Sequential Testing: Precision Over Speed

Clinicians must adopt a methodical approach to testing, particularly in hypertensive patients. Initial baseline tests should be conducted separately from subsequent tests like overnight dexamethasone suppression. Baseline assessments typically include measuring ACTH, DHA sulfate, cortisol, plasma aldosterone, and renin. Following this, an overnight dex suppression test should be performed, with specific cortisol level thresholds established for normal suppression. A critical shortcut in evaluation is that if DHA sulfate exceeds 100 micrograms per dl, the patient is unlikely to have Cushing's syndrome, underscoring the importance of interpretative context in adrenal function assessment.