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Table 2 Endocrinological data of loading test

From: A case of autonomous cortisol secretion in a patient with subclinical Cushing’s syndrome, GNAS mutation, and paradoxical cortisol response to dexamethasone

Loading agent

Variable, unit

Value, pre-operation

Value, post-operation

Reference range

1 mg of DEX, overnight

Serum cortisol, μg/dL

11.8

4.6

<  1.8

8 mg of DEX, overnight

Serum cortisol, μg/dL

13.1

8.7

<  1.0

100 μg of CRH intravenously

Basal ACTH, pg/mL

2.7

2.6

7.2–63.3

 

Peak ACTH, pg/mL (time, min)

5.2 (90)

9.1 (90)

>  2× basal ACTH

2 L of saline intravenously

PAC (before loading), pg/mL

78

73

29.9–159

 

PAC (after loading), pg/mL

92

81

<  60

50 mg of captopril orally

PAC (0 min), pg/mL

56

114

29.9–159

 

PAC (60 min), pg/mL

59

102

N/A

 

PAC (90 min), pg/mL

50

82

N/A

 

ARR (0 min)

140

285

<  200

 

ARR (60 min)

590

102

<  200

 

ARR (90 min)

496

74

<  200

40 mg of furosemide intravenously with keeping upright

PRA (0 min), ng/mL/h

0.3

0.4

0.3–2.9

PRA (60 min), ng/mL/h

0.3

0.5

>  2.0

PRA (120 min), ng/mL/h

0.4

0.8

>  2.0

<Dexamethasone suppression test, Liddle’s method>

No DEX

Urinary- free cortisol, μg/day

74

14

11.2–80.3

2 mg/day of DEX, the first day

Urinary- free cortisol, μg/day

538

32

 

2 mg/day of DEX, the second day

Urinary- free cortisol, μg/day

284

28

 

8 mg/day of DEX, the first day

Urinary- free cortisol, μg/day

141

21

 

8 mg/day of DEX, the second day

Urinary- free cortisol, μg/day

136

20

 
  1. Overnight suppression test with 1 mg and 8 mg of DEX did not suppress cortisol levels, but paradoxically resulted in an increase in urinary cortisol levels
  2. DEX, dexamethasone; CRH, corticotropin-releasing hormone; ACTH, adrenocorticotropic hormone; PAC, plasma aldosterone concentration; ARR, plasma aldosterone / plasma renin activity ratio; PRA, plasma renin activity; N/A, not applicable