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Summary Purpose In order to differentiate between Cushing's syndrome (CS) and Pseudo-Cushing's syndrome, it is customary to use a test that is conducted by cortisol suppression with low-dose dexamethasone, followed by the administration of corticotropin releasing hormone (Dex-CRH test). In children with severe obesity, Dex-CRH test has shown a specificity of 55%. The aim of current study was to evaluate the specificity of Dex-CRH test in morbid obese adults. Methods The study included a total of 19 subjects with a body mass index (BMI) equal or higher than 40kg/m 2 . In all subjects Dex-CRH test was performed, and 24h urinary free cortisol was collected prior the test and during the second day of dexamethasone administration (2nd-day-UFC). Results BMI was 45.1±4.6kg/m 2 and 45.7±3.3kg/m 2 in women and men, respectively. 14 subjects underwent bariatric surgery. No subject had surgical or perioperative complications and surgically treated subjects had mean body weight loss of 46.5±16.6kg. All except for 2 subjects had normal Dex-CRH test, as 15-min cortisol falling below 1.4μg/dl. During follow-up, no subject gained additional weight, neither developed signs of CS. 15-min-cortisol concentration of 1.4μg/dl revealed a specificity of 89% and 2nd-day-UFC of 16μg/24h showed a specificity of 100%. Conclusions Morbid obesity in adults seems not to comprise a significant confounder in Dex-CRH test, and 15-min-cortisol concentration of 1.4μg/dl had a higher specificity than previously reported in obese children.

Blunt abdominal injury to the pancreas is infrequent and associated with high mortality and morbidity. Treatment of this condition depends on whether the main pancreatic duct has been injured. There is, however, no consensus on the best way of treating pancreatic transection. We present a case of a child with pancreatic disruption and a large pseudocyst treated by double channel papillotomy and endoscopic cyst-gastrostomy.