome, lysine vasopressin test and metopirone test were most reliable, and plasma ACTH was also useful for this purpose, whereas insulin test and ACTH stimulation test were less valuable.

17-Ketosteroids↗
PubMed1979

Cushing's syndrome: a review of diagnostic tests.

This review presents an analysis and interpretation of the published experimental data that form the basis for laboratory tests commonly used for screening, definitive diagnosis, and differential diagnosis in Cushing's syndrome. The single-dose overnight dexamethasone suppression test is excellent for screening outpatients since this test has a very low incidence of false-negative results (1.9% of 154 patients with Cushing's syndrome). The definitive diagnosis of Cushing's syndrome is best established by combining basal state measurements of the daily urine-free cortisol excretion and late evening plasma cortisol levels with the 2-mg low-dose dexamethasone suppression test. The etiology of Cushing's syndrome is best determined by combining measurements of basal state plasma adrenocorticotropin (ACTH) levels with the 8-mg high-dose dexamethasone suppression test. Under certain conditions, the basal state daily urine excretion of 17-hydroxycorticosteroids and 17-ketogenic steroids, the insulin tolerance test, and the metyrapone test may be useful in the definitive or differential diagnosis of Cushing's syndrome.

Adrenal Cortex Hormones↗
PubMed1979

Evaluation of steroid laboratory tests and adrenal gland imaging with radiocholesterol in the aetiological diagnosis of Cushing's syndrome.

Basal values of the urinary excretion of 17-oxogenic steroids and serum levels of cortisol were not satisfactory in the differentiation of 'suspected' subjects from patients with true Cushing's syndrome. With an RIA method for serum cortisol determination, the overnight dexamethasone suppression test provided the most reliable single test in establishing adrenocortical hyperfunction. Thirty-five normal subjects, fifty-nine obese patients, thirteen 'suspected' patients, and thirteen patients with disease states other than Cushing's syndrome had suppressed values below 4.0 microgram/100 ml. None of the ten patients with Cushing's syndrome had a cortisol concentration less than 16.3 microgram/100 ml. Adrenal gland scintigraphy after radiocholesterol injection is a more valuable tool than the metyrapone test and the high-dose dexamethasone suppression test in the localization and differential diagnosis of adrenocortical lesions causing Cushing's syndrome. It obviates the need for angiographic procedure in the localization of adenomas. It is a reliable technique for identifying functioning adrenal remnants. We therefore propose a schedule for studying patients with suspected adrenocortical hyperfunction.

17-Ketosteroids↗
PubMed1976

Neuroendocrine regulation in depression. II. Discrimination of depressed from nondepressed patients.

Forty-two patients with endogenomorphic depression (ED) and 42 patients with other psychiatric disorders received an overnight dexamethasone test of hypothalamopituitary-adrenal (HPA) suppressibility. Plasma and urinary cortisol measures showed that the ED patients had significantly greater HPA activity before dexamethasone and less complete HPA suppression after dexamethasone. High cortisol vlaues after dexamethasone correlated strongly with spontaneous HPA disinhibition, as indicated by high baseline midnight plasma cortisol levels. Criteria for defining normal suppression responses were developed. All patients with depressive neuroses and most patients with other nondepressive disorders had completely normal responses to dexamethasone. About half of the ED patients had abnormal responses, whether or not they were receiving other drugs at the time of the test. Drug-free patients with depressive neuroses or other disorders showed no abnormal responses to dexamethasone. The effects of psychotropic drugs on the test require further study. Patients with two or more abnormal cortisol values after administration of dexamethasone were identified correctly as ED at confidence levels close to 100%. The dexamethasone suppression test may be of value as a laboratory aid in the diagnosis of "endogenous" depression.

Adrenal Glands↗
PubMed1976

[Adrenocortical diagnosis in ambulatory practice].

The determination of plasma cortisol concentrations is a valuable aid in the diagnosis of some important adrenocortical diseases. Since cortisol is secreted episodically, the diagnostic value of diurnal profiles of plasma cortisol is often limited. On the other hand, a simple ACTH test or an overnight dexamethasone suppression test permit, in most instances, definite diagnosis or exclusion of adrenocortical insufficiency and Cushing's syndrome respectively.

Adrenal Cortex Diseases↗