Dexamethasone-suppressed corticotropin-releasing hormone stimulation test in morbid obese adults.
In order to differentiate between Cushing's syndrome (CS) and Pseudo-Cushing's syndrome, it is customary to use a test that is conducted by cortisol suppression with low-dose dexamethasone, followed by the administration of corticotropin releasing hormone (Dex-CRH test). In children with severe obesity, Dex-CRH test has shown a specificity of 55%. The aim of current study was to evaluate the specificity of Dex-CRH test in morbid obese adults.



The study included a total of 19 subjects with a body mass index (BMI) equal or higher than 40kg/m(2). In all subjects Dex-CRH test was performed, and 24h urinary free cortisol was collected prior the test and during the second day of dexamethasone administration (2nd-day-UFC).



BMI was 45.1±4.6kg/m(2) and 45.7±3.3kg/m(2) in women and men, respectively. 14 subjects underwent bariatric surgery. No subject had surgical or perioperative complications and surgically treated subjects had mean body weight loss of 46.5±16.6kg. All except for 2 subjects had normal Dex-CRH test, as 15-min cortisol falling below 1.4μg/dl. During follow-up, no subject gained additional weight, neither developed signs of CS. 15-min-cortisol concentration of 1.4μg/dl revealed a specificity of 89% and 2nd-day-UFC of 16μg/24h showed a specificity of 100%.



Morbid obesity in adults seems not to comprise a significant confounder in Dex-CRH test, and 15-min-cortisol concentration of 1.4μg/dl had a higher specificity than previously reported in obese children.
Department of Endocrinology, Bnai-Zion Medical Center, Haifa, Israel. Electronic address: leonard.saiegh@gmail.com.
Leonard
L
Saiegh
Department of Gastroenterology, Bnai-Zion Medical Center, Haifa, Israel.
Dean
D
Keren
Department of Gastroenterology, Bnai-Zion Medical Center, Haifa, Israel.
Tova
T
Rainis
Department of Endocrinology, Bnai-Zion Medical Center, Haifa, Israel.
Mohammad
M
Sheikh-Ahmad
Department of Endocrinology, Bnai-Zion Medical Center, Haifa, Israel.
Maria
M
Reut
Department of Endocrinology, Bnai-Zion Medical Center, Haifa, Israel.
Afif
A
Nakhleh
Department of Endocrinology, Bnai-Zion Medical Center, Haifa, Israel.
Irit
I
Wirsansky
Department of Endocrinology, Bnai-Zion Medical Center, Haifa, Israel.
Limor
L
Chen-Konak
Department of Internal Medicine B, Bnai-Zion Medical Center, Haifa, Israel.
Elad
E
Schiff
Department of Endocrinology, Bnai-Zion Medical Center, Haifa, Israel.
Carmela
C
Shechner
D000328:Adult; D050110:Bariatric Surgery; D015992:Body Mass Index; D003346:Corticotropin-Releasing Hormone / Q000008:administration & dosage; D003480:Cushing Syndrome / Q000150:complications / Q000175:diagnosis* / Q000652:urine; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000652:urine*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery; D012680:Sensitivity and Specificity; D055815:Young Adult
D003907:Dexamethasone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone
Corticotropin-releasing hormone; Cushing's syndrome; Dexamethasone; Obesity