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Low-Dose Test: Standard 2-Day (2-mg) Test


Use


  • The 2-day test is used to assess suppressibility in patients with an equivocal overnight test or in patients who have not had an overnight test.
  • Dexamethasone, 0.5 mg, is taken orally every 6 hours, usually at 8 am, 2 pm, 8 pm, and 2 am, for a total of eight doses.
  • Blood is drawn 2 or 6 hours after the last dose for measurement of cortisol.

Interpretation


  • The normal response to the 2-day test consists of the following:
    • Urinary cortisol excretion should fall to <10 Ž ¼g/24 hours on the 2nd day of dexamethasone administration.
    • Serum cortisol concentration is <5 Ž ¼g/dL, a plasma ACTH concentration is <5 pg/mL, and a serum dexamethasone concentration is between 2.0 and 6.5 ng/mL.
    • In a recent meta-analysis, the 1-mg test and the 2-day 2-mg test were both accurate, but the 2-mg test had slightly less diagnostic accuracy.
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