Understanding The Dexamethasone Suppression Test

[@chrisnjoku2777]

Who is here after watching this video some months back and feeling like they have 'finally' understood the DMST and will never forget it only to come back to watch it again.

[@ZeroToFinals]

haha! I made the video and I still have to come back to remind myself. It is a tricky topic

[@saleemullah4991]

🖐️🖐️

[@qwertyuioparya]

No

[@alviyt6627]

I am here for the same reason 😂

[@iknowthatiknownot]

Me

[@lawyerdoctor]

Brilliant. You explained this test 100% better than the pharm professor at my medical school. I was confused and now I understand, thank you!

[@amandamccrary9773]

I really couldn't get this through my head until now. Thank you.

[@ZeroToFinals]

glad to help!

[@rmacd]

I've gone through 3 years of medical school and it's literally taken me this video for everything to click into place

[@billkuo1]

My notes on steps with dexamethasone suppression test (with Fahad's input) • 1 mg of dexamethasone (low dose suppression test) is given at 10pm at night and blood levels of cortisol and ACTH are measured at 9am next morning • If the person have normal CRH-ACTH-cortisol function, ACTH would be suppressed via negative feedback • low ACTH -> low cortisol • Blood test would show low cortisol • If blood test show normal or elevated cortisol levels, it indicates Cushing syndrome, ACTH should then be measured (note: measure cortisol first because measuring ACTH first cannot rule out Cushing syndrome) • If Cushing syndrome is caused by primary causes, Cortisol would remain high, but ACTH will react to suppression ie. Low ACTH in adrenal adenoma, or exogenous steroids • If syndrome is caused by excess ACTH: Cushing disease (pituitary adenoma), or ectopic ACTH in paraneoplastic syndromes in SCLC, ACTH will remain high or normal • In this case, high dose suppression test is used where 8mg of dexamethasone is given at 10pm and ACTH is measured next morning • High dose dexamethasone is able to suppress ACTH release from the pituitary, therefore, low ACTH would mean pituitary adenoma / Cushing disease (cortisol would be low as well because ACTH is low) • ACTH remaining high would mean it is not released at the pituitary, and ectopic ACTH would be likely

[@joleneong8173]

you are a legend!! this saved my life!!

[@zwenyinyihtun6988]

The best one

[@Callmeperrys]

Finally after years of studying this I get it

[@trafficjon400]

Dexamethasone tortured my life for over 6 years now? 1 injection for Swelling from a product effected my adrenal Cortisol very badly by still shaking while waking and told my cortisole is sopposed to react with waking but is not. it takes the life out of a person and waking in hell . if your a believer in God dexamethasone will take the belief away for sure when you feel like your in hell unexplainable. ENDOCRINOLOGIST i dare not to see because they don't really know the correct levels of treating with this hormone. Any body abused and have emotional problems better keep far from Steroids Corticasteroids that induce PTSD or any kind of fear will be doubled in Severity.

[@meliketopaloglu3308]

Oh wow, you are making everything so easy , thank you so much, I did not even have internet during my medical school , I wish I had and watched you 🙌🏼

[@s101077]

🙌🏼

[@iqrakanwal6438]

Best explanation of Dexamethasone Suppression Test I have ever come across. Cheers.

[@ZeroToFinals]

Wow, that great feedback!

[@jehangiri6]

Once the Low Dose Dexamethasone Suppression Test is positive , the next step is to measure Serum ACTH levels , if the are low , its either exogenous steroid (most common cause) or Adrenal adenoma , you do not need to do High dose suppression in this situation. However if Serum ACTH is high after a positive low dose suppression , then you do High dose suppression test to determine whether its Cushing Disease (Cortisol Suppressed) or Lung Cancer(Cortisol Unchanged ). I like your channel though , from Pakistan.

[@ZeroToFinals]

Thanks for your comment Fahad. You are right!

[@faisalhaqparast357]

Now i understood from your comment

[@LostSmiler]

legend man. Thanks

[@adamjohnzon]

very helpful, thanks!

[@fahadafridi8173]

sher ye sher

[@muhammadyaqoob877]

Your way of teaching is outstanding

[@ZeroToFinals]

Thank you!

[@As-ht5rw]

Crystal Clear. Thank you. When I saw over 7min I skipped to a shorter video...then to another shorter video then..... another shorter video as. I have not clearly been convinced that I understood it... So I went back to your video.... I would have saved time by listening to my gut feeling and just watched your video. It was crystal clear. Thank you.💌

[@davidoconnor4028]

made everything so much clearer, thank you

[@سهيالفرجابي]

I just cant really believe l understood it specially after all these years of graduation.. Really thank u so much

[@abifarinopeyemi1688]

This was broken down to bits and really helpful. Thank you.

[@ZeroToFinals]

Glad it was helpful!

[@krisshassebrock7518]

Finally I'm getting the answers to my questions!! Thank you so very much

[@ZeroToFinals]

No problem, glad to help Kriss

[@reemabdelhay3497]

Amazing video.. I can’t believe that I understand it finally.. lots of love and support.. keep up the good work 🎉❤

[@34.muhammadhusnulhakimibin76]

''Wah thank you, already include the summary in my slide this week for my presentation on pituitary gland pathology to my beloved students from Malaysia'' -Dr. Asawari Sant.

[@stalinthomas8187]

Simplified the test in a beautiful way.... Congrats

[@ZeroToFinals]

Thanks!

[@leenahmed147]

The summary at the end was so helpful, Thank you!

[@CS-kb6by]

Best explanation on the internet

[@ZeroToFinals]

wow, thanks!

[@Shubham-td9yz]

This was easy to understand.... thanks for making it crystal clear 😇

[@lightadetoun796]

Wow! As clear as you cam ever have it!!! Brilliant 👍. Thank you very much

[@chutee5991]

Thank you so much for this video. I can finally understand this test.

[@sameeragunasekara2785]

Nicely & simply explained 👍thank you

[@Wanos-zw9sf]

OmG thank you sooooo much I was dying with this test .. you r my hero . Thanks alot

[@Dj2anime]

Awesome explanation! It was simple and easy to follow - I can actually wrap my head around it now :D

[@preeshillashibchurn3847]

Finallyy a video that helped me to understand DMST.. thank you..very helpful😊

[@ZeroToFinals]

no problem Preeshilla, glad you liked it!

[@amanchauhan7934]

Simple, to the point and perfect

[@champikasam]

Thanks for the detailed explanation. keep up the good work!

[@ZeroToFinals]

Will do!

[@ManuSidhuMD]

Incredibly clear, informative, helpful and easy to understand - perfectly explained. Thanks very much.

[@haniehrezaei7914]

Wooow,great. As a nurse I couldn't get it until I watched this video

[@funmiade575]

I am truly enjoying these videos. Thank you so much.

[@ZeroToFinals]

Thanks again. I'm going to keep making them!

[@amymunro1419]

This is such a great explanation of the test - thank you!

[@leoguy1609]

Had dual tumors on my adrenal glands, had a full left adrenalectomy, have to have the low test done annually. Suffered severe health issues that nearly killed me twice.

[@trafficjon400]

Dexamethasone nearly killed Me? never have it again. the Nurses were very worried about the injection but ll stay away from now on. Adrenal Shut down is hell.

[@SBASAK25071996]

amazing!! understood at one go! brilliant teaching❤

[@deevanshirathore2730]

Thank you so much, was super confused and now all clear mind, thank you

[@keanutax4951]

This is a very good and simple video, thanks!!

[@ZeroToFinals]

Thanks Keanu!

[@abdulazizalhowaish2692]

Thank you for the video, it's very helpful to understand the dexamethasone suppression test.

[@ZeroToFinals]

glad to help!

[@safayounis2762]

Awesome video, helpful and to the point! thank you

[@hichembennaoum8871]

that guy is my new superhero ! ..god bless u !

[@ZeroToFinals]

awesome!

[@Dangerous0Fairy]

Saved me a brain ache 🤣 thank you !

[@Anonymous-mq5lv]

Thanks for this video it was so clear and helpful! However, it does slightly contradict your previous video on Cushing's syndrome where you said that after the high dose dexamethasone suppression test an a pituitary adenoma (cushing's disease) would have low cortisol and high ACTH. Could you please clarify which is correct?

[@NehaShaikh21]

Thank you so much Really couldn't get it until now

[@drosmanzahmil1130]

Best explanation 😍keep it up

[@kyizinthant6097]

Thank u. You make it easier to understand. ❤️

[@ZeroToFinals]

Thanks, I'm glad to have helped

[@felipevergara4894]

Thanks you very much, very clear your video, it help to understand very good diferents tests, cheers from Arngentina.

[@hayleyellenwatson7166]

Hi, I’ve had two non suppressed and 3 suppressed tests - is that likely to be cyclical cushings?

[@aayaam3010]

tysm for this amazing clear explanation !!

[@reznof2011]

What a lovely explanation

[@ZeroToFinals]

thanks johnny!

[@KrissAstronomist]

A great explanation, thank you!

[@lausanchezaguirre12]

please would someone tell me what did he said at 4:05 minute when he says "even though.....". because thath my doubt abuout this specific topic, I dont understand why a neoplasm that produce ACTH would stop the production for a feedback, when a neopllasm produce ACTH without any kind of signal, so, why it would be stop for an exogenous high cortisol

[@rawannkaa7821]

it will stop the production only for pitutary adenoma as it still the same cells responsible for the acth production , bur not for the ectopic (produced from the lung cancer as they're totaly differnet type of cells and they do not recgonize this feedback)

[@inaduttagupta5747]

Made me understand so well ❤

[@reemsulaiman6796]

this video saved my life. thank you so much

[@trafficjon400]

Steroid Dexamethisone put many in a dark place of sevier Depression. a very nice Girl on You tube is still suffering from this 4 years and suicidal. Cushings and all the symtems these horible steroids can cause.

[@robinhall3426]

Excellent video and explanation!

[@LetmeTellyou11]

Actually, in pan-neoplastic syndrome the SC lung cancer will produce ACTH and cortisol on its own. So if the question is asking what happens in High dose dexamethasone the answer is NO CHANGE. The lab values on the other hand is Increase in both ACTH and Cortisol ( same as baseline lab values)

[@darkmoon3646]

Thankyou man, may god bless u!

[@kmysl2219]

Perfect explanation. Thank you!

[@marcotayala]

Nice vídeo, very interesting and educational. Now I understand better this system.

[@AhmedHassan7807]

Thank u so much. Finally, I understood it.❤❤

[@Hichamnostik_YT]

Love your explanation thank you ❤️

[@ZeroToFinals]

Thanks! I'm glad it helped

[@AjayChoudhary10M]

Wow nice sir u r exploring the costecosteroid Thnks sir

[@abdullahishosmanomar7758]

Wonderful illustration Thanks Now i can say "i know"

[@muhammadwali203]

Awesome explanation!

[@biiiaNcaXD]

Thanks for this! Great video!

[@lukwagonicholas1305]

Thank you Dr. Tom.

[@muntadhralsuwela7514]

i thought pituitary adenoma with high does of DST 8 mg it should increase ACTH and decrease cortisol

[@ZeroToFinals]

Hi Muntadhr, thanks for your comment. Giving dexamethasone will suppress ACTH in a pituitary adenoma. You are correct that with a pituitary adenoma the ACTH level will be high, however with a high dose of dexamethasone there is still enough response from the pituitary to see some suppression. Giving dexamethasone will never increase ACTH.

[@naihouyly2683]

Thanks for your good explanation

[@ZeroToFinals]

Glad it was helpful!

[@ikhlas9569]

Thank you sooooo much!!!! very well explained!!

[@mycah1993]

Thank you! You're the best!

[@moeyousef9006]

thanks for the video it was really helpful

[@TahmidRahman]

Really good explanation !

[@jaredwainwright4621]

what a wonderful video. this med student thanks you

[@Bambii348]

Thank you, made it so easy to understand!

[@natarajumididoddi5985]

Lot clearer.big thanks

[@annmareepearce6568]

What if you have a reversed durinal rhythm? When should you take the hydrocortisone?

[@winnie6504]

I don't see the need of dexamethasine suppression test to diagnose Adrenal cushing, because acth is always lower than 5 pg/ml

[@halimasaleh6870]

thank you may god bless y'all

[@wobbyyy]

Thank you for this video!

[@Arpit4063]

Very comprehensive video. 👍

[@rachaelk196]

Thanks for this upload. Very helpful

[@ZeroToFinals]

Glad to help

[@ak3143]

great explanation, thank you!!

[@almostawhisper1990h]

Very helpful! Thank you so much ❤

[@adissabooz7131]

Muchas gracias, súper práctico y explícito!!! I like it

[@gummy4650]

Good explanation ❤

[@blastoff2moon429]

Really helpful thank you so much 🙏

[@michaelgilman4068]

Tom, thank you. I so appreciate your instruction. Will you please explain how a high dose of Dexamethasone affects an a pituitary tumor? Why would the tumor "care"? Is it that the suppression of CRH from hypothalamus and ACTH from normal pituitary gland cells result in a net reduction.of ACTH and there a reduction in cortisol? And when you say cortisol is "reduced" does this mean less than it's initial high level but perhaps still > normal, does it mean a < normal level? Thanks again. Michael Gilman PA-C, Cape Cod. Massachusetts

[@mta5277]

Best one

[@SydnieBrianne]

It cleared my acne in one overnight test I never got my results back... it makes me feel something is up.

[@wafawiwi460]

this was very helpful thank you

[@chogabykyu]

Thank you so much for this.

[@luzjurado4575]

Low dosage test- If the cortisol level is 0.9 ug/dL (L) and the Dexamethasone plasma the 400.2ng/dl what does that means?

[@yasminyassir7633]

But if the negative feedback is still functional & is able to reduce the exogenous dexamethasone, then why not suppress the cortisol ??? (In pituitary adenoma)

[@despinavr]

I CANT THANK YOU ENOUGH

[@ZeroToFinals]

glad to help!

[@saadmalik9073]

Who’s here after it show signs of becoming a treatment for the coronavirus

[@afriherpphoto7924]

Yeah, watch this videos views sky rocket in the next mont

[@YasmineAsaadd]

Nope just here for my 5th year exam lmao

[@YasmineAsaadd]

@Conor Chrisso dude what? I'm studying for my endocrinology exam (I'm a med school sudent) and I just didn't understand the test so I youtubed it

[@YasmineAsaadd]

@Conor Chrisso oh I just came because of dexamethasone suppression test didnt watch the video

[@TheTovin]

@Conor Chrisso You don't know what you are talking about.

[@tracykusterbeck8784]

What level (number) of cortisol is considered high or low after the low supression test.

[@kristinesliter5386]

What causes a false positive result of a lower than normal level of dexamethasone? Does the 24 hour urine test give a more conclusive result? What would be the next diagnostic test?

[@sashwattarenia258]

excellent explanation

[@hanhane0]

thank you so much for this! really helpful

[@ZeroToFinals]

Glad to help

[@Mohammadi2200]

thank you. loved it!

[@dewisartika9990]

thank you so much, so helpful!!

[@genevievebrunte2996]

Can someone explain why petrosal sinus sampling would be necessary to differentiate between pituitary adenoma and ectopic when you can just use the ACTH and cortisol results from this suppression test to differentiate???