Do you recommend completing a 1 mg dexamethasone suppression test for an asymptomatic incidental pituitary microadenoma?

Yes, if the patient has any feature of hypercortisolism, such as DM, HTN, osteoporosis, etc.

See: Fleseriu et al., PMID 40555795

"Screening should be performed for clinical suspicion based on features and/or comorbidities suggestive of Cushing disease, even in the absence of classic hypercortisolism c...

In my experience, the yield of doing a 1-mg DST in an asymptomatic patient with a pituitary incidentaloma is very low. Accordingly, I only evaluate for Cushing syndrome in cases with some clinical evidence of underlying hypercortisolism. In contrast, I obtain at least one set of labs for prolactin a...