Skip to main content
SpringerLink
Log in

Assessment of 1 mg Dexamethasone Suppression Test in Patients with Obesity Before Bariatric Surgery

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Purpose

This study aims to examine the prevalence of Cushing’s syndrome (CS) in class 3 obese patients before bariatric surgery.

Materials and Methods

The data of 1037 class 3 obese patients admitted to the endocrinology outpatient clinic for endocrinological evaluation before bariatric surgery between 2012 and 2019were reviewed retrospectively. One milligram dexamethasone suppression test (DST) was used for the evaluation of hypercortisolism in all cases and cutoff accepted as 1.8 μg/dL.

Results

The mean body mass index (BMI) was 48 ± 8.9 kg/m2 and age was 42 ± 10 years with female preponderance (F/M: 799/238] being observed in this cohort. Insufficient cortisol suppression was found in 40 patients; confirmed hypercortisolemia was detected in 8 patients. The prevalence of pathologic DST was 3.85% and 0.77% in confirmed hypercortisolism. The specificity for 1-mg DST with the cutoff 1.8 μg/dL was calculated as 96.8%.

Conclusion

Hypercortisolism prevalence was found to be low, and 1 mg DST is a sufficient test for the screening of CS in class 3 obese patients evaluated before bariatric surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

BMI:

body mass index

CS:

Cushing’s syndrome

DST:

dexamethasone suppression test

F:

female

M:

male

References

  1. Pasquali R, Casanueva F, Haluzik M, et al. European Society of Endocrinology Clinical Practice Guideline: endocrine work-up in obesity. Eur J Endocrinol. 2020;182(1):G1–G32. Epub 2019/12/20

    Article  CAS  Google Scholar 

  2. Urwyler SA, Cupa N, Christ-Crain M. Comparison of 1 mg versus 2 mg dexamethasone suppression test in patients with obesity. Horm Metab Res. 2017;49(11):854–9. Epub 2017/09/30

    Article  CAS  Google Scholar 

  3. Lammert A, Nittka S, Otto M, et al. Performance of the 1 mg dexamethasone suppression test in patients with severe obesity. Obesity (Silver Spring). 2016;24(4):850–5. Epub 2016/03/08

    Article  CAS  Google Scholar 

  4. Belvederi Murri M, Prestia D, Mondelli V, et al. The HPA axis in bipolar disorder: systematic review and meta-analysis. Psychoneuroendocrinology. 2016;63:327–42. Epub 2015/11/09

    Article  CAS  Google Scholar 

  5. Besemer F, Pereira AM, Smit JW. Alcohol-induced Cushing syndrome. Hypercortisolism caused by alcohol abuse. Neth J Med. 2011;69(7):318–23. Epub 2011/09/22

    CAS  PubMed  Google Scholar 

  6. Tamada D, Otsuki M, Kashine S, et al. Obstructive sleep apnea syndrome causes a pseudo-Cushing’s state in Japanese obese patients with type 2 diabetes mellitus. Endocr J. 2013;60(12):1289–94. Epub 2013/09/21

    Article  CAS  Google Scholar 

  7. 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(5):1526–40. Pubmed Central PMCID: PMC2386281. Epub 2008/03/13

    Article  CAS  Google Scholar 

  8. Sahin SB, Sezgin H, Ayaz T, et al. Routine screening for Cushing’s syndrome is not required in patients presenting with obesity. ISRN Endocrinol. 2013;2013:321063. Pubmed Central PMCID: PMC3693110. Epub 2013/07/11

    Article  Google Scholar 

  9. Tiryakioglu O, Ugurlu S, Yalin S, et al. Screening for Cushing’s syndrome in obese patients. Clinics (Sao Paulo). 2010;65(1):9–13. Pubmed Central PMCID: PMC2815288. Epub 2010/02/04

    Article  Google Scholar 

  10. Jankovic D, Wolf P, Anderwald CH, et al. Prevalence of endocrine disorders in morbidly obese patients and the effects of bariatric surgery on endocrine and metabolic parameters. Obes Surg. 2012;22(1):62–9. Epub 2011/11/05

    Article  Google Scholar 

  11. Fierabracci P, Pinchera A, Martinelli S, et al. Prevalence of endocrine diseases in morbidly obese patients scheduled for bariatric surgery: beyond diabetes. Obes Surg. 2011;21(1):54–60. Epub 2010/10/19

    Article  Google Scholar 

  12. van Hulsteijn L, Pasquali R, Casanueva FF, et al. Prevalence of endocrine disorders in obese patients: systematic review and meta-analysis. Eur J Endocrinol. 2019;1 Epub 2019/10/28

  13. Catargi B, Rigalleau V, Poussin A, et al. Occult Cushing’s syndrome in type-2 diabetes. J Clin Endocrinol Metab. 2003;88(12):5808–13. Epub 2003/12/13

    Article  CAS  Google Scholar 

  14. Leibowitz G, Tsur A, Chayen SD, et al. Pre-clinical Cushing’s syndrome: an unexpected frequent cause of poor glycaemic control in obese diabetic patients. Clin Endocrinol. 1996;44(6):717–22. Epub 1996/06/01

    Article  CAS  Google Scholar 

  15. Steffensen C, Pereira AM, Dekkers OM, et al. DIAGNOSIS OF ENDOCRINE DISEASE: Prevalence of hypercortisolism in type 2 diabetes patients: a systematic review and meta-analysis. Eur J Endocrinol. 2016;175(6):R247–R53. Epub 2016/06/30

    Article  CAS  Google Scholar 

  16. Wood PJ, Barth JH, Freedman DB, et al. Evidence for the low dose dexamethasone suppression test to screen for Cushing’s syndrome--recommendations for a protocol for biochemistry laboratories. Ann Clin Biochem. 1997;34(Pt 3):222–9. Epub 1997/05/01

    Article  CAS  Google Scholar 

  17. Nieman LK. Recent updates on the diagnosis and management of Cushing’s syndrome. Endocrinol Metab (Seoul). 2018;33(2):139–46. Pubmed Central PMCID: PMC6021313. Epub 2018/06/28

    Article  CAS  Google Scholar 

  18. Altman DG, Bland JM. Diagnostic tests. 1: Sensitivity and specificity. BMJ. 1994;308(6943):1552. Pubmed Central PMCID: PMC2540489. Epub 1994/06/11

    Article  CAS  Google Scholar 

  19. Fassnacht M, Arlt W, Bancos I, et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2016;175(2):G1–G34. Epub 2016/07/09

    Article  CAS  Google Scholar 

  20. Newell-Price J, Trainer P, Besser M, et al. The diagnosis and differential diagnosis of Cushing’s syndrome and pseudo-Cushing’s states. Endocr Rev. 1998;19(5):647–72. Epub 1998/10/30

    CAS  PubMed  Google Scholar 

  21. Arnaldi G, Angeli A, Atkinson AB, et al. Diagnosis and complications of Cushing's syndrome: a consensus statement. J Clin Endocrinol Metab. 2003;88(12):5593–602. Epub 2003/12/13

    Article  CAS  Google Scholar 

  22. Knoops AJ, van der Graaf Y, Mali WP, et al. Age-related changes in hypothalamic-pituitary-adrenal axis activity in patients with manifest arterial disease. Endocrine. 2010;37(1):231–8. Epub 2010/10/22

    Article  CAS  Google Scholar 

  23. Gungunes A, Sahin M, Demirci T, et al. Cushing's syndrome in type 2 diabetes patients with poor glycemic control. Endocrine. 2014;47(3):895–900. Epub 2014/04/18

    Article  CAS  Google Scholar 

  24. Iacobone M, Citton M, Scarpa M, et al. Systematic review of surgical treatment of subclinical Cushing's syndrome. Br J Surg. 2015;102(4):318–30. Epub 2015/02/03

    Article  CAS  Google Scholar 

Download references

Author Contribution Statement

All authors made substantial contributions to conception and design, and/or acquisition of data, and/or analysis and interpretation of data; participated in drafting the article or revising it critically for important intellectual content; and gave final approval of the version to be submitted.

Author information

Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey

    Dilek Gogas Yavuz & Tugce Apaydin

  2. Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey

    Hatice Gizem Gunhan

  3. Department of Endocrinology and Metabolism, Yeni Yuzyil University, Gaziosmanpasa Hospital, Istanbul, Turkey

    Meliha Melin Uygur

Authors
  1. Dilek Gogas Yavuz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tugce Apaydin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hatice Gizem Gunhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Meliha Melin Uygur
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tugce Apaydin.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yavuz, D.G., Apaydin, T., Gunhan, H.G. et al. Assessment of 1 mg Dexamethasone Suppression Test in Patients with Obesity Before Bariatric Surgery. OBES SURG 30, 4981–4985 (2020). https://doi.org/10.1007/s11695-020-04865-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-020-04865-x

Keywords

Search

Navigation