Is evaluation of cortisol after dexamethasone suppression test enough? Analysis of steroid profile after dexamethasone suppression test using tandem mass spectrometry

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00023001%3A_____%2F25%3A00085962" target="_blank" >RIV/00023001:_____/25:00085962 - isvavai.cz</a>

Alternative codes found

RIV/00216208:11110/25:10501594 RIV/00064165:_____/25:10501594

Result on the web

<a href="https://ec.bioscientifica.com/view/journals/ec/14/9/EC-25-0281.xml" target="_blank" >https://ec.bioscientifica.com/view/journals/ec/14/9/EC-25-0281.xml</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1530/EC-25-0281" target="_blank" >10.1530/EC-25-0281</a>

Result language

angličtina

Original language name

Is evaluation of cortisol after dexamethasone suppression test enough? Analysis of steroid profile after dexamethasone suppression test using tandem mass spectrometry

Original language description

Introduction The overnight dexamethasone suppression test (DST) is recommended for the initial testing of Cushing&apos;s syndrome. Simultaneous measurement of dexamethasone and cortisol is recommended. This study aimed to determine the cutoff value for dexamethasone measured in DST analyzed via liquid chromatography tandem mass spectrometry (2D-LC-MS/MS) and to assess whether analysis of adrenal steroids other than cortisol may improve diagnostic accuracy. Methods A prospective study was conducted including patients with adrenal incidentalomas (n = 55), pituitary incidentalomas and symptoms of Cushing&apos;s disease (n = 18), and healthy controls (n = 100) undergoing DST. Plasma levels of ten steroids and dexamethasone were determined via 2D-LC-MS/MS, while cortisol levels were also determined via a chemiluminescence immunoassay. Results The lower 2.5th percentile of plasma dexamethasone in the control group (cortisol level &lt;50 nmol/L) was 3.48 nmol/L, which was set as the cutoff. In the subgroup of patients with adrenal incidentalomas, regardless of the results of DST, subjects exhibited identical changes in the basal adrenal steroid profile: increased 11-deoxycortisol and decreased DHEA and DHEAS levels. After 1 mg dexamethasone administration, cortisol and cortisone levels increased, while decreased androstenedione and 17-OHP levels were detected. Statistically significant changes were found in the subgroup of patients with pituitary incidentalomas: increased levels of 11-deoxycortisol, plasma cortisol, cortisone, and androstenedione were observed only in those with serum cortisol levels &gt;50 nmol/L. Based on the ROC curves, none of the steroid hormones exhibited higher specificity than cortisol. Conclusion Simultaneous measurement of cortisol and dexamethasone increases DST specificity. The cutoff value for dexamethasone was set at 3.48 nmol/L. None of the adrenal steroids in the DST demonstrated increased specificity; thus, a cortisol concentration &lt;50 nmol/L remains the gold standard for ruling out Cushing&apos;s syndrome.

Czech name

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Czech description

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Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

—

OECD FORD branch

30202 - Endocrinology and metabolism (including diabetes, hormones)

Project

—

Continuities

V - Vyzkumna aktivita podporovana z jinych verejnych zdroju

Publication year

2025

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

Endocrine Connections

ISSN

2049-3614

e-ISSN

2049-3614

Volume of the periodical

14

Issue of the periodical within the volume

9

Country of publishing house

GB - UNITED KINGDOM

Number of pages

11

Pages from-to

"art. no. e250281"

UT code for WoS article

001614836500011

EID of the result in the Scopus database

2-s2.0-105016153438