![]() Tests such as random serum cortisol, plasma ACTH level, urinary 17-ketosteroid level, insulin tolerance testing, and loperamide testing have fallen out of favor and are no longer recommended ( Nieman et al., 2008).Īdministration of low-dose dexamethasone followed by measurement of serum cortisol the next morning probes the patient's glucocorticoid negative feedback system. The Evaluation of Adrenal Lesions in Urologic Practice section at the end of this chapter outlines practical algorithms for the metabolic evaluation of adrenal lesions. The physiologic principles underlying these tests are important to understand and are described in this section ( Findling and Raff, 2005). Second-line tests include the 2-day LD-DST and midnight plasma cortisol testing ( Arnaldi et al., 2003 Newell-Price et al., 2006 Nieman et al., 2008 Pivonello et al., 2008). ![]() Late-night salivary cortisol is also used. ![]() The sensitivity of the former test, however, may not be adequate for screening patients with incidentalomas ( Nieman et al., 2008). ![]() The two evaluations performed most frequently are the 24-hour urinary free cortisol (UFC) evaluation and the overnight LD-DST. When the diagnosis of Cushing syndrome is suspected, the clinician can choose among several laboratory studies. Partin MD, PhD, in Campbell-Walsh-Wein Urology, 2021 Establishing the Diagnosis of Cushing Syndrome
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