Bilateral inferior petrosal sinus sampling in the diagnosis of Cushing disease

Resumen Objetivos El diagnóstico del síndrome de Cushing (SC) sigue siendo un reto ya que sus síntomas y signos clínicos se superponen a los de otras enfermedades. Caso clínico Varón remitido a Endocrinología por sospecha de SC. Para el estudio del SC se realizaron pruebas de cribado que confirman el hipercortisolimo y pruebas de diagnóstico que confirman un SC-adrenocorticotropina (ACTH) dependiente. Para discriminar entre origen hipofisario y ectópico se realizó el test de estimulación con corticoliberina (CRH). Ante la falta de respuesta en este test y la resonancia magnética nuclear (RMN) negativa se realizó el CSPI que sugería origen hipofisario por lo que se realizó cirugía transesfenoidal. El resultado anatomopatológico confirmó el origen corticotropo del tumor. Conclusiones La investigación etiológica del SC y su diagnóstico diferencial constituye un proceso complejo utilizando diversas pruebas bioquímicas y de imagen. Es importante establecer la secuencia del estudio bioquímico realizando pruebas de cribado, confirmación y localización para establecer origen adrenal, hipofisario o ectópico. A pesar del buen rendimiento diagnóstico, este no es definitivo, especialmente en los casos ACTH dependiente. En nuestro caso, el resultado no concluyente en el test de CRH, requirió un procedimiento invasivo (CSPI) que resultó eficiente en el diagnóstico.

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Importancia del cateterismo de senos petrosos inferiores en el diagnóstico de síndrome de Cushing, a propósito de un caso

García

Sirera

Quesada

et al. 2022

Advances in Laboratory Medicine / Avances en Medicina De Laboratorio

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Relevance of inferior petrosal sinus sampling in the diagnosis of Cushing’s syndrome: a case report

García

Sirera

Quesada

et al. 2022

Advances in Laboratory Medicine / Avances en Medicina De Laboratorio

View full text Add to dashboard Cite

Objectives Non-specific signs and symptoms of Cushing’s syndrome (CS) can pose a diagnostic challenge. Case presentation We report the case of a man referred to the service of endocrinology for suspected CS. Hypercortisolism was confirmed on CS screening tests, whereas diagnostic tests confirmed the presence of adrenocorticotropin (ACTH) -dependent CS. The corticotropin-releasing hormone stimulation (CRH) test was performed to determine whether CS had an endogenous or ectopic origin. Since the CRH and the magnetic resonance imaging (MRI) test were negative, IPSS was performed and suggested that CS was originated in the pituitary glands. Transsphenoidal pituitary resection was carried out. Histopathological analysis confirmed the cortitotrope origin of the tumor. Conclusions The etiological study and differential diagnosis of CS are complex processes that involve a variety of biochemical and imaging tests. It is important that a sequence of biochemical screening and diagnostic tests is performed, along with studies for establishing the location of the lesion, to determine whether CS has an adrenal, pituitary or ectopic origin. Despite its good diagnostic performance, the results of biochemical tests may not be conclusive, especially in ACTH-dependent CS. In the case reported, the inconclusive results obtained in the CRH test rendered an invasive procedure (IPSS) necessary, which ultimately confirmed diagnosis.

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Bilateral inferior petrosal sinus sampling in the diagnosis of Cushing disease

Cited by 2 publications

References 41 publications

Importancia del cateterismo de senos petrosos inferiores en el diagnóstico de síndrome de Cushing, a propósito de un caso

Importancia del cateterismo de senos petrosos inferiores en el diagnóstico de síndrome de Cushing, a propósito de un caso

Relevance of inferior petrosal sinus sampling in the diagnosis of Cushing’s syndrome: a case report

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