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This version published online on May 2, 2006
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2005-2143
A more recent version of this article appeared on July 1, 2006
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Submitted on September 28, 2005
Accepted on April 24, 2006

Comparison Of The Dexamethasone-Suppressed Corticotrophin-Releasing Hormone Test and Low Dose Dexamethasone Suppression Test In The Diagnosis Of Cushing's Syndrome

N M Martin, W S Dhillo, A Banerjee, A Abdulali, C N Jayasena, M Donaldson, J F Todd, and K Meeran*

Department of Endocrinology & Metabolic Medicine, Imperial College London & Hammersmith Hospitals NHS Trust, Du Cane Road, London, W12 0HS

* To whom correspondence should be addressed. E-mail: k.meeran{at}imperial.ac.uk.

Context: The low-dose dexamethasone suppression test (LDDST) is widely used in confirming a diagnosis of Cushing's syndrome. Corticotrophin-releasing hormone (CRH) administration at the end of an LDDST has been reported to improve the diagnostic accuracy of this test.

Objective: To assess whether CRH administration following a standard LDDST (LDDST-CRH test) improves diagnostic accuracy in Cushing's syndrome.

Design, Setting and Participants: 36 individuals with a clinical suspicion of Cushing's syndrome each completed a standard LDDST and a LDDST-CRH test at Hammersmith Hospitals NHS Trust, London. The LDDST involved administration of 0.5 mg oral dexamethasone given 6 hourly for 48 h. Serum cortisol was measured 6 h after the last dose of dexamethasone, with a value of 50 nmol/L or below excluding Cushing's syndrome. Immediately following this, the LDDST-CRH test commenced with administration of a ninth dose of 0.5 mg dexamethasone. Exactly 2 h later, 100 µg human sequence CRH was administered. Serum cortisol was measured 15 min post-CRH injection, with a value of less than 38 nmol/L also excluding Cushing's syndrome.

Main outcome measure: Diagnosis or exclusion of Cushing's syndrome.

Results: 12 subjects were diagnosed with Cushing's syndrome (8 Cushing's disease, 4 primary adrenal). The sensitivity of the LDDST in diagnosing Cushing's syndrome was 100%, with a specificity of 88%. In contrast, although the sensitivity of the LDDST-CRH test was also 100%, specificity was reduced at 67%. These results give a positive predictive value of 80% for the LDDST and 60% for the LDDST-CRH test.

Conclusions: This small study suggests that the addition of CRH to the LDDST does not improve the diagnostic accuracy of the standard LDDST in Cushing's syndrome.
Key words: dexamethasone suppression test • corticotrophin releasing hormone • Cushing's • pseudo-Cushing's • cortisol




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