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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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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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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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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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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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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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Takuhiro Sonoyama Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan

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Masakatsu Sone Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan

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Naohisa Tamura Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan

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Kyoko Honda Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan

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Daisuke Taura Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan

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Katsutoshi Kojima Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan

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Yorihide Fukuda Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan

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Naotetsu Kanamoto Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan

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Masako Miura Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan

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Akihiro Yasoda Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan

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Hiroshi Arai Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan

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Hiroshi Itoh Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan

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Kazuwa Nakao Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan

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cortisol level ≥82.77 nmol/l after overnight 1-mg dexamethasone suppression test) were excluded from the study. Hormone measurement and dexamethasone suppression test The levels of ACTH, cortisol, PRA, and PAC were measured in blood samples obtained after

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Carla Scaroni Dipartimento di Medicina, U.O.C. Endocrinologia, Università di Padova, Padova, Italy

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Nora M Albiger Dipartimento di Medicina, U.O.C. Endocrinologia, Università di Padova, Padova, Italy

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Serena Palmieri Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy

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Davide Iacuaniello Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Napoli, Italy

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Chiara Graziadio Department of Experimental Medicine, University La Sapienza, Rome, Italy

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Luca Damiani Department of Medical Sciences, Endocrinology and Internal Medicine Section, University of Ferrara, Ferrara, Italy

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Marialuisa Zilio Dipartimento di Medicina, U.O.C. Endocrinologia, Università di Padova, Padova, Italy

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Antonio Stigliano Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University La Sapienza, Rome, Italy

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Annamaria Colao Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Napoli, Italy

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Rosario Pivonello Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Napoli, Italy

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the Altogether to Beat Cushing’s Syndrome (ABC) study group
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. ( https://doi.org/10.1177/0004563218766566 ) 11 Vastbinder M Kuindersma M Mulder AH Schuijt MP Mudde AH . The influence of oral contraceptives on overnight 1 mg dexamethasone suppression test . Netherlands Journal of Medicine 2016 158

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Anne-Sophie C A M Koning Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands

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Philippe C Habets Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands

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Marit Bogaards Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands

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Jan Kroon Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands

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Hanneke M van Santen Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
Department of Pediatric Neuro-Oncology, Prinses Máxima Centrum, Utrecht, The Netherlands

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Judith M de Bont Department of Pediatric Neuro-Oncology, Prinses Máxima Centrum, Utrecht, The Netherlands

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Onno C Meijer Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands

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effects. The alternative explanation for a beneficial effect of cortisol would be that cortisol-activated GR exerts different effects from dexamethasone-activated GR. Given the strong suppression of the HPA axis after dexamethasone, and the differences

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Alberto Giacinto Ambrogio Neuroendocrinology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy

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Massimiliano Andrioli Neuroendocrinology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy

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Martina De Martin Neuroendocrinology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy

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Francesco Cavagnini Neuroendocrinology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy

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Francesca Pecori Giraldi Neuroendocrinology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

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treated at 16 and 17 years after surgery. Patients who subsequently developed elevated UFC, abnormal overnight suppression test (OST; cortisol >3 µg/dL after 1 mg dexamethasone administered at midnight ( 26 )) and clinical signs of hypercortisolism were

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