The influence of oral contraceptives on overnight 1 mg dexamethasone suppression test

BACKGROUND: In suspected hypercortisolism the 1 mg dexamethasone suppression test is the usual initial test. In fertile women false-positive test results are often due to the use of oral contraceptives. By elevating cortisol-binding globulin these contraceptives increase the total serum cortisol concentration. The aim of this study was to assess the duration and degree of influence of oral contraceptives on the low-dose dexamethasone suppression test. METHODS: Thirteen healthy female volunteers without symptoms or signs of overt hypercortisolism aged 18-55 years who were using oral contraceptives underwent a 1 mg dexamethasone suppression test. Tests were repeated one and six weeks after withdrawal of the contraceptive. In addition 24-hour urinary cortisol excretion and late-night salivary cortisol were measured. RESULTS: Of the 13 volunteers (62%) eight had inadequate suppression of cortisol by 1 mg dexamethasone while using oral contraceptives. One week after the contraceptive was withdrawn the number of false-positive results significantly decreased to 1 (8% p < 0.02). Six weeks after discontinuation all tests were normal. None of the 24-hour urinary cortisol samples and just one late-night salivary cortisol level was elevated. CONCLUSION: The results of the 1 mg dexamethasone suppression test performed one week after cessation of oral contraceptives are accurate in almost all subjects. In case of inadequate suppression a second test may be performed after six weeks. In this manner the 1 mg dexamethasone suppression test can reliably be done at the end of a seven-day break from contraceptive use in nearly all cases.