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Serum Cortisol Levels in Cushing's Syndrome After Low- and High-Dose Dexamethasone Suppression

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Grant support: in part by USPHS CRC Grant RR 00865 and USPHS training grant AM-07094.

▸ Requests for reprints should be addressed to Andre J. Van Herle, M.D.; UCLA School of Medicine, Department of Medicine/Endocrinology, Los Angeles, CA 90024.

Los Angeles, California

©1982 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1982;97(1):21-26. doi:10.7326/0003-4819-97-1-21
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To standardize the cutoff points of serum Cortisol values in the evaluation of Cushing's syndrome during a low- and high-dose dexamethasone suppression test, daily serum Cortisol measurements (0800 hours and 1600 hours) and urinary 17-hydroxycorticosteroids were compared (Study A). Forty-seven subjects were studied (11 normal subjects, 15 patients with Cushing's disease, five patients with adrenal adenoma, and 16 subjects with suspected Cushing's syndrome). A serum cortisol measurement at 1600 hours of more than 5μg/dL on low-dose dexamethasone suppression and more than 10 μg/dL on high-dose dexamethasone were ascertained to be nonsuppressed values. A baseline dehydroepiandrosterone-sulfate value less than 0.4 μg/ mL indicated patients with an adrenocorticol adenoma. Study B was a prospective study of 17 patients in which no urine samples were collected. Serum Cortisol levels, obtained at 1600 hours on the second day of low- and high-dose dexamethasone, accurately allowed a differential diagnosis of suspected Cushing's syndrome. Serum Cortisol measurements can replace the urinary 17hydroxycorticoid measurements in a cost-effective manner without a decrease in the degree of accuracy.





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