Screening for Subclinical Hypercortisolism (SH)

[Guest guest]

Dr. Grim, we were talking about how to screen for excess Cortisol, here is how

they did it for this study:

" Beneficial Metabolic Effects of Prompt Surgical Treatment in Patients with an

Adrenal Incidentaloma Causing Biochemical Hypercortisolism "

Source: http://jcem.endojournals.org/content/95/6/2736.full

All patients were screened for the presence of SH, which was diagnosed on the

basis of the presence of at least two of the following three alterations of

hypothalamic-pituitary-adrenal (HPA) axis: 1) urinary free cortisol (UFC) levels

greater than 70 ìg per 24 h (193 nmol per 24 h; normal values 10–70 ìg per 24 h,

28–193 nmol per 24 h), which is the cutoff of both our own and international

normal reference values (34); 2) serum cortisol levels after 1 mg dexamethasone

suppression test (DST) greater than 3.0 ìg/dl (83 nmol/liter); and 3) morning

(0800 h) ACTH levels less than 10 pg/ml (2.2 pmol/liter). The use of a 1-mg DST

cutoff of 3.0 ìg/dl (83 nmol/liter) rather than 5 ìg/dl (138 nmol/liter) as

recommended by the National Institutes of Health (30), was preferred to increase

the test sensitivity

[Guest guest]

Thanks but then someone told you there that most with adrenal Cushings have normal 24 hr HFC. But this seems to be saying something else. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn May 9, 2012, at 14:08, <jclark24p@...> wrote:

Dr. Grim, we were talking about how to screen for excess Cortisol, here is how they did it for this study:

"Beneficial Metabolic Effects of Prompt Surgical Treatment in Patients with an Adrenal Incidentaloma Causing Biochemical Hypercortisolism"

Source: http://jcem.endojournals.org/content/95/6/2736.full

All patients were screened for the presence of SH, which was diagnosed on the basis of the presence of at least two of the following three alterations of hypothalamic-pituitary-adrenal (HPA) axis: 1) urinary free cortisol (UFC) levels greater than 70 ìg per 24 h (193 nmol per 24 h; normal values 10–70 ìg per 24 h, 28–193 nmol per 24 h), which is the cutoff of both our own and international normal reference values (34); 2) serum cortisol levels after 1 mg dexamethasone suppression test (DST) greater than 3.0 ìg/dl (83 nmol/liter); and 3) morning (0800 h) ACTH levels less than 10 pg/ml (2.2 pmol/liter). The use of a 1-mg DST cutoff of 3.0 ìg/dl (83 nmol/liter) rather than 5 ìg/dl (138 nmol/liter) as recommended by the National Institutes of Health (30), was preferred to increase the test sensitivity

[Guest guest]

I hear you! I plan to have a detailed discussion with Dr. Moraitis once I get

my Lab Results. I think there is more to this story than what I've heard!

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> > Dr. Grim, we were talking about how to screen for excess Cortisol, here is

how they did it for this study:

> >

> > " Beneficial Metabolic Effects of Prompt Surgical Treatment in Patients with

an Adrenal Incidentaloma Causing Biochemical Hypercortisolism "

> >

> > Source: http://jcem.endojournals.org/content/95/6/2736.full

> >

> > All patients were screened for the presence of SH, which was diagnosed on

the basis of the presence of at least two of the following three alterations of

hypothalamic-pituitary-adrenal (HPA) axis: 1) urinary free cortisol (UFC) levels

greater than 70 ìg per 24 h (193 nmol per 24 h; normal values 10†" 70 ìg per

24 h, 28†" 193 nmol per 24 h), which is the cutoff of both our own and

international normal reference values (34); 2) serum cortisol levels after 1 mg

dexamethasone suppression test (DST) greater than 3.0 ìg/dl (83 nmol/liter);

and 3) morning (0800 h) ACTH levels less than 10 pg/ml (2.2 pmol/liter). The use

of a 1-mg DST cutoff of 3.0 ìg/dl (83 nmol/liter) rather than 5 ìg/dl (138

nmol/liter) as recommended by the National Institutes of Health (30), was

preferred to increase the test sensitivity

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