The practical application of the overnight dexamethasone suppression test for preliminary screening for Cushing's syndrome can be extended by the utilization of a steroid-creatinine ratio calculated from urine collected in a five-hour period, ie, 7:00 AM to 12:00 noon. The use of the urine ratio obviates the necessity of a quantitatively accurate urine collection, and hence makes it a more feasible outpatient screening procedure. A ratio of less than 4 makes the diagnosis of Cushing's syndrome highly unlikely, whereas a ratio greater than 4 requires that further studies be performed to establish a definitive diagnosis of Cushing's syndrome.
Tucci JR, Jagger PI, Lauler DP, Thorn GW. Rapid Dexamethasone Suppression Test for Cushing's Syndrome. JAMA. 1967;199(6):379–382. doi:10.1001/jama.1967.03120060077012
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