Clinical endocrinology · 2025
Value of the Serum Dexamethasone Determination for the Diagnosis of Mild Autonomous Cortisol Secretion.
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Araujo-Castro Marta, Cortés Gómez Alejandro, Rosillo Marta, Rodríguez Argeme, Madrid Imanol, Pascual-Corrales Eider, García Cano Ana M
Аннотация
PURPOSE: To analyze the dexamethasone bioavailability in the 1mg-dexamethasone suppression test (DST) in patients with adrenal incidentalomas (AIs) to assess the reliability of the DST for the diagnosis of mild autonomous cortisol secretion (MACS).
METHODS: A prospective cross-sectional study of 140 consecutive patients with AIs who underwent simultaneous testing of serum dexamethasone and cortisol levels after the DST. MACS diagnosis was based on a DST value > 1.8 µg/dL in absence of specific clinical data of Cushing's syndrome, and nonfunctioning adrenal incidentaloma (NFAIs) diagnosis was established when cortisol post-DST was ≤ 1.8 µg/dL and no evidence of other adrenal hormonal hypersecretion. Serum dexamethasone was measured with liquid chromatography coupled to mass spectrometry (LC-MS/MS).
RESULTS: We enrolled 89 patients with MACS and 51 patients with NFAIs. Patients with MACS had higher late-nigh salivary cortisol and cortisol post-DST levels and lower DHEAS and ACTH values than NFAIs. In addition, they were older, had a higher prevalence of hypertension, diabetes and bilateral and larger adrenal tumors than NFAIs. Considering the 3.3 nmol/L serum dexamethasone threshold, we found that only 3.6% (n = 5) of the patients who underwent DST did not achieve proper serum dexamethasone levels during the DST. A weak positive correlation between age and serum dexamethasone levels (r = 0.191, p = 0.024) was observed. In addition, patients with MACS, hypertension and dyslipidemia reached higher serum dexamethasone levels after DST than those without these comorbidities.
CONCLUSION: Up to 4% of the patients with MACS diagnosis based on a DST > 1.8 µg/dl do not achieve enough dexamethasone levels to suppress the hypothalamic pituitary adrenal axis, suggesting that the positive results in the DST were not related with autonomous cortisol secretion.
METHODS: A prospective cross-sectional study of 140 consecutive patients with AIs who underwent simultaneous testing of serum dexamethasone and cortisol levels after the DST. MACS diagnosis was based on a DST value > 1.8 µg/dL in absence of specific clinical data of Cushing's syndrome, and nonfunctioning adrenal incidentaloma (NFAIs) diagnosis was established when cortisol post-DST was ≤ 1.8 µg/dL and no evidence of other adrenal hormonal hypersecretion. Serum dexamethasone was measured with liquid chromatography coupled to mass spectrometry (LC-MS/MS).
RESULTS: We enrolled 89 patients with MACS and 51 patients with NFAIs. Patients with MACS had higher late-nigh salivary cortisol and cortisol post-DST levels and lower DHEAS and ACTH values than NFAIs. In addition, they were older, had a higher prevalence of hypertension, diabetes and bilateral and larger adrenal tumors than NFAIs. Considering the 3.3 nmol/L serum dexamethasone threshold, we found that only 3.6% (n = 5) of the patients who underwent DST did not achieve proper serum dexamethasone levels during the DST. A weak positive correlation between age and serum dexamethasone levels (r = 0.191, p = 0.024) was observed. In addition, patients with MACS, hypertension and dyslipidemia reached higher serum dexamethasone levels after DST than those without these comorbidities.
CONCLUSION: Up to 4% of the patients with MACS diagnosis based on a DST > 1.8 µg/dl do not achieve enough dexamethasone levels to suppress the hypothalamic pituitary adrenal axis, suggesting that the positive results in the DST were not related with autonomous cortisol secretion.