Faculty, Staff and Student Publications
Publication Date
1-16-2024
Journal
Journal of the Endocrine Society
Abstract
CONTEXT: Data on the overnight 1 mg-dexamethasone suppression test (ONDST) in renal dysfunction are limited.
OBJECTIVE: We aim to determine the normative range of ONDST cortisol across chronic kidney disease (CKD) stages and reasons for its alteration.
METHODS: Prospectively, 180 CKD (30 each in G2-G5/5D) patients and 30 healthy controls underwent ONDST 8 Am serum cortisol (chemiluminescent immunoassay [CLIA]). In an exploratory cohort, 45 (15 each: G3b/G4, G5/G5D, and healthy controls) individuals' blood biochemistry for basal (8 Am) cortisol and adrenocorticotropin (ACTH), post-ONDST 8 Am dexamethasone, ACTH, cortisol (CLIA and liquid chromatography-tandem mass spectrometry), and 4 Pm cortisol was collected.
RESULTS: Post-ONDST cortisol (µg/dL) correlated inversely (r = 0.47; P < .005) with estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2), with 95th percentile being 1.2 in controls, 3.0 in G2, 3.2 in G3a, 4.3 in G3b, 4.7 in G4, 5.7 in G5, and 7.1 in G5D. In the exploratory cohort, basal 8 am cortisol and ACTH, and post-ONDST dexamethasone were similar among controls and CKD subgroups. ONDST ACTH (for evaluating the hypothalamo-pituitary-adrenal axis) was slightly higher in G5/5D vs controls (8.9 vs 6.1 pg/mL), while it was similar in G3b/G4 vs controls. Median 8 am ONDST cortisol was similar on CLIA and LC-MS/MS in controls and higher on CLIA in G3b/4 (1.7 vs 1.1 µg/dL; P = .012) and G5/5D (2.4 vs 1.7 µg/dL; P = .002) than LC-MS/MS. Post-ONDST serum cortisol drop from 8 am to 4 pm was significant in controls (0.5-<0.2 µg/dL) and G3b/4 (1.7-1.2 µg/dL), but not in G5/5D (2.4-2.2 µg/dL).
CONCLUSION: The normative data of ONDST serum cortisol with eGFR-based cutoffs are useful in evaluating Cushing syndrome in CKD. Prolonged cortisol half-life and immunoassay-related assay cross-reaction are likely contributors to higher ONDST cortisol.
Keywords
ONDST, chronic kidney disease, dexamethasone suppressed cortisol, Cushing, CKD, ONDST cortisol
DOI
10.1210/jendso/bvae002
PMID
38249430
PMCID
PMC10825827
PubMedCentral® Posted Date
July 2024
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Included in
Internal Medicine Commons, Medical Sciences Commons, Mental and Social Health Commons, Psychiatry and Psychology Commons, Psychology Commons
Comments
See commentary "The Overnight Low-Dose Dexamethasone Suppression Test Can Be Used to Evaluate Patients With Chronic Kidney Disease" in volume 8, bvae007. See "The Overnight Low-Dose Dexamethasone Suppression Test Can Be Used to Evaluate Patients With Chronic Kidney Disease" in volume 8, bvae007.