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Low-dose and high-dose variations of the test exist. [4] The test is given at low (usually 1–2 mg) and high (8 mg) doses of dexamethasone, and the levels of cortisol are measured to obtain the results. [5] A low dose of dexamethasone suppresses cortisol in individuals with no pathology in endogenous cortisol production.
The ACTH test (also called the cosyntropin, tetracosactide, or Synacthen test) is a medical test usually requested and interpreted by endocrinologists to assess the functioning of the adrenal glands' stress response by measuring the adrenal response to adrenocorticotropic hormone (ACTH; corticotropin) or another corticotropic agent such as tetracosactide (cosyntropin, tetracosactrin; Synacthen ...
Two dexamethasone suppression tests (DSTs) are generally used, the overnight test and the 48 hour test. [8] For both tests, a plasma cortisol level above 50 nmol/L is indicative of Cushing's disease. [8] However, 3–8% of patients with Cushing's disease will test negative due to a retention of dexamethasone suppression abilities. [8]
A fluid or water deprivation test is a medical test [1] which can be used to determine whether the patient has diabetes insipidus as opposed to other causes of polydipsia (a condition of excessive thirst that causes an excessive intake of water). The patient is required, for a prolonged period, to forgo intake of water completely, to determine ...
Evocative/suppression testing refers to a class of tests performed where one substance is measured both before and after the administration of another substance to determine if the levels are stimulated ("evocative") or suppressed.
[2] [3] Dexamethasone should be used as the corticosteroid of choice in these cases as it is the only corticosteroid that will not affect diagnostic test results. [2] [29] To confirm inappropriately low cortisol secretion, testing can include baseline morning cortisol level in the blood or morning cortisol level in the saliva. [2]
Waking up earlier in the morning increases the response. [11]Shift work: nurses working on morning shifts with very early awakening (between 4:00–5:30 a.m.) had a greater and prolonged cortisol awakening response than those on the late day shift (between 6:00–9:00 a.m.) or the night shift (between 11:00 a.m.–2:00 p.m.). [12]
Various clinical results, besides the steroids, require regular monitoring. The negative consequences are primarily the result of non-physiological glucocorticoid replacement. [212] During illness or physical or mental stress, the demand for cortisol can increase, sometimes leading to adrenal crises.