{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:49:03Z","timestamp":1790470143406,"version":"4.1.0"},"reference-count":6,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,1,23]],"date-time":"2021-01-23T00:00:00Z","timestamp":1611360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The low-dose dexamethasone suppression test (DST) using a cortisol cutoff of 1.8\u2009\u00b5g\/dL has approximate sensitivity of 95% and specificity of 80% for detecting Cushing syndrome. False-positive DST results can be caused by a variety of conditions, by low dexamethasone bioavailability, or by failure to take dexamethasone as instructed. In an effort to reduce false positives caused by low bioavailability or medication noncompliance, we evaluated the yield of serum dexamethasone measurement for identifying invalid results.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data were queried for orders requesting concurrent measurement of serum cortisol and dexamethasone over a 41-month period. Inclusion criteria were serum cortisol and dexamethasone measured from the same specimen, specimen collection before 9 AM after 1\u2009mg dexamethasone administration, and results for both analytes documented in the electronic medical record. Seventy paired measurements were identified with these criteria. Results were categorized into 4 groups based on observed cortisol and dexamethasone concentrations: (a) suppressed cortisol, low dexamethasone; (b) suppressed cortisol, therapeutic dexamethasone; (c) unsuppressed cortisol, low dexamethasone; or (d) unsuppressed cortisol, therapeutic dexamethasone.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Overall, 35 (50%) results demonstrated suppressed cortisol and therapeutic dexamethasone levels. The next largest group was unsuppressed cortisol and therapeutic dexamethasone, representing approximately 32% (n\u2009=\u200922) of the study population. Ten result sets (14%) fell into the unsuppressed cortisol and low dexamethasone category, and 3 paired measurements (4%) fit the criteria for suppressed cortisol and low dexamethasone.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The measurement of serum dexamethasone following DST reduces the false-positive rate associated with subtherapeutic dexamethasone levels.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jalm\/jfaa193","type":"journal-article","created":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T19:14:15Z","timestamp":1610651655000},"page":"480-485","source":"Crossref","is-referenced-by-count":17,"title":["Yield of Serum Dexamethasone Measurement for Reducing False-Positive Results of Low-Dose Dexamethasone Suppression Testing"],"prefix":"10.1093","volume":"6","author":[{"given":"Stephen M","family":"Roper","sequence":"first","affiliation":[{"name":"Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,1,23]]},"reference":[{"key":"2021030606033198800_jfaa193-B1","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1210\/jc.2008-0125","article-title":"The diagnosis of Cushing's syndrome: an Endocrine Society clinical practice guideline","volume":"93","author":"Nieman","year":"2008","journal-title":"J Clin Endocrinol Metab"},{"key":"2021030606033198800_jfaa193-B2","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1111\/j.1365-2265.1982.tb00733.x","article-title":"Dexamethasone suppression tests: usefulness of simultaneous measurement of plasma cortisol and dexamethasone","volume":"16","author":"Meikle","year":"1982","journal-title":"Clin Endocrinol"},{"key":"2021030606033198800_jfaa193-B3","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1530\/EJE-17-0078","article-title":"Simultaneous assay of cortisol and dexamethasone improved diagnostic accuracy of the dexamethasone suppression test","volume":"176","author":"Ueland","year":"2017","journal-title":"Eur J Endocrinol"},{"key":"2021030606033198800_jfaa193-B4","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1530\/EC-13-0023","article-title":"Multisteroid LC-MS\/MS assay for glucocorticoids and androgens, and its application in Addison's disease","volume":"2","author":"Methlie","year":"2013","journal-title":"Endocr Connect"},{"key":"2021030606033198800_jfaa193-B5","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.jchromb.2016.06.009","article-title":"LC-MS\/MS method for simultaneous determination of thalidomide, lenalidomide, cyclophosphamide, bortezomib, dexamethasone, and adriamycin in serum of multiple myeloma patients","volume":"1028","author":"Shu","year":"2016","journal-title":"J Chromatogr B Analyt Technol Biomed Life Sci"},{"key":"2021030606033198800_jfaa193-B6","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1210\/jc.2003-030207","article-title":"The low-dose dexamethasone suppression test: a reevaluation in patients with Cushing's syndrome","volume":"89","author":"Findling","year":"2004","journal-title":"J Clin Endocrinol Metab"}],"container-title":["The Journal of Applied Laboratory Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jalm\/article-pdf\/6\/2\/480\/36419257\/jfaa193.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jalm\/article-pdf\/6\/2\/480\/36419257\/jfaa193.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,6]],"date-time":"2021-03-06T06:11:00Z","timestamp":1615011060000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jalm\/article\/6\/2\/480\/6114708"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,23]]},"references-count":6,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,1,23]]},"published-print":{"date-parts":[[2021,3,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jalm\/jfaa193","relation":{},"ISSN":["2576-9456","2475-7241"],"issn-type":[{"value":"2576-9456","type":"print"},{"value":"2475-7241","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,3,1]]},"published":{"date-parts":[[2021,1,23]]}}}