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Authors’ Response: The Value of the Low-Dose Dexamethasone Suppression Test in the Differential Diagnosis of Hyperandrogenism in Women

Department of Endocrinology, St. Bartholomew’s Hospital London EC1A 7BE, United Kingdom

Address correspondence to: Ashley B. Grossman, M.D., St. Bartholomew’s Hospital, Department of Endocrinology, West Smithfield, London, ECIA 7BE, United Kingdom. E-mail: A.B.Grossman{at}qmul.ac.uk.

To the editor:

The comments of Dr. Rosenfield and colleagues are useful in the discussion of the establishment of the optimal tests to distinguish between the different causes of hyperandrogenism in women (1, 2). According to their experience, measurement of free testosterone (fT) levels after 4-d dexamethasone administration presents the most sensitive method to diagnose an ACTH-dependent source of androgen excess (1). However, we would emphasize that our study was designed to identify those patients with virilizing tumors rather than congenital adrenal hyperplasia, which was an uncommon diagnosis in our cohort. In addition, although the duration of dexamethasone administration in our study is shorter than their 4 d of dexamethasone, in our experience a significant proportion of patients with nontumorous hyperandrogenism, principally due to polycystic ovarian syndrome, achieved adequate androgen suppression (as defined by either normalization of the elevated basal level or at least a 40% reduction) (3). The most prominent reduction in particular was obtained in DHEAS levels (3). Unfortunately, we do not have data on 17-hydroxyprogesterone levels (17PROG) in this cohort who underwent dexamethasone testing, and we are therefore unable to comment regarding the utility of these data in diagnosing congenital adrenal hyperplasia.

Finally, there is a minor misunderstanding in that they note that our last dose of dexamethasone is given "2 h before blood sampling." This is incorrect; the doses are given strictly 6-hourly, such that the last dose is given 6 h before sampling. We are sorry if this was not clear; further details, as well as data on the sensitivity of this test in diagnosing Cushing’s syndrome, are given in a recent publication from our group (4).

Received September 11, 2003.

References

1. Ehrmann DA, Rosenfield RL 1990 An endocrinologic approach to the patient with hirsutism. J Clin Endocrinol Metab 71:1–4[Medline]
2. Ehrmann DA, Rosenfield RL, Barnes RB, Brigell DF, Sheikh Z 1992 Detection of functional ovarian hyperandrogenism in women with androgen excess. N Engl J Med 327:157–162[Abstract]
3. Kaltsas GA, Isidori AM, Kola BP, Skelly RH, Chew SL, Jenkins PJ, Monson JP, Grossman A, Besser GM 2003 The value of the low-dose dexamethasone suppression test in the differential diagnosis of hyperandrogenism in women. J Clin Endocrinol Metab 88:2634–2643[Abstract/Free Full Text]
4. Isidori AM, Kaltsas GA, Mohamed S, Morris DG, Jenkins P, Chew SL, Monson JP, Besser GM, Grossman AB 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 88:5299–5306[Abstract/Free Full Text]

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