Impaired accuracy of the dexamethasone suppression test after bariatric surgery: implications for post-surgical cortisol interpretation
Authors' conclusion
Post-BS subjects showed higher post-DST cortisol levels and reached lower plasma dexamethasone concentration compared with non-operated individuals, which may lead to false-positive results. These findings highlight the need to consider dexamethasone measurements to enhance DST interpretation in post-BS patients. Further studies are necessary to validate these findings in broader populations. The underlying mechanisms need to be explored.
Study context
- Population
- Patients undergoing bariatric surgery (BS), evaluated with the 1 mg dexamethasone suppression test (DST) before and 2 years after BS
- Participants
- 38 patients
- Exposure
- DST after vs before BS; post-BS vs non-operated pwO vs healthy controls
- Post-BSn = 21
- pwOn = 10
- Healthy controlsn = 7reference
- Outcome
- Intraindividual cortisol after 1 mg DST before and after BS
- Follow-up
- 2 years after BS
Methodological detailsintraindividual before–after comparison, cross-sectional comparison with pwO and healthy controls
- Intraindividual before–after comparison
- Cross-sectional comparison with pwO and healthy controls
Main finding
As reported in the abstract
Cortisol after DST · 2 years post-BS vs before
P < 0.01
- Post-BS individuals with cortisol >1.8 µg/dL in the absence of autonomous cortisol secretion
- 4
Observational data: associations, not effects.
Further findings
| Outcome | Post-BS | pwO | Healthy controls | P value |
|---|---|---|---|---|
| Plasma dexamethasone levelsPost-BS vs pwO and Healthy controls · significantly lower post-BS | 1.9 ng/dL | 3.7 ng/dL | 4.0 ng/mL | P < 0.01 |
Independent predictors of plasma dexamethasone concentrations (multivariate analysis)
- BS (β)
- −1.258, P = .01
- SHBG levels (β)
- −.013, P = .04
Original publication
Impaired accuracy of the dexamethasone suppression test after bariatric surgery: implications for post-surgical cortisol interpretation. Eur J Endocrinol. Published 25 March 2025. doi:10.
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