Initial Screening

THE 1-MG DEXAMETHASONE SUPPRESSION TEST (DST)

According to guidelines, the 1-mg DST is recognized as being sensitive for the detection of all etiologies of hypercortisolism.1,2 The 1-mg DST is also considered a reliable test for screening patients with adrenal autonomous cortisol secretion, which is common in patients who present with difficult-to-control T2D and hypertension.3,4 It is inexpensive, accessible, and relatively easy to manage.5

The patient is instructed to take a 1-mg oral dose of dexamethasone between 11 PM and midnight and fast overnight.1

A sample of blood is drawn the next morning between 8 AM and 9 AM to measure plasma cortisol.1

An AM dexamethasone level ≥140 ng/dL confirms adequate HPA axis suppression occurred and verifies the DST cortisol result.6

A post-DST cortisol >1.8 μg/dL with AM dexamethasone ≥140 ng/dL is indicative of a hypercortisolism diagnosis.6

A POST 1-MG DST CORTISOL >1.8 μg/dL IS RECOMMENDED FOR SCREENING2,4

1-MG DST

Measures suppression of adrenocorticotropic hormone and autonomous cortisol secretion

post 1-mg-DST cortisol level of>1.8 μg/dL

Indicates evidence of possible hypercortisolism. Subsequent testing is needed to support a diagnosis and identify the source of hypercortisolism.

VIEW EVALUATION & DIAGNOSIS

After an initial post 1-mg-DST cortisol level of >1.8 μg/dL, subsequent tests and further evaluation may be needed to confirm hypercortisolism and will be needed to identify the source of hypercortisolism.

Other screening tests, such as the late-night salivary cortisol (LNSC) test and urinary-free cortisol (UFC) test, may have a low sensitivity and may be less reliable.2,7,8

  • The LNSC test often has discordant results in patients with an adrenal source of hypercortisolism8

  • Patients with confirmed hypercortisolism often have UFC levels in the normal range3,7

Twenty-four percent.

Nearly 1 in 4 patients with difficult-to-control T2D had endogenous hypercortisolism6

UNCOVER PREVALENCE

Do you have patients who may need a hypercortisolism specialist?

FIND A SPECIALIST

Discuss the recent prevalence data with a Corcept representative

CONTACT A REP

References

1. DeFronzo RA, Auchus RJ, Bancos I, et al. BMJ Open. 2024;14(7):e081121. doi:10.1136/bmjopen-2023-081121 2. Nieman LK, Biller BM, Findling JW, et al. J Clin Endocrinol Metab. 2008;93(5):1526-1540. doi:10.1210/jc.2008-0125 3. Chiodini I, Ramos-Rivera A, Marcus AO, Yau H. J Endocr Soc. 2019;3(5):1097-1109. doi:10.1210/js.2018-00382 4. Fassnacht M, Tsagarakis S, Terzolo M, et al. Eur J Endocrinol. 2023;189(1):G1-G42. doi:10.1093/ejendo/lvad066 5. Ciftel S, Mercantepe F. Cureus. 2023;15(11):e48383. doi:10.7759/cureus.48383 6. Buse JB, Kahn SE, Aroda VR, et al. Diabetes Care. 2025;48(00):1-9. doi:10.2337/dc24-2841 7. Giovanelli L, Aresta C, Favero V, et al. J Endocrinol Invest. 2021;44(8):1581-1596. doi:10.1007/s40618-020-01484-2 8. Kuzu I, Zuhur SS, Demir N, Aktas G, Yener Ozturk F, Altuntas Y. Endokrynol Pol. 2016;67(5):487-492. doi:10.5603/EP.a2016.0028