{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:51:08Z","timestamp":1788537068994,"version":"build-2803163510"},"reference-count":15,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,11,15]],"date-time":"2020-11-15T00:00:00Z","timestamp":1605398400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100008310","name":"Lisa och Johan Gr\u00f6nbergs Stiftelse","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008310","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>During the investigation of adrenal incidentalomas, it is important to accurately diagnose autonomous cortisol secretion (ACS) but the specificity of cortisol \u226550\u00a0nmol\/L after overnight dexamethasone suppression (cortisol<jats:sub>ONDST<\/jats:sub>) is low. Therefore, ACTH following overnight dexamethasone suppression (ACTH<jats:sub>ONDST<\/jats:sub>) and cortisol following a 2\u2010day dexamethasone suppression test (cortisol<jats:sub>2\u2010DAYDST<\/jats:sub>) were examined as markers of HPA axis suppression during ONDST.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>This cross\u2010sectional study examined patients with adrenal incidentalomas and basal ACTH\u00a0\u2265\u00a02.0\u00a0pmol\/L who underwent ONDST.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>ACTH<jats:sub>ONDST<\/jats:sub>\/ACTH ratio (ACTH ratio) was calculated for all patients. To define cut\u2010off levels for ACTH<jats:sub>ONDST<\/jats:sub> and ACTH ratio as markers of HPA axis suppression, ROC curves were used to separate patients with cortisol<jats:sub>ONDST<\/jats:sub> &lt;50 and \u226550\u00a0nmol\/L.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Cortisol<jats:sub>ONDST<\/jats:sub> was \u226550\u00a0nmol\/L in 140 out of 373 patients. In patients with cortisol<jats:sub>ONDST<\/jats:sub> &lt;50\u00a0nmol\/L, ACTH<jats:sub>ONDST<\/jats:sub> was 0.28\u00a0pmol\/L (&lt;0.23\u20132.7). DHEAS was positively correlated to ACTH<jats:sub>ONDST<\/jats:sub>, demonstrating a 9% increase with a doubling in ACTH<jats:sub>ONDST<\/jats:sub>, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.02. The best cut\u2010off levels for ACTH<jats:sub>ONDST<\/jats:sub> and ACTH ratio to detect cortisol<jats:sub>ONDST<\/jats:sub> \u226550\u00a0nmol\/L were \u22650.6\u00a0pmol\/L and \u226518% respectively. These cut\u2010off levels were tested on patients with cortisol<jats:sub>ONDST<\/jats:sub> &lt;50\u00a0nmol\/L, considered to have adequate suppression (<jats:italic>n<\/jats:italic>\u00a0=\u00a0233), and patients with reduction of \u226550\u00a0nmol\/L from cortisol<jats:sub>ONDST<\/jats:sub> to cortisol<jats:sub>2\u2010DAYDST<\/jats:sub>, who were considered to have inadequate suppression (<jats:italic>n<\/jats:italic>\u00a0=\u00a016). ACTH<jats:sub>ONDST<\/jats:sub> \u22650.6\u00a0pmol\/L and ACTH ratio \u226518% had a sensitivity of 75% and 81% respectively, and a specificity of 78% and 85% respectively, for detecting patients with inadequate suppression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>ACTH<jats:sub>ONDST<\/jats:sub> and ACTH ratio can be markers of HPA axis suppression in the investigation of adrenal incidentalomas. Cortisol<jats:sub>ONDST<\/jats:sub> \u226550\u00a0nmol\/L with ACTH<jats:sub>ONDST<\/jats:sub> &lt;0.6\u00a0pmol\/L or ACTH ratio &lt;18% should lead to the suspicion of ACS.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.14357","type":"journal-article","created":{"date-parts":[[2020,10,27]],"date-time":"2020-10-27T19:41:26Z","timestamp":1603827686000},"page":"168-175","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["ACTH following overnight dexamethasone suppression can be used in the verification of autonomous cortisol secretion in patients with adrenal incidentalomas"],"prefix":"10.1111","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7211-087X","authenticated-orcid":false,"given":"Shobitha","family":"Puvaneswaralingam","sequence":"first","affiliation":[{"name":"Department of Endocrinology Skane University Hospital Lund 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