Performance of the 1 mg dexamethasone suppression test in patients with severe obesity
Alexander Lammert, Stefanie Nittka, Mirko Otto, Verena Schneider-Lindner, Anne Kemmer, Bernhard K Krämer, Rainer Birck, Hans-Peter Hammes, Urs Benck, Alexander Lammert, Stefanie Nittka, Mirko Otto, Verena Schneider-Lindner, Anne Kemmer, Bernhard K Krämer, Rainer Birck, Hans-Peter Hammes, Urs Benck
Abstract
Objective: To analyze the performance of the 1 mg dexamethasone suppression test (DST) in patients with obesity. Special attention was paid to the influence of interfering medication on DST.
Methods: In this prospective cohort study (Mannheim Obesity Study), patients with obesity were evaluated before bariatric surgery. For evaluation of hypercortisolism, a 1 mg dexamethasone-suppression test (DST) in all subjects was performed. Medication was assessed for possible interference.
Results: Two hundred seventy-eight patients with a mean age of 42.3 years (68.8% women) and a mean BMI of 47.9 ± 8.4 kg/m(2) were screened. Insufficient suppression of cortisol after DST was found in 24 patients (8.6%). In two patients hypercortisolism was confirmed. The specificity for DST was calculated at 92.0%. Only CYP3A4 inducers (n = 22, 7.9%) and estrogen therapy (n = 17, 6.1%) were significantly associated with falsely elevated cortisol after DST. Regression analysis excluded any interrelation between DST and anthropometry.
Conclusions: Low prevalence of hypercortisolism (0.7 or <1.8%) was found. Specificity of DST in this cohort typically screened for hypercortisolism was 92.0% (≤ 50 nmol/L). DST should be avoided in patients taking CYP3A4 inducers or estrogen therapy, due to their significant interaction. In summary, the 1 mg DST is an adequate test for screening for hypercortisolism even in patients with extreme obesity.
Trial registration: ClinicalTrials.gov NCT00770276.
© 2016 The Obesity Society.
Source: PubMed