{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T05:17:30Z","timestamp":1793423850480,"version":"4.5.0"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"6","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>The overnight dexamethasone (DXM) suppression test (DST) has high sensitivity, but moderate specificity, for diagnosing hypercortisolism. We have evaluated if simultaneous measurement of S-DXM may correct for variable DXM bioavailability and increase the diagnostic performance of DST, and if saliva (sa) is a feasible adjunct or alternative to serum.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and methods<\/jats:title><jats:p>Prospective study of DST was carried out in patients with suspected Cushing\u2019s syndrome (CS) (<jats:italic>n<\/jats:italic>\u2009=\u200949), incidentaloma (<jats:italic>n<\/jats:italic>\u2009=\u2009152) and healthy controls (<jats:italic>n<\/jats:italic>\u2009=\u2009101). Cortisol, cortisone and DXM were assayed by liquid chromatography\u2013tandem mass spectrometry (LC\u2013MS\/MS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three hundred and two subjects underwent DST; S-cortisol was \u226550\u2009nmol\/L in 83 patients, of whom 11 had CS and 27 had autonomous cortisol secretion. The lower 2.5 percentile of S-DXM in subjects with negative DST (<jats:italic>n<\/jats:italic>\u2009=\u2009208) was 3.3\u2009nmol\/L, which was selected as the DXM cut-off level. Nine patients had the combination of low S-DXM and positive DST. Of these, three had been misdiagnosed as having autonomous cortisol secretion. DST results were highly reproducible and confirmed in a replication cohort (<jats:italic>n<\/jats:italic>\u2009=\u200958). Patients with overt CS had significantly elevated post-DST sa-cortisol and sa-cortisone levels compared with controls; 23 of 25 with autonomous cortisol secretion had elevated sa-cortisone and 14 had elevated sa-cortisol.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Simultaneous measurement of serum DXM and cortisol reduced false-positive DSTs by 20% and improved the specificity. S-DXM &gt;3.3\u2009nmol\/L is sufficient for the suppression of cortisol &lt;50\u2009nmol\/L. Measurement of glucocorticoids in saliva is a non-invasive and easy procedure and post-DST sa-cortisone was found particularly useful in the diagnosis of CS.<\/jats:p><\/jats:sec>","DOI":"10.1530\/eje-17-0078","type":"journal-article","created":{"date-parts":[[2017,3,16]],"date-time":"2017-03-16T00:50:19Z","timestamp":1489625419000},"page":"705-713","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":91,"title":["Simultaneous assay of cortisol and dexamethasone improved diagnostic accuracy of the dexamethasone suppression test"],"prefix":"10.1093","volume":"176","author":[{"given":"Grethe \u00c5","family":"Ueland","sequence":"first","affiliation":[{"name":"1Department of Clinical ScienceUniversity of Bergen, Bergen, Norway"},{"name":"2Department of Medicine"},{"name":"3Department of the Hormone LaboratoryHaukeland University Hospital, Bergen, 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