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Case Reports in Endocrinology
Volume 2016, Article ID 3684287, 3 pages
http://dx.doi.org/10.1155/2016/3684287
Case Report

Nonsuppressible Oral Dexamethasone Suppression Tests but Not Cushing Syndrome

1Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi 110029, India
2Department of Pediatrics, ESIC Model & Super Specialty Hospital, Asramam, Kollam, Kerala 691002, India

Received 25 September 2015; Revised 27 February 2016; Accepted 8 March 2016

Academic Editor: Eli Hershkovitz

Copyright © 2016 Abilash Nair et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

In spite of the presence of definitive diagnostic criteria to diagnose Cushing syndrome diagnosis may become challenging. We report a young female with mild clinical features of Cushing syndrome, who had nonsuppressible oral dexamethasone suppression tests; also she had a suspicious pituitary lesion. She underwent pituitary surgery and a pituitary microadenoma (non-ACTH staining) was removed. Now she had come to us with similar complaints to those before. Again she had nonsuppressible oral dexamethasone suppression tests. As the diurnal variation of serum and salivary cortisol was maintained and urinary free cortisol was normal, further evaluation with IV dexamethasone suppression test was performed which clearly ruled out Cushing syndrome. The patient was not on any medicines known to alter dexamethasone metabolism. Fat malabsorption was also ruled out using appropriate tests. The reason for this discrepancy is thought to be altered (increased) metabolism of dexamethasone in this patient as it is widely variable in the general population.