The 1 mg overnight dexamethasone suppression test: a danger to the adrenal gland?

Chaim Vanek, Lynn Loriaux

Research output: Contribution to journalReview articlepeer-review


Purpose of reviewThe 1 mg overnight dexamethasone suppression test (ONDST) with a cutoff cortisol value of 1.8 mcg/dl (50 nmol/l) is routinely used for the assessment of incidental, benign adrenal nodules. Patients with an abnormal test are diagnosed with mild autonomous cortisol secretion (MACS). This timely commentary reviews the origins of the ONDST, its relationship to the diagnoses of MACS, and whether this is clinically relevant for clinical care.Recent findingsMillions of incidental adrenal nodules are found on CT scans annually. Several papers in the last three years discuss and advocate for the diagnose of MACS via the ONDST.SummaryAn ONDST cutoff of 1.8 mcg/dl (50 nmol/l) in patients with no clinical features of Cushing's syndrome will produce false positive results and a diagnosis of MACS that could result in unnecessary adrenalectomy.

Original languageEnglish (US)
Pages (from-to)403-405
Number of pages3
JournalCurrent Opinion in Endocrinology, Diabetes and Obesity
Issue number4
StatePublished - Aug 1 2022


  • Cushing's disease
  • Cushing's syndrome
  • adrenal nodule
  • adrenalectomy
  • cortisol
  • dexamethasone
  • mild autonomous cortisol secretion
  • overnight dexamethasone suppression test

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology
  • Nutrition and Dietetics


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