Editorial update and 2019 George Fleming Prizewinner

Abstract

There is limited information regarding the value of constitutive components of the ACTH stimulation test (ACTHST) and low-dose dexamethasone suppression test (LDDST) including serum baseline cortisol (BC), difference between post-ACTH stimulation cortisol (PC) and BC (ΔACTHC), cortisol concentration 4 h after dexamethasone administration (4HC), difference between 4HC and BC (Δ4C), and the difference between cortisol concentration 8 h after dexamethasone administration and 4HC (Δ8C). Therefore, the objective of this study was to determine if these components can predict hyperadrenocorticism, pituitary-dependent hyperadrenocorticism (PDH), or functional adrenocortical tumor (FAT) in dogs. Cortisol concentrations were normalized, as fold change (FC), to the PC reference interval upper limit.A total of 1267 dogs were included, with hyperadrenocorticism diagnosed in 537 (PDH, n = 356; FAT, n = 28; undetermined, n = 153) and excluded in 730. The area under the receiver operating curves for BC, ΔACTHC, 4HC, Δ4C, and Δ8C to predict hyperadrenocorticism were 0.76 (95% confidence interval (CI), 0.73–0.79), 0.91 (95% CI, 0.89–0.93), 0.83 (95% CI, 0.80–0.87), 0.55 (95% CI, 0.50–0.60), and 0.67 (95% CI, 0.62–0.72), respectively. A diagnostic limit of ≥0.78 FC for ΔACTHC had excellent sensitivity (1.00; 95% CI, 0.74–1.00), but poor specificity (0.67; 95% CI, 0.64–0.71), to predict FAT in dogs with a positive ACTHST. A diagnostic limit of ≥−0.26 FC for Δ4C had excellent sensitivity (1.00; 95% CI, 0.79–1.00), but poor specificity (0.21; 95% CI, 0.18–0.26), to predict FAT in dogs with a positive LDDST. In hyperadrenocorticoid dogs that have positive ACTHST or LDDST results, ΔACTHC or Δ4C, respectively, could be used to exclude FAT.