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Old 02-01-2014
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Question Establishing the Cause of Hypercortisolism

Guys ... either i don't understand the whole concept how the dexamethasone suppression tests work or this is an error in MTB.




what do you think?

Thx
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Old 02-01-2014
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Originally Posted by beka-CTS View Post
Guys ... either i don't understand the whole concept how the dexamethasone suppression tests work or this is an error in MTB.




what do you think?

Thx
remove the word "not"
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Old 02-01-2014
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remove the word "not"
გავაკეთე უკვე მარა მეთქი რამე ხოარ მრჩება
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Old 04-04-2015
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Default 'not' can be corect

If ACTH is elevated and high dose dexamethasone suppresses it → pituitary tumor.
If ACTH is elevated and high dose dexamethasone does NOT suppresses it → ectopic ACTH.
I agree it's confusing. I understand it the following way:
When MTB it says 'if ACTH is elevated and dexamethasone does NOT suppress ACTH scan the brain' maybe because NOT suppressed doesn't mean ectopic souce right away. Even though we know that if this is pituitary source high dose dexamethasone should suppress it if NOT suppressed we still need to make sure by MRI.
If no lesion on MRI we should do inferior petrosal sinus sampling for ACTH.
If pituitary ACTH from venous drainage is elevated Pituitary source is confirmed.
So even though ACTH was not suppressed by high dose dexamehtasone or MRI didn't show pituitary lesion pituitary still can be the source and can't be excluded by first 2 tests.
If petrosal sinus sample didn't show elevated ACTH only after that we can look for ectopic ACTH source.
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Endocrinology-, Internal-Medicine-

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