Early postoperative low-dose dexamethasone suppression test (LDDST) enhances remission prediction beyond morning cortisol in cushing’s disease
Authors' conclusion
Early postoperative MSeC and LDDST are reliable predictors of remission after TSS in CD. MSeC < 50 nmol/L safely define biochemical remission. LDDST adds diagnostic value, particularly in cases with borderline, normal or elevated MSeC, and should be included in routine postoperative assessment.
Study context
- Population
- Cushing's disease (CD) surgical cases who underwent transsphenoidal surgery (TSS) in one department, 2004–2024342 CD surgical cases
- Participants
- 342 vs 197
- Exposure
- Early postoperative morning serum cortisol (MSeC) vs overnight 2 mg LDDST for predicting remission after TSS
- MSeCn = 342
- LDDSTn = 197
- Outcome
- Accuracy of early postoperative MSeC and LDDST for predicting early and long-term remission after TSS
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
Predictive accuracy for remission (ROC) · first follow-up and long-term
| Group | AUC, first FU | AUC, long-term |
|---|---|---|
| MSeC | 0.9229 | 0.8267 |
| LDDST | 0.9413 | 0.8058 |
AUC, first FU
MSeC0.9229
LDDST0.9413
AUC, long-term
MSeC0.8267
LDDST0.8058
Observational data: associations, not effects.
Further findings
Immediate postoperative biochemical remission (IPBR; MSeC < 50 nmol/L)
- IPBR achieved
- 170 cases (49.7%)
Complete LDDST suppression (< 50 nmol/L) · postoperative day five
- LDDST performed
- 197 cases (57.6%)
- Complete suppression
- 137 (69.5%)
Remission at first follow-up · 3-6 months
- Remission with IPBR
- 99.4%
- Remission with complete LDDST suppression
- 98.5%
- Remission without IPBR or suppression
- 45.0%
- Significantly higher with IPBR and/or suppression
- P < 0.0001*
Long-term remission
- Correlated significantly with postoperative MSeC and LDDST
- P < 0.0001*
Recurrence risk · 5 years
- Without LDDST suppression
- 71.1%
- With LDDST suppression
- 6.8%
Original publication
Early postoperative LDDST enhances remission prediction beyond morning cortisol in cushing’s disease. Pituitary. Published 9 February 2026. doi:10.
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