Does Serum-DXM Increase Diagnostic Accuracy of the Overnight DXM Suppression Test in the Work-up of Cushing's Syndrome?

NCT ID: NCT01504555

Last Updated: 2016-09-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

300 participants

Study Classification

OBSERVATIONAL

Study Start Date

2011-10-31

Study Completion Date

2017-09-30

Brief Summary

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Background: The evaluation for hypercortisolism includes an overnight 1mg dexamethasone (DXM) suppression test. An important shortcoming is the diagnostic specificity of only 80%, which is likely due to inter-individual differences in gut absorption or metabolism of DXM.

Study hypothesis: The investigators hypothesize that serum-DXM measurements will increase the diagnostic accuracy of the overnight DXM-test in the work-up of hypercortisolism.

Aims: The primary aim of this prospective study is to evaluate if serum-DXM measured simultaneously with serum-cortisol in morning samples could increase the diagnostic accuracy this diagnostic test. There are several secondary aims. One is to estimate the prevalence and causes of unusual DXM absorption or metabolism. The investigators will also evaluate the feasibility and diagnostic accuracy of salivary DXM. Moreover, the diagnostic accuracy of midnight salivary cortisol and cortisone, and urinary cortisol, will be evaluated and compared.

Design: Levels of DXM in morning serum following an overnight DXM-test will be analyzed in patients under evaluation for hypercortisolism (including incidentalomas). A cut-off level to identify inadequate DXM concentrations in serum to suppress endogenous cortisol production will be established based on the negative tests. This cut-off level will then be applied in a retrospective analysis of the diagnostic accuracy of DXM-tests. This prospective study has a blinded design as the DXM measurements are disclosed after the end of the trial.

Detailed Description

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Conditions

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Cushing's Syndrome Adrenal Incidentalomas Alcoholism Obesity

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

PROSPECTIVE

Study Groups

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Patients under investigation for hypercortisolism

Patients undergoing routine evaluation for hypercortisolism at Haukeland University Hospital, Bergen, Norway, will be asked to participate.

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

* Age over 18 years
* Under investigation for hypercortisolism
* Able and willing to make informed consent

Exclusion Criteria

* Use of systemic or local glucocorticoids
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Haukeland University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Grethe Åstrøm Ueland, MD

Role: STUDY_CHAIR

Haukeland University Hospital

Locations

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Haukeland Universitetssykehus- Rusmedisinsk avdeling

Bergen, , Norway

Site Status NOT_YET_RECRUITING

Haukeland Universitetssykehus- Endokrinologisk avdeling

Bergen, , Norway

Site Status RECRUITING

Institutt for farmakologi

Bergen, , Norway

Site Status RECRUITING

Haukeland University Hospital- Hormonlaboratory

Bergen, , Norway

Site Status RECRUITING

Countries

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Norway

Central Contacts

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Grethe Åstrøm Ueland, MD

Role: CONTACT

+4790950021

Paal Methli, MD

Role: CONTACT

+4797677930

Facility Contacts

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Pia Synøve Kloster, Cand.med

Role: primary

55975000

Grethe Åstrøm Ueland, Doctor

Role: primary

+4790950021

Hrafnkell Baldur Thordarsson, Doctor

Role: backup

+4755972995

Simon Steinar Hustad, Dr.Med

Role: primary

Grethe Åstrøm Ueland, Doctor

Role: primary

+4790950021

Paal Methli, Doctor

Role: backup

+4797677930

References

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Baid SK, Rubino D, Sinaii N, Ramsey S, Frank A, Nieman LK. Specificity of screening tests for Cushing's syndrome in an overweight and obese population. J Clin Endocrinol Metab. 2009 Oct;94(10):3857-64. doi: 10.1210/jc.2008-2766. Epub 2009 Jul 14.

Reference Type BACKGROUND
PMID: 19602562 (View on PubMed)

Nieman LK, Biller BM, Findling JW, Newell-Price J, Savage MO, Stewart PM, Montori VM. The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008 May;93(5):1526-40. doi: 10.1210/jc.2008-0125. Epub 2008 Mar 11.

Reference Type BACKGROUND
PMID: 18334580 (View on PubMed)

Carroll TB, Findling JW. The diagnosis of Cushing's syndrome. Rev Endocr Metab Disord. 2010 Jun;11(2):147-53. doi: 10.1007/s11154-010-9143-3.

Reference Type BACKGROUND
PMID: 20821267 (View on PubMed)

Related Links

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http://tidsskriftet.no/article/1502899

Kortisol i spytt ved sykdom i binyrene

http://tidsskriftet.no/article/1501521

Spyttprøver til kortisolmåling

Other Identifiers

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2011/1810

Identifier Type: -

Identifier Source: org_study_id

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