{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:15:33Z","timestamp":1788498933998,"version":"build-2803163510"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Assessment of cortisol secretion in patients with adrenal incidentalomas remains challenging. We evaluated the guideline-recommended cortisol cut-off value for cortisol suppression (50 nmol\/L) following a 1 mg overnight dexamethasone suppression test (DST) against a control-derived threshold and compared patient classification using the two thresholds. Secondary objectives included assessing associations of pre-DST ACTH, post-DST dexamethasone, and comorbidities with post-DST cortisol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this cross-sectional study (NCT07350031), pre- and post-DST plasma samples from patients with adrenal incidentalomas (\n                      <jats:italic>N<\/jats:italic>\n                      =\u00a0108) and matched controls (\n                      <jats:italic>N<\/jats:italic>\n                      =\u00a0101) were prospectively collected, and cortisol was analysed using immunoassay (Elecsys\n                      <jats:sup>\u00ae<\/jats:sup>\n                      Cort II) and LC\u2013MS\/MS. Post-DST dexamethasone \u22653 nmol\/L defined appropriate dexamethasone exposure. The 97.5th percentile of LC\u2013MS\/MS-measured post-DST cortisol in controls defined the control-derived threshold. Associations between pre-DST ACTH, post-DST dexamethasone, and post-DST cortisol were assessed. The performance of pre-DST ACTH for identifying post-DST cortisol &amp;gt;50 nmol\/L was evaluated using receiver operating characteristic analysis. Logistic regression examined associations between post-DST cortisol and diabetes, dyslipidaemia, hypertension, and osteoporosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The 97.5\n                      <jats:sup>th<\/jats:sup>\n                      percentile of post-DST cortisol in controls was 66 nmol\/L. The 50 nmol\/L threshold corresponded to the 90\n                      <jats:sup>th<\/jats:sup>\n                      percentile of controls and classified 44% of patients as having hypercortisolism, compared with 26% using the control-derived threshold (66 nmol\/L). Pre-DST ACTH showed poor discrimination for post-DST cortisol &amp;gt;50 nmol\/L (AUC 0.69). Post-DST cortisol was not associated with dexamethasone concentrations or comorbidities.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main conclusions<\/jats:title>\n                    <jats:p>The guideline-recommended post-DST cortisol threshold of 50 nmol\/L may be too low, suggesting that higher thresholds warrant further evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1872524","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:25:12Z","timestamp":1788495912000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Plasma cortisol cut-off concentrations using the dexamethasone suppression test in patients with adrenal incidentalomas"],"prefix":"10.3389","volume":"17","author":[{"given":"Nanna Thurmann","family":"J\u00f8rgensen","sequence":"first","affiliation":[{"name":"Department of Nephrology and Endocrinology, Copenhagen University Hospital, Rigshospitalet","place":["Copenhagen, Denmark"]},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University","place":["Copenhagen, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stina Willemoes","family":"Borresen","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Endocrinology, Copenhagen University Hospital, Rigshospitalet","place":["Copenhagen, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Hilsted","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet","place":["Copenhagen, 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Medicine, Copenhagen University Hospital","place":["Herlev, Copenhagen, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus Larsen","family":"Feltoft","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Internal Medicine, Copenhagen University Hospital","place":["Herlev, Copenhagen, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Line Koch","family":"Skaanning","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Immunology, Vejle Hospital","place":["Vejle, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per Medb\u00f8e","family":"Thorsby","sequence":"additional","affiliation":[{"name":"Hormone Laboratory, Dep of Medical Biochemistry and Endocrinology and Metabolism Research Group, Oslo University Hospital","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c5se 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