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Number One Do not Touch Your Spots, Pimples or Red areas

For the former, we propose an overnight dexamethasone suppression test with/without 24 hour urinary cortisol as screening tests. This has a relatively high false positive rate but very low false negative. The localisation of the source of ACTH is extremely difficult and it is probably appropriate to refer patients to an endocrinologist when non suppressible cortisol has been demonstrated; and for this reason we have not included a protocol for the low dose dexamethasone suppression test.

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