Comparison of 1 mg and 2 mg Overnight Dexamethasone Suppression Tests for the Screening of Cushings Syndrome in Obese Patients
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概要
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Objective Obesity is currently a major public health problem and one of the potential underlying causes of obesity in a minority of patients is Cushings syndrome (CS). Traditionally, the gold standard screening test for CS is 1 mg dexamethasone overnight suppression test. However, it is known that obese subjects have high false positive results with this test. Design We have therefore compared the 1 mg and 2 mg overnight dexamethasone suppression tests in obese subjects. Patients whose serum cortisol after ODST was >50 nM underwent and a low-dose dexamethasone suppression test (LDDST); 24-hour urine cortisol was collected for basal urinary free cortisol (UFC). For positive results after overnight 1-mg dexamethasone suppression test we also performed the overnight 2-mg dexamethasone suppression test. Patients We prospectively evaluated 100 patients (22 men and 78 women, ranging in age from 17 to 73 years with a body mass index (BMI) >30 kg/m2 who had been referred to our hospital-affiliated endocrine clinic because of simple obesity. Suppression of serum cortisol to <50 nM (1.8 μg/dL) after dexamethasone administration was chosen as the cut-off point for normal suppression. Measurements Thyroid function tests, lipid profiles, homocysteine, antithyroglobulin, anti-thyroid peroxidase antibody levels, vitamin B12, folate levels, insulin resistance [by homeostasis model assessment (HOMA)] and 1.0 mg postdexamethasone (postdex) suppression cortisol levels were measured. Results We found an 8% false-positive rate in 1 mg overnight test and 2% in 2 mg overnight test (p=0.001). There was no correlation between the cortisol levels after ODST and other parameters. Conclusions Our results indicate that the 2 mg overnight dexamethasone suppression test (ODST) is more convenient and accurate than 1-mg ODST as a screening test for excluding CS in subjects with simple obesity.
著者
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Kebapcilar Levent
Department of Internal Medicine, Division of Endocrinology and Metabolism, Izmir Bozyaka Training an
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Sahin Mustafa
Department of Endocrinology and Metabolism, Gulhane School of Medicine
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Taslipinar Abdullah
Department of Endocrinology and Metabolism, Gulhane School of Medicine
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Azal Omer
Department of Endocrinology and Metabolism, Gulhane School of Medicine
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Ozgurtas Taner
Department of Biochemistry, Gulhane School of Medicine
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Corakci Ahmet
Department of Endocrinology and Metabolism, Gulhane School of Medicine
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Akgul Emin
Department of Biochemistry, Gulhane School of Medicine
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Yavuz Taslipinar
Department of Biochemistry, SB Etlik Ihtisas Hospital
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Yazici Mahmut
Department of Endocrinology and Metabolism, Gulhane School of Medicine
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Kutlu Mustafa
Department of Endocrinology and Metabolism, Gulhane School of Medicine
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Akgul Emin
Department Of Biochemistry Gulhane School Of Medicine
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Sahin Mustafa
Department Of Dermatology Celal Bayar University Faculty Of Medicine
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Corakci Ahmet
Department Of Endocrinology & Metabolism Gulhane School Of Medicine
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Ozgurtas Taner
Department Of Biochemistry Gulhane School Of Medicine
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Kutlu Mustafa
Department Of Endocrinology And Metabolism Gulhane School Of Medicine
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