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This Article Accepted manuscript (PDF) All Versions of this Article: EJE-08-0402v1 159/5/569    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Reimondo, G. Articles by Terzolo, M. PubMed PubMed Citation Articles by Reimondo, G. Articles by Terzolo, M.

The combined low-dose dexamethasone suppression corticotropin releasing-hormone test as a tool to rule out Cushing's syndrome

G Reimondo, Dipartimento di Scienze Cliniche e Biologiche, Universita  di Torino, ASO San Luigi, Medicina Interna I, Orbassano, Italy
S Bovio, Dipartimento di Scienze Cliniche e Biologiche, Universita  di Torino, ASO San Luigi, Medicina Interna I, Orbassano, Italy
B Allasino, Dipartimento di Scienze Cliniche e Biologiche, Universita  di Torino, ASO San Luigi, Medicina Interna I, Orbassano, Italy
S De Francia, Dipartimento di Scienze Cliniche e Biologiche, Universita  di Torino, ASO San Luigi, Farmacologia, Orbassano, Italy
B Zaggia, Dipartimento di Scienze Cliniche e Biologiche, Universita  di Torino, ASO San Luigi, Medicina Interna I, Orbassano, Italy
I Micossi, Dipartimento di Scienze Cliniche e Biologiche, Universita  di Torino, ASO San Luigi, Medicina Interna I, Orbassano, Italy
A Termine, Dipartimento di Scienze Cliniche e Biologiche, Universita  di Torino, ASO San Luigi, Medicina Interna I, Orbassano, Italy
F De Martino, Dipartimento di Scienze Cliniche e Biologiche, Universita  di Torino, ASO San Luigi, Farmacologia, Orbassano, Italy
P Paccotti, Dipartimento di Scienze Cliniche e Biologiche, Universita  di Torino, ASO San Luigi, Medicina Interna I, Orbassano, Italy
F Di Carlo, Dipartimento di Scienze Cliniche e Biologiche, Universita  di Torino, ASO San Luigi, Farmacologia, Orbassano, Italy
A Angeli, Dipartimento di Scienze Cliniche e Biologiche, Universita  di Torino, ASO San Luigi, Medicina Interna I, Orbassano, Italy
M Terzolo, Dipartimento di Scienze Cliniche e Biologiche, Universita  di Torino, ASO San Luigi, Medicina Interna I, Orbassano, Italy

Correspondence: Giuseppe Reimondo, Email: giuseppe.reimondo{at}unito.it

Abstract

Objective: It remains to be evaluated whether the combined low-dose dexamethasone suppression corticotropin releasing-hormone test (LDDST-CRH test) may add to the diagnostic approach of patients suspected to have Cushing's syndrome (CS). Aim of the present study was to evaluate whether the LDDST-CRH test may have a place in the diagnostic strategy of CS.

Design: Prospective evaluation of a consecutive series of patients with suspected CS from 2004 to 2006.

Methods: All the subjects underwent the same screening protocol including 1-mg-dexamethasone suppression test (DST), 24-hour urinary free cortisol (UFC) and midnight serum cortisol, followed by the LDDST-CRH test. Plasma dexamethasone concentration was measured 2 h after the last dose of dexamethasone.

Results: 16 patients had CS while in the remaining 15 subjects CS was excluded. Even if non statistically significant, the sensitivity and the negative predictive value of the cortisol 15 min after CRH was better than the other tests; on the other hand, the test specificity was lower. All of the patients classified as indeterminate were correctly diagnosed by the LDDST-CRH test. Nevertheless, the repeat assessment of the screening tests and the active follow-up gave the same correct results. In all of the patients misclassified by the LDDST-CRH the plasma dexamethasone concentrations were in the normal range.

Conclusions: Based on our findings, we suggest that LDDST-CRH test may still find a place as a rule-out procedure in patients who present with indeterminate results after screening and may be unavailable to repeat testing during follow-up.