Elevated ACTH levels indicate a pituitary or ectopic source of ACTH secretion. A high-dose (8 mg/day) dexamethasone suppression test (2 mg every 6 hr) can differentiate between a pituitary adenoma and an ectopic source. Serum cortisol that is not suppressed by more than 50% with high-dose dexamethasone indicates that the source of ACTH hypersecretion is ectopic (eg, small cell lung cancer, carcinoid tumor in the lung).
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