title: Performance of the 1 mg dexamethasone suppression test in patients with severe obesity.
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.
authors.affiliation: 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lammert
authors.affiliation: Institute for Clinical Chemistry, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Nittka
authors.affiliation: Department of Surgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Mirko
authors.initials: M
authors.lastname: Otto
authors.affiliation: Department of Anesthesiology and Surgical Intensive Care Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Schneider-Lindner
authors.affiliation: 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Kemmer
authors.affiliation: 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Bernhard K
authors.initials: BK
authors.lastname: Krämer
authors.affiliation: 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Birck
authors.affiliation: 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Hammes
authors.affiliation: 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Urs
authors.initials: U
authors.lastname: Benck
mesh_terms: D000328:Adult; D003480:Cushing Syndrome / Q000175:diagnosis; D003907:Dexamethasone / Q000627:therapeutic use*; D003940:Diagnostic Techniques, Endocrine; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000503:physiopathology*; D011446:Prospective Studies
chemical_list: D003907:Dexamethasone; D006854:Hydrocortisone