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  #1  
Old 07-22-2011
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Question Best Initial test for Cushing syndrome?

With a clinical suspicion of a cushing syndrome..which one would you perform initially...
A..1 mg dexamethasone test
B..24 hr urine free cortisol
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  #2  
Old 07-22-2011
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best initial test low dose dexamethasone suppression test.
confirmatory test for cushing is 24 hr urinary cortisone
later for source you going to do high dose dexa suppression test.
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  #3  
Old 07-22-2011
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I think its B........
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Old 07-22-2011
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It is B, if you get an abnormal result, then you proceed with dexamethasone suppresion test.
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Old 07-22-2011
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it's A (low dose overnight dexamethasone suppression test) as best INITIAL test.

B. 24 hr urinary cortisol is CONFIRMATORY test for cushings.

High dose dexamethasone suppression test is to identify the source of cushings.
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Old 07-22-2011
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as initial test its A)..low dose dexamethasone test &
than to identify the coz B) is done
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Old 07-22-2011
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I had my bets on B too..but according to MTB its low Dexa test first....I am hoping alot of pple confirm that as well...
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Old 07-22-2011
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Quote:
Originally Posted by Kais_MD View Post
I had my bets on B too..but according to MTB its low Dexa test first....I am hoping alot of pple confirm that as well...
yes, if you mean BEST INITIAL TEST, both kaplan and mtb say low dose dexa supp. test only, and i did not have such a question on uw till now, so can't tell ya what Uworld says about it.
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Old 07-23-2011
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This is an area of controversy and no clear answer exists. UpToDate says that 2 of the 3 24h UFC, LDDMST, and salivary cortisol should be abnormal. But these are all suggestions. So there is no wrong answer between these two choices!
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  #10  
Old 07-23-2011
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A..1 mg dexamethasone test
__________________
I'm Predictable In The Unpredictable Future !
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  #11  
Old 07-24-2011
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Quote:
Originally Posted by Kais_MD View Post
With a clinical suspicion of a cushing syndrome..which one would you perform initially...
A..1 mg dexamethasone test
B..24 hr urine free cortisol

the correct answer is A for 'best INITIAL test' question..
im quoting Dr. Conrad fischer (i heard him debate and answer this controversial topic live in class)

there are lots of false positives with the DST which is why the 24hrcortisol is the "BEST DIAGNOSTIC TOOL". to add- u wudnt need to do a dexa test after the 24hr test cuz the dexa test is simply put "a screening tool" for in-question pts, the 24hr cortisol is the most accurate test.. if additional test is needed due to a increased ACTH level u wud do a Radio scan..

its a controversial topic.. as dr.fischer said (reassuringly) u wudnt see both of these answers on a usmle q due to its "uncertainty". but if it does come up remember:

BEST INITIAL TEST- DEXAMETHASONE SUPPRESSION TEST

BEST DIAGNOSTIC TEST- 24HR URINARY CORTISOL

-hope that helps all
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  #12  
Old 07-24-2011
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that cleared things up alot...thanks
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  #13  
Old 11-20-2011
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Warning!

The Endocrine Society, in collaboration with the European Society for Endocrinology, has issued evidence-based guidelines for the diagnosis of Cushing’s syndrome.

Recommendations are to proceed initially with one of four highly sensitive screening tests: urinary free cortisol, late-night salivary cortisol, long overnight dexamethasone, or the 2-mg/48-hour dexamethasone screening test. Abnormality detected by of any of these tests in a patient with clinically suspected Cushing’s syndrome should be confirmed with one of the additional tests.

So, best initial are 24 U free cortisol OR overnight dexa...

Nieman LK, Biller BM, Findling JW, et al. The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008;93:1526-1540.

Now, according to MTB 2 (p119):
Best initial test = 24 U free cortisol
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  #14  
Old 11-20-2011
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4 hour urinary cortisol
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