Bilateral Inferior Petrosal Sinuses Sampling in the Routine Investigation of Cushing's Syndrome: A Comparison with MRI

Kaskarelis, Ioannis; Tsatalou, Emmanouela; Benakis, Stylianos; Malagari, Katerina; Komninos, Ioannis; Vassiliadi, Dimitra Argyro; Tsagarakis, Stylianos; Thalassinos, Nikolaos

doi:10.2214/ajr.05.0557

Cited by 64 publications

(56 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In fact, MRI shows a high specificity to diagnose Cushing's disease [17]. The ability of MRI to detect pituitary ACTH-secreting adenomas in patients with Cushing's disease is, however, limited, because the calculated accuracy for detecting a pituitary source of ACTH is reported to be almost 60% for MRI [18]. In some cases of EAS, (18) F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) would be helpful to detect the localization [19].…”

Section: Bmentioning

confidence: 99%

Evaluation of Diagnostic Tests for ACTH-Dependent Cushing’s Syndrome

et al. 2009

View full text Add to dashboard Cite

because of the Cushingoid appearance, with the characteristic features of central obesity, moon face, skin atrophy, purple striae and buffalo hump, and the clinical criteria are clear, a debate exists in the literature over the biochemical diagnosis of this disease [3]. Recently, the diagnostic criteria for Cushing's disease have been reported by the Ministry of Health, Labour, and Welfare of Japan [4]. In the guideline, the following endocrinological findings were considered as diagnostic criteria: 1) The presence of a Cushingoid appearance; 2) Evidence of autonomic or abnormal secretion of ACTH, such as (a) normal-high ACTH and cortisol levels, and (b) high levels of urinary excretion of free cortisol; 3) Screening tests show (a) incomplete suppression of cortisol (> 5 µg/dl) by a lowdose (0.5 mg) overnight dexamethasone suppression test (DST), (b) high cortisol levels (> 5 µg/dl) during night time sleeping, and (c) response of plasma ACTH levels to the desmopressin (DDAVP) test; 4) The dif- Abstract. We evaluated the usefulness and accuracy of diagnostic tests for adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome, based on our experience of 88 cases, including 73 cases with Cushing's disease, and 15 cases with ectopic ACTH syndrome (EAS). In our study, 0.5 mg of dexamethasone failed to suppress the morning cortisol secretion in 100% of cases with Cushing's disease and EAS. Plasma ACTH levels were significantly increased by desmopressin (DDAVP) in 86% of cases with Cushing's disease, especially in microadenomas (90%), while these levels were not affected in normal subjects. In EAS, 44% responded to DDAVP. Plasma ACTH levels were increased in response to the human corticotropin-releasing hormone (CRH) test in 100% of microadenomas and 73% of macroadenomas with Cushing's disease, but only in 27% of cases with EAS. A high dose (8 mg) of dexamethasone suppressed the morning cortisol secretion in 89% of microadenomas with Cushing's disease, and in 82% of all cases with Cushing's disease, while it did in only 20% of cases with EAS. Taken together, the 0.5 mg dexamethasone suppression test (DST) and DDAVP test are considerably useful for the screening of ACTH-dependent Cushing's syndrome. The CRH test and 8 mg DST would be effective for the diagnosis of Cushing's diseases, because our study shows a sensitivity of 81% in cases with Cushing's disease when these tests are considered together. These data were submitted to prepare the diagnostic criteria for Cushing's disease, suggested by the working group of the Ministry of Health, Labour, and Welfare of Japan.

show abstract

Section: Bmentioning

confidence: 99%

Evaluation of Diagnostic Tests for ACTH-Dependent Cushing’s Syndrome

et al. 2009

View full text Add to dashboard Cite

show abstract

“…7 However, dynamic studies have improved sensitivity but, still in many cases MRI fail to localize the adenoma as happened in our case. 8 About 10% of general population may be harboring incidentaloma in pituitary, which may result in false positivity and failed surgery. 9 Here is the role of BIPSS, which depicts central to peripheral gradient of ACTH in basal conditions and which becomes even more pronounced after corticotrophs are stimulated for production of ACTH by exogenous agent.…”

Section: Discussionmentioning

confidence: 99%

Inferior petrosal sinus sampling: Final solution to a riddle called “Cushing's syndrome”

Kharb

Gundgurthi

Pandit

et al. 2013

Medical Journal Armed Forces India

View full text Add to dashboard Cite

“…Actually CgA is a neuroendocrine marker that may reflect the tumour size, activity and malignancy [1,15] and that may be 1,000 times higher than the normal reference range in NETs [15]. IPSS, with a sensitivity of more than 95% and very rare false-positive results [4], has proved to be a highly sensitive test regarding the distinction between pituitary and non-pituitary sources of ACTH excess [1,4,7,16], as opposed to pituitary MRI in which false negatives due to Cushing's disease (CD) microadenomas are common [16,17].…”

Section: Discussionmentioning

confidence: 99%

Pitfalls in the Diagnosis of Ectopic Adrenocorticotropic Hormone Syndrome: A Case Report

Gomes¹

2013

J Endocrinol Metab

View full text Add to dashboard Cite

Ectopic production of adrenocorticotropic hormone by carcinoid tumours is uncommon and covert and occult presentations often hamper its diagnosis. A 27-year-old man was admitted with multiple vertebral bodies collapse related to osteoporosis along with other clinical features consistent with Cushing's syndrome. Both basal and dynamic laboratory evaluation suggested adrenocorticotropicdependent Cushing's syndrome diagnosis, specifically ectopic adrenocorticotropic syndrome. Laboratory testing also showed high serum levels of chromogranin A and urinary 5 hydroxyindoleacetic acid. Pituitary and thoracic-abdominal-pelvic imaging proved to be normal, including the octreoscan. To reduce cortisol levels, and before resorting to adrenalectomy, metyrapone was prescribed but eucortisolism was not achieved. Octreotide therapy reduced plasma adrenocorticotropic hormone and cortisoluria to half although the octreoscan had been negative. As no primitive tumour had been detected, the patient underwent bilateral adrenalectomy. Two years and a half after the diagnosis, an octreoscan detected a lung tumour, which was resected. Pathological analysis revealed an atypical carcinoid tumour and immunohistochemistry was positive for adrenocorticotropic hormone but negative for corticotropin-releasing hormone and chromogranin A. Clinical and biochemical resolution of Cushing' syndrome followed but chromogranin A levels remained above normal. This case highlights both that, although rare, an exuberant osteoporosis can be the initial presentation of ectopic adrenocorticotropic hormone syndrome and high chromogranin A levels may have other origin than direct tumour production. It also raises the question of prescribing somatostatin agonists in patients whose octreoscan is negative as small tumours may produce false negative results. Moreover, the reduction of hypercortisolism before surgery may improve the surgical outcome and with bilateral adrenalectomy may contribute to the primary tumour growth and detection.

show abstract

Bilateral Inferior Petrosal Sinuses Sampling in the Routine Investigation of Cushing's Syndrome: A Comparison with MRI

Abstract: MRI is of only limited diagnostic performance, while BIPSS is the most accurate way to establish the diagnosis of CD. The routine use of a multimodality diagnostic approach including BIPSS, MRI, and biochemical tests is suggested to avoid the risk of mismanagement for patients with CS.

Cited by 64 publications

References 28 publications

Evaluation of Diagnostic Tests for ACTH-Dependent Cushing’s Syndrome

Evaluation of Diagnostic Tests for ACTH-Dependent Cushing’s Syndrome

Inferior petrosal sinus sampling: Final solution to a riddle called “Cushing's syndrome”

Pitfalls in the Diagnosis of Ectopic Adrenocorticotropic Hormone Syndrome: A Case Report

Contact Info

Product

Resources

About

Bilateral Inferior Petrosal Sinuses Sampling in the Routine Investigation of Cushing's Syndrome: A Comparison with MRI

Abstract: MRI is of only limited diagnostic performance, while BIPSS is the most accurate way to establish the diagnosis of CD. The routine use of a multimodality diagnostic approach including BIPSS, MRI, and biochemical tests is suggested to avoid the risk of mismanagement for patients with CS.

Cited by 64 publications

References 28 publications

Evaluation of Diagnostic Tests for ACTH-Dependent Cushing&rsquo;s Syndrome

Evaluation of Diagnostic Tests for ACTH-Dependent Cushing&rsquo;s Syndrome

Inferior petrosal sinus sampling: Final solution to a riddle called “Cushing's syndrome”

Pitfalls in the Diagnosis of Ectopic Adrenocorticotropic Hormone Syndrome: A Case Report

Contact Info

Product

Resources

About

Evaluation of Diagnostic Tests for ACTH-Dependent Cushing’s Syndrome

Evaluation of Diagnostic Tests for ACTH-Dependent Cushing’s Syndrome