Screening Tests for Hypercortisolism – Adrenal Gland

by Carlo Raj, MD

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    Screening tests for hypercortisolism: dexamethasone suppression, low dose is 1 mg administered at night. Normal individual will have suppressed, normal, okay, I am walking through this quickly because I already talked about it, everything that we talked about discussed is now in verbiage just to? for reinforcement purposes. Patient with Cushing?s syndrome will not suppress cortisol normally, syndrome maybe from the adrenal cortex. Positive test to suppress cortisol is, well, here is a little bit more detail. Cortisol better positive predictive value that is more or less your biostatistics question. So, you probably want to know positive predictive value of being greater than 5 micrograms. If you find it to be greater than 1.8, then as a better negative predictive value, that?s why you want to know about these two bullet points, negative and positive predictive values are very important on your boards for biostatistics. Do you imagine that we are doing pathology and yet we are linking biostatistics? Of course, we are. Everything is evidence based, haha! 24 hour urine free cortisol measurement, 4 times upper limit of normal is diagnostic. Screening tests for hypercortisolism, I went through just quickly, much of this we already discussed, make sure that it?s firmly implanted in your head. Now, I am going to get into more specificities about how to screen for hypercortisolism, this will be in current day practice, pay attention. Salivary control, it is a sensitive screening test, loss of normal or diurnal variation usually precedes overt hypercortisolism. Once again, loss of normal or diurnal, what does diurnal mean? Low at the end of the day, high in the morning of cortisol. Relatively easy to do, but requires reliable labs, measures free hormone only. Mildly abnormal screening results may represent pseudo-Cushing?s. Pseudo-Cushing?s an important topic maybe due to depression or...

    About the Lecture

    The lecture Screening Tests for Hypercortisolism – Adrenal Gland by Carlo Raj, MD is from the course Adrenal Gland Disorders.

    Included Quiz Questions

    1. 4x upper limit of normal
    2. 2x upper limit of normal
    3. 4x average normal
    4. 2x average normal
    5. 10x upper limit of normal
    1. Alcoholism
    2. Adrenal adenoma
    3. Cushing's disease
    4. Pituitary hyperplasia
    5. Loss of normal diurnal cortisol levels
    1. Undetectable ACTH
    2. Excess cortisol
    3. Normal or high ACTH
    4. Normal Dexamethasone Suppression test
    5. Elevated 24 hour urine cortisol levels
    1. Hypoparathyroidism
    2. Physical stress
    3. PCOS
    4. Major Depressive Disorder
    5. Anorexia nervosa

    Author of lecture Screening Tests for Hypercortisolism – Adrenal Gland

     Carlo Raj, MD

    Carlo Raj, MD

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