The Dexamethasone-Suppressed Corticotropin-Releasing Hormone Test in the Differential Diagnosis of Hypercortisolism

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Abstract
It is often difficult to distinguish patients with mild Cushing's syndrome from obese patients with pseudo-Cushing states who also have increased Cortisol production. Several tests are described as useful in determining which patients have Cushing's syndrome, but none have high sensitivity and specificity for the diagnosis of Cushing's syndrome. This paper reviews a new test developed at the NIH, the dexamethasone-suppressed CRH test, which appears to be quite useful in making the difficult discrimination between mild Cushing's disease and pseudo-Cushing states. A single Cortisol value measured after 2 days of low-dose dexamethasone suppression and 15 minutes after CRH stimulation was 100% specific and sensitive for the diagnosis of Cushing's syndrome. Limitations of the test, and suggestions for its interpretation, are discussed. (C) Lippincott-Raven Publishers.

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