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Transcript
Internal Medicine
Patients with Cushing’s syndrome will have cortisol level > 5 µg/dl usually greater than 10
µg/dl .This result indicates further study is needed.
2.
The standard dexamethasone suppression test: is the most relied up on test for Cushing’s
syndrome
Table VII-3-1 Standard Dexamethasone Suppression Test in the diagnosis of Cushing’s
syndrome
Method
Day
1
Dosage of Dexamethasone
Measurement
None ( baseline )
24 hrs urinary 17-hydroxycorticosteriod
and 4 PM serum cortisol level
2,3
Low dose ( O.5 mg dexamethasone Repeat measurement on day 3
PO QID )
4,5
Repeat measurement on day 5
High dose dexamethasone 2 mg
every QID
Response
Diagnosis
Suppression with low Suppression
dose
high dose
Normal
Yes
Yes
Cushing’s diseases
No
Yes
Adrenal tumor
or ectopic ACTH No
with
No
production
3. ACTH measurement : may help to differentiate the cause of Cushing’s syndrome
a. High normal or slightly elevated ACTHÆCushing’s diseases
b. Markedly elevated ACTH Æ Ectopic ACTH production
c. Extremely low ACTH levelÆ automatically functioning adrenal tumor is the
source of excess cortisol. Pituitary secretion of ACTH is suppressed due to the
excess cortisol
476