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Bjørn O Åsvold Department of Endocrinology, Department of Public Health, Department of Cancer Research and Molecular Medicine, Department of Medical Biochemistry, St Olavs Hospital, Trondheim University Hospital, P O Box 3250 Sluppen, N-7006 Trondheim, Norway
Department of Endocrinology, Department of Public Health, Department of Cancer Research and Molecular Medicine, Department of Medical Biochemistry, St Olavs Hospital, Trondheim University Hospital, P O Box 3250 Sluppen, N-7006 Trondheim, Norway

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Valdemar Grill Department of Endocrinology, Department of Public Health, Department of Cancer Research and Molecular Medicine, Department of Medical Biochemistry, St Olavs Hospital, Trondheim University Hospital, P O Box 3250 Sluppen, N-7006 Trondheim, Norway
Department of Endocrinology, Department of Public Health, Department of Cancer Research and Molecular Medicine, Department of Medical Biochemistry, St Olavs Hospital, Trondheim University Hospital, P O Box 3250 Sluppen, N-7006 Trondheim, Norway

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Ketil Thorstensen Department of Endocrinology, Department of Public Health, Department of Cancer Research and Molecular Medicine, Department of Medical Biochemistry, St Olavs Hospital, Trondheim University Hospital, P O Box 3250 Sluppen, N-7006 Trondheim, Norway

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Marit R Bjørgaas Department of Endocrinology, Department of Public Health, Department of Cancer Research and Molecular Medicine, Department of Medical Biochemistry, St Olavs Hospital, Trondheim University Hospital, P O Box 3250 Sluppen, N-7006 Trondheim, Norway
Department of Endocrinology, Department of Public Health, Department of Cancer Research and Molecular Medicine, Department of Medical Biochemistry, St Olavs Hospital, Trondheim University Hospital, P O Box 3250 Sluppen, N-7006 Trondheim, Norway

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Introduction The 1 mg overnight dexamethasone suppression test (DST) is a common initial test for endogenous Cushing's syndrome (1) . The principle of the test is that dexamethasone will suppress ACTH and cortisol secretion in healthy individuals

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Sweta Budyal Department of Endocrinology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400012, India

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Swati Sachin Jadhav Department of Endocrinology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400012, India

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Rajeev Kasaliwal Department of Endocrinology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400012, India

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Hiren Patt Department of Endocrinology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400012, India

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Shruti Khare Department of Endocrinology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400012, India

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Vyankatesh Shivane Department of Endocrinology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400012, India

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Anurag R Lila Department of Endocrinology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400012, India

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Tushar Bandgar Department of Endocrinology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400012, India

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Nalini S Shah Department of Endocrinology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400012, India

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participants underwent a 1 mg overnight dexamethasone suppression test (ODST) on an outpatient basis. The patients were advised to take two tablets of 0.5 mg of dexamethasone at 2300 h and the sample for cortisol was collected on the next morning between 0800

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Ramjan Sanas Mohamed Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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Biyaser Abuelgasim Imperial College School of Medicine, Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK

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Sally Barker Imperial College School of Medicine, Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK

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Hemanth Prabhudev Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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Niamh M Martin Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK

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Karim Meeran Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK

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Emma L Williams Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK

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Sarah Darch Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK

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Whitlock Matthew Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK

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Tricia Tan Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK

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Florian Wernig Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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for CS including late-night salivary cortisol (LNSC), overnight dexamethasone suppression test (ODST), low-dose dexamethasone suppression test (LDDST) and 24-h urinary free cortisol (UFC) ( 1 , 2 , 3 ). A hallmark of CS is the disruption of the

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Ana Podbregar Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
University Rehabilitation Institute Republic of Slovenia, Ljubljana, Slovenia

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Tomaž Kocjan Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Department of Endocrinology, Diabetes and Metabolic Disease, University Medical Center Ljubljana, Ljubljana, Slovenia

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Matej Rakuša Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Department of Endocrinology, Diabetes and Metabolic Disease, University Medical Center Ljubljana, Ljubljana, Slovenia

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Peter Popović Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Clinical Institute of Radiology, University Medical Center Ljubljana, Ljubljana, Slovenia

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Manca Garbajs Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Clinical Institute of Radiology, University Medical Center Ljubljana, Ljubljana, Slovenia

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Katja Goricar Faculty of Medicine, Institute of Biochemistry, Pharmacogenetics Laboratory, University of Ljubljana, Ljubljana, Slovenia

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Andrej Janez Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Department of Endocrinology, Diabetes and Metabolic Disease, University Medical Center Ljubljana, Ljubljana, Slovenia

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Mojca Jensterle Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Department of Endocrinology, Diabetes and Metabolic Disease, University Medical Center Ljubljana, Ljubljana, Slovenia

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to January 2011 and were characterized as NFAI. NFAI was confirmed when cortisol after 1 mg overnight dexamethasone suppression test (ODST) was < 50 nmol/L, no typical clinical signs of Cushing’s syndrome were present and pheochromocytoma and primary

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Agnieszka Adamska Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Bialystok, Poland

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Vitalii Ulychnyi Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Bialystok, Poland

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Katarzyna Siewko Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Bialystok, Poland

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Anna Popławska-Kita Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Bialystok, Poland

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Małgorzata Szelachowska Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Bialystok, Poland

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Marcin Adamski Faculty of Computer Science, Bialystok University of Technology, Białystok, Poland

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Angelika Buczyńska Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland

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Adam Jacek Krętowski Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Bialystok, Poland
Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland

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Cushing’s syndrome ( 9 ). The definition of MACS is based on the serum cortisol values after a 1 mg overnight dexamethasone suppression test (DST); however, the cut-off values are not clearly established ( 9 ). In the European Society of Endocrinology (ESE

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M S Elston Department of Endocrinology, Waikato Hospital, Hamilton, New Zealand
Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand

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V B Crawford Department of Endocrinology, Waikato Hospital, Hamilton, New Zealand

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M Swarbrick Department of Radiology, Waikato Hospital, Hamilton, New Zealand

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M S Dray Department of Pathology, Waikato Hospital, Hamilton, New Zealand

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M Head Department of Oncology, Tauranga Hospital, Tauranga, New Zealand

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J V Conaglen Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand

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–700 nmol/L Serum bicarbonate 36.3 22–26 mmol/L Venous pH 7.498 7.35–7.45 PSA 1.35 <6.5 ng/mL Initial endocrine evaluation  Midnight cortisol >1655 <50 nmol/L  1 mg overnight dexamethasone suppression test

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Richard W Carroll Endocrine, Diabetes, and Research Centre, Wellington Regional Hospital, New Zealand

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Brian Corley Endocrine, Diabetes, and Research Centre, Wellington Regional Hospital, New Zealand
Department of Medicine, University of Otago, Wellington, New Zealand

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Joe Feltham Department of Radiology, Wellington Regional Hospital, New Zealand

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Patricia Whitfield Endocrine, Diabetes, and Research Centre, Wellington Regional Hospital, New Zealand
Department of Medicine, University of Otago, Wellington, New Zealand

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William Park University of Otago, Wellington, New Zealand

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Rowena Howard Diabetes and Endocrinology Service, Hutt Hospital, New Zealand

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Melissa Yssel Department of Biochemistry & Endocrinology, Awanui Labs, New Zealand

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Ian Phillips Department of Biochemistry, Awanui Labs, Dunedin, New Zealand

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Simon Harper Department of Surgery & Anaesethesia, University of Otago, Wellington, New Zealand
Department of General Surgery, Wellington Regional Hospital, New Zealand

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Jun Yang Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
Department of Medicine, Monash University, Clayton, Victoria, Australia

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41 (73%) patients, through the use of urinary free cortisol measurement in 9 out of 36 (25%) patients, midnight salivary cortisol measurements in 1 out of 36 (3%) patients, and an overnight dexamethasone suppression test in 21 out of 36 (58%) patients

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Grethe Å Ueland Department of Clinical Science, University of Bergen, Bergen, Norway
Department of Medicine, Haukeland University Hospital, Bergen, Norway

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Thea Grinde Department of Clinical Science, University of Bergen, Bergen, Norway

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Paal Methlie Department of Clinical Science, University of Bergen, Bergen, Norway
Department of Medicine, Haukeland University Hospital, Bergen, Norway
K. G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway

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Oskar Kelp Department of Medicine, Akershus University Hospital, Nordbyhagen, Norway

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Kristian Løvås Department of Medicine, Haukeland University Hospital, Bergen, Norway
K. G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway

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Eystein S Husebye Department of Clinical Science, University of Bergen, Bergen, Norway
Department of Medicine, Haukeland University Hospital, Bergen, Norway
K. G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway

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therefore recommended that all patients with AI should be assessed for ACS. The most recent international guidelines recommend the 1 mg overnight dexamethasone suppression test (DST) to screen for ACS ( 1 ). This test is not optimal, as the DST has low

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Gamze Akkuş Division of Endocrinology, Internal Medicine and Endocrinology, Cukurova University Medical Faculty, Department of Internal Medicine, Adana, Turkey

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Isa Burak Güney Nuclear Medicine Department, Cukurova University Medical Faculty, Adana, Turkey

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Fesih Ok Urology Department, Cukurova University Medical Faculty, Adana, Turkey

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Mehtap Evran Division of Endocrinology, Internal Medicine and Endocrinology, Cukurova University Medical Faculty, Department of Internal Medicine, Adana, Turkey

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Volkan Izol Urology Department, Cukurova University Medical Faculty, Adana, Turkey

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Şeyda Erdoğan Pathology Department, Cukurova University Medical Faculty, Adana, Turkey

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Yıldırım Bayazıt Urology Department, Cukurova University Medical Faculty, Adana, Turkey

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Murat Sert Division of Endocrinology, Internal Medicine and Endocrinology, Cukurova University Medical Faculty, Department of Internal Medicine, Adana, Turkey

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Tamer Tetiker Division of Endocrinology, Internal Medicine and Endocrinology, Cukurova University Medical Faculty, Department of Internal Medicine, Adana, Turkey

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 mg of overnight dexamethasone suppression tests or 2 days of low-dose dexamethasone suppression test plus the following additional measurements; 24-h urinary free cortisol excretion (UFC), suppressed serum adrenocorticotrophic hormone (ACTH) levels

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Kuang Hung Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

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Bo-Ching Lee Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

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Po-Ting Chen Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

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Kao-Lang Liu Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

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Chin-Chen Chang Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

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Vin-Cent Wu Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

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Yen-Hung Lin Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

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PA was confirmed by an LI value ≥ 2.0 ( 20 , 23 , 24 ). Screening for ACS The 1 mg overnight dexamethasone suppression test (DST) was performed to obtain the hypercortisolism status of the patients. Patients who failed to suppress cortisol

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