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An Overnight High-Dose Dexamethasone Suppression Test for Rapid Differential Diagnosis of Cushing's Syndrome

J. BLAKE TYRRELL, M.D.; JAMES W. FINDLING, M.D.; DAVID C. ARON, M.D.; PAUL A. FITZGERALD, M.D.; and PETER H. FORSHAM, M.D.
[+] Article and Author Information

Grant support: in part by the Levi J. and Mary C. Skaggs Foundation of Oakland, California, the Susan Greenwall Foundation of New York City, and, at the General Clinical Research Center of the University of California, San Francisco, by funds from the Division of Research Resources (RR-79), U.S. Public Health Service. Dr. Aron is a Research Associate of the Veterans Administration.

Presented in part 13-15 June 1979, at the annual meeting of the Endocrine Society, Anaheim, California.

▸Requests for reprints should be addressed to J. Blake Tyrrell, M.D.; Metabolic Research Unit, 1143-HSW, University of California; San Francisco, CA 94143.


San Francisco, California; Milwaukee, Wisconsin; and Cleveland, Ohio


©1986 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1986;104(2):180-186. doi:10.7326/0003-4819-104-2-180
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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 adrenocorticotropic 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 17hydroxycorticosteroids 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.

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