Dexamethasone suppression test
Dexamethasone suppression test Diagnostics
OPS-301 code 1-797 proopiomelanocortin derivatives POMC γ-MSH ACTH β-lipotropin α-MSH CLIP γ-lipotropin β-endorphin β-MSH
It has also been used in the research of depression.
Dexamethasone is an exogenous steroid that provides negative feedback to the pituitary to suppress the secretion of ACTH. This steroid is unable to pass the blood brain barrier which allows this test to assess a specific part of the hypothalamic-pituitary-adrenal axis. Specifically, dexamethasone binds to glucocorticoid receptors in the pituitary gland, which lies outside the blood brain barrier, resulting in regulatory modulation.
Low-dose and high-dose variations of the test exist.
A low dose dexamethasone suppresses cortisol in individuals with no pathology in endogenous cortisol production. A high dose dexamethasone exerts negative retro-control on pituitary ACTH producing cells but not on ectopic ACTH producing cells or adrenal adenoma.
A normal result is decrease in cortisol levels upon administration of low-dose dexamethasone. Results indicative of Cushing's disease involve no change in cortisol on low-dose dexamethasone, but inhibition of cortisol on high-dose dexamethasone. If the cortisol levels are unchanged by low- and high-dose dexamethasone then other causes of Cushing's syndrome must be considered with further work-up necessary.
After the high-dose dexamethasone, it may be possible to make further interpretations.
ACTH Cortisol Interpretation undetectable or low is not suppressed by high or low doses. Primary Adrenal Cushing syndrome is likely. normal to elevated is not suppressed by low or high doses Ectopic ACTH syndrome is likely. If an adrenal tumor is not apparent, a chest CT and abdominal CT is indicated to rule out a different tumor secreting ACTH. elevated is not suppressed by low doses, but is suppressed by high doses Cushing's disease should be considered. A pituitary MRI would be needed to confirm.
- ^ a b Medline Plus "Dexamethasone suppression test"
- ^ Fountoulakis KN, Gonda X, Rihmer Z, Fokas C, Iacovides A (2008). "Revisiting the Dexamethasone Suppression Test in unipolar major depression: an exploratory study". Ann Gen Psychiatry 7: 22. doi:10.1186/1744-859X-7-22. PMC 2590593. PMID 19014558. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2590593.
- ^ Cole MA, Kim PJ, Kalman BA, Spencer RL (February 2000). "Dexamethasone suppression of corticosteroid secretion: evaluation of the site of action by receptor measures and functional studies". Psychoneuroendocrinology 25 (2): 151–67. doi:10.1016/S0306-4530(99)00045-1. PMID 10674279. http://linkinghub.elsevier.com/retrieve/pii/S0306-4530(99)00045-1.
- ^ Isidori AM, Kaltsas GA, Mohammed S, et al (November 2003). "Discriminatory value of the low-dose dexamethasone suppression test in establishing the diagnosis and differential diagnosis of Cushing's syndrome". J. Clin. Endocrinol. Metab. 88 (11): 5299–306. doi:10.1210/jc.2003-030510. PMID 14602765. http://jcem.endojournals.org/cgi/pmidlookup?view=long&pmid=14602765.
- ^ Kumar, Abbas, Fausto. Robbins and Cotran Pathologic Basis of Disease, 7th ed. Elsevier-Saunders; New York, 2005
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