INITIAL SCREENING

THE 1-MG DEXAMETHASONE SUPPRESSION TEST (DST)

According to experts and guidelines, the 1-mg DST is recognized as being sensitive for the detection of all etiologies of hypercortisolism.1,2 It is inexpensive, accessible, and relatively easy to manage.3

The patient is instructed to take a 1-mg oral dose of dexamethasone between 11 pm and midnight and fast overnight1

A sample of blood is drawn the next morning between 8 to 9 am to measure plasma cortisol1

A dexamethasone level may be evaluated in conjunction with the initial DST to confirm adequate suppression of HPA axis1,2

Dexamethasone levels of ≥140 ng/dL may help confirm the validity of a properly performed DST1,2

A 1-MG DST CUTOFF OF >1.8 μg/dL IS RECOMMENDED FOR SCREENING2,4

1-MG DST

Measures suppression of adrenocorticotropic hormone and autonomous cortisol secretion

≤1.8 μg/dL

May exclude autonomous cortisol secretion

>1.8 μg/dL

Evidence of possible hypercortisolism.
Additional tests are needed to support a diagnosis

VIEW EVALUATION & DIAGNOSIS

  • The urinary-free cortisol (UFC) test may be less reliable in people suspected of having an adrenal source of hypercortisolism, since these people will often have normal UFC results5,6

    • The Endocrine Society Guidelines recommend a 1-mg DST rather than the UFC test for people suspected of having an adrenal source of hypercortisolism2

  • The late-night salivary cortisol test may have a low sensitivity for predicting the presence of adrenal autonomous cortisol secretion7

24 percent.

Nearly 1 in 4 people with difficult-to-control T2D had endogenous hypercortisolism8

UNCOVER PREVALENCE

Do you have patients who may need a hypercortisolism specialist?

FIND A SPECIALIST

Contact a rep and stay informed about recent data

SIGN UP

References

1. DeFronzo RA, Auchus RJ, Bancos I, et al. BMJ Open. 2024;14(7):e081121. doi:10.1136/bmjopen-2023-081121 2. Nieman LK, Biller BM, Findling JW, et al. J Clin Endocrinol Metab. 2008;93(5):1526-1540. doi:10.1210/jc.2008-0125 3. Ciftel S, Mercantepe F. Cureus. 2023;15(11):e48383. doi:10.7759/cureus.48383 4. Fassnacht M, Tsagarakis S, Terzolo M, et al. Eur J Endocrinol. 2023;189(1):G1-G42. doi:10.1093/ejendo/lvad066 5. Giovanelli L, Aresta C, Favero V, et al. J Endocrinol Invest. 2021;44(8):1581-1596. doi:10.1007/s40618-020-01484-2 6. Chiodini I, Ramos-Rivera A, Marcus AO, Yau H. J Endocr Soc. 2019;3(5):1097-1109. doi:10.1210/js.2018-00382 7. Kuzu I, Zuhur SS, Demir N, Aktas G, Yener Ozturk F, Altuntas Y. Endokrynol Pol. 2016;67(5):487-492. doi:10.5603/EP.a2016.0028 8. Buse JB, Kahn SE, Aroda VR, et al. Prevalence of hypercortisolism in patients with difficult-to-control type 2 diabetes: updated results from CATALYST part 1 [symposium]. Presented by Fonseca, V. at the 22nd World Congress Insulin Resistance Diabetes & Cardiovascular Disease; December 12-14, 2024; Los Angeles, CA.