Petrosal Sinus Sampling with and without Corticotropin-Releasing Hormone for the Differential Diagnosis of Cushing's Syndrome

Eh, Oldfield; Jl, Doppman; Lk, Nieman; Gp, Chrousos; Dl, Miller; Katz, David A.; Gb, Cutler; Dl, Loriaux

doi:10.1056/nejm199109263251301

Cited by 777 publications

(502 citation statements)

References 45 publications

Supporting

Mentioning

449

Contrasting

Unclassified

Order By: Relevance

“…stimulation with 100 μ g human CRH, which confirmed the pituitary origin of hypercortisolism in all eight patients. 32 To document the persistence of hypercortisolism after TS or relapse of hypercortisolism in patients who were in remission for some time after TS, 24-h urinary free cortisol was measured, an overnight 1 mg dexamethasone suppression test was performed, and midnight plasma cortisol was assessed. A new MRI scan was performed before the second TS in all patients.…”

Section: Diagnostic Evaluation Before the First And Second Tsmentioning

confidence: 99%

Repeated transsphenoidal pituitary surgery (TS) via the endoscopic technique: a good therapeutic option for recurrent or persistent Cushing's disease (CD)

Wagenmakers¹,

Netea‐Maier²,

Lindert

et al. 2009

Clinical Endocrinology

View full text Add to dashboard Cite

SummaryBackground No data on results of repeated transsphenoidal surgery via the endoscopic technique for patients with persistent or recurrent Cushing's disease are available. Design and patients We retrospectively evaluated the remission rates and complications of repeated transsphenoidal surgery via the endoscopic technique in 14 patients with persistent ( N = 6) or recurrent ( N = 8) Cushing's disease treated in our centre between 1999 and 2007. Main outcomes Remission was defined as the disappearance of symptoms of hypercortisolism with basal plasma cortisol level ≤ 50 nmol/l 24-48 h after glucocorticoid withdrawal and/or suppression of plasma cortisol level ≤ 50 nmol/l after 1 mg dexamethasone overnight within the first 3 months after transsphenoidal surgery. Results With repeated endoscopic transsphenoidal surgery a remission rate of 10/14 (71%) was achieved. No patient had a relapse during a median follow-up of 24 months. Cerebrospinal fluid leakage was the most frequent complication (6 patients) and 11 patients required hormonal substitution after surgery. The success of repeated transsphenoidal surgery could not be predicted by visualization of an adenoma on MRI before first or second surgery, histopathological confirmation of an ACTH secreting adenoma after first or second surgery, treatment with cortisol lowering agents before first or second surgery, the operation technique used during the first surgery, persistent vs. recurrent disease after the first surgery, age, gender and interval between the two surgeries. Conclusion Repeated transsphenoidal surgery via the endoscopic technique is a good treatment option for selected patients with recurrent or persistent Cushing's disease following primary pituitary surgery.

show abstract

Section: Diagnostic Evaluation Before the First And Second Tsmentioning

confidence: 99%

Repeated transsphenoidal pituitary surgery (TS) via the endoscopic technique: a good therapeutic option for recurrent or persistent Cushing's disease (CD)

Wagenmakers¹,

Netea‐Maier²,

Lindert

et al. 2009

Clinical Endocrinology

View full text Add to dashboard Cite

show abstract

“…Oldfield et al reported that a central-to-peripheral ACTH ratio of greater than 2.0 has a sensitivity of 95% and specificity of 100% and after CRH administration the ratio of greater than 3.0 has a sensitivity and a specificity of 100% in inferior petrosal sinus sampling (IPSS) [18]. However, additional experience has revealed some false-negative results.…”

Section: Discussionmentioning

confidence: 98%

“…As for lateralization of the tumor in the pituitary gland, Oldfield et al also reported that a greater than 1.4-fold difference in ACTH concentrations between the two inferior petrosal sinuses accurately localized the microadenoma in 68% of cases during basal sampling [18]. The accuracy of determining lateralization by means of bilateral inferior petrosal sinus sampling is reported to be approximately 75% [28], and that by means of bilateral CSS ranges widely from 40% to 94% [19,29,30].…”

Section: Discussionmentioning

confidence: 99%

“…A number of studies have evaluated the role of venous sampling by microcatheter in the diagnosis of ACTH-dependent Cushing's syndrome [18][19][20][21][22]. Oldfield et al reported that a central-to-peripheral ACTH ratio of greater than 2.0 has a sensitivity of 95% and specificity of 100% and after CRH administration the ratio of greater than 3.0 has a sensitivity and a specificity of 100% in inferior petrosal sinus sampling (IPSS) [18].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Reduction of a Pancreatic Tumor after Total Removal of an ACTH Secreting Pituitary Tumor: Differential Diagnosis of Cushing's Syndrome

et al. 2006

View full text Add to dashboard Cite

Abstract. Endocrinologic tests sometimes fail to distinguish adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma from ectopic ACTH-secreting tumor. The authors experienced a case of Cushing's disease associated with a pancreatic tumor. Venous sampling contributed to the final diagnosis of Cushing's disease in this complex case, while endocrinologic tests showed paradoxical results. A 54-year-old woman presented with Cushing's syndrome and pancreatic tumor. Magnetic resonance imaging (MRI) failed to reveal a pituitary tumor, but a gadolinium-enhanced tumor with cystic components was seen in the pancreatic tail. Results of conventional endocrinologic tests suggested ectopic ACTH syndrome, but venous sampling including cavernous sinus sampling indicated an ACTH-secreting pituitary adenoma. Transsphenoidal surgery revealed a pituitary microadenoma, and total removal of the tumor was achieved. Postoperative abdominal MRI revealed that the pancreatic tumor diminished gradually without treatment. Selective cavernous sinus sampling was useful for distinguishing ACTH-secreting pituitary adenoma from ectopic ACTH syndrome in this complex case. This was a rare case in which the pancreatic tumor diminished after total removal of the ACTHsecreting pituitary adenoma.

show abstract

“…The procedure is performed under stimulation of oCRH (145,152), hCRH or desmopressin (144,153,154) at the same doses as those used for dynamic secretion tests. Samples are taken at 0, 3, 5 and 10 minutes after the stimulus, and the peak is usually 3 to 5 min after stimulus.…”

Section: Bilateral and Simultaneous Inferior Petrosal Sinus Samplingmentioning

confidence: 99%

Recommendations of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism for the diagnosis of Cushing’s disease in Brazil

Machado

Fragoso

Moreira

et al. 2016

Arch. Endocrinol. Metab.

View full text Add to dashboard Cite

Although it is a rare condition, the accurate diagnosis and treatment of Cushing's disease is important due to its higher morbidity and mortality compared to the general population, which is attributed to cardiovascular diseases, diabetes mellitus and infections. Screening for hypercortisolism is recommended for patients who present multiple and progressive clinical signs and symptoms, especially those who are considered to be more specific to Cushing's syndrome, abnormal findings relative to age (e.g., spinal osteoporosis and high blood pressure in young patients), weight gain associated with reduced growth rate in the pediatric population and for those with adrenal incidentalomas. Routine screening is not recommended for other groups of patients, such as those with obesity or diabetes mellitus. Magnetic resonance imaging (MRI) of the pituitary, the corticotropin-releasing hormone (CRH) test and the high-dose dexamethasone suppression test are the main tests for the differential diagnosis of ACTH-dependent Cushing's syndrome. Bilateral and simultaneous petrosal sinus sampling is the gold standard method and is performed when the triad of initial tests is inconclusive, doubtful or conflicting. The aim of this article is to provide information on the early detection and establishment of a proper diagnosis of Cushing's disease, recommending follow-up of these patients at experienced referral centers. Arch Endocrinol Metab. 2016;60(3):267-86

show abstract

Petrosal Sinus Sampling with and without Corticotropin-Releasing Hormone for the Differential Diagnosis of Cushing's Syndrome

Abstract: Simultaneous bilateral sampling of plasma from the inferior petrosal sinuses, with the adjunctive use of CRH, distinguishes patients with Cushing's disease from those with ectopic adrenocorticotropin secretion with high diagnostic accuracy.

Cited by 777 publications

References 45 publications

Repeated transsphenoidal pituitary surgery (TS) via the endoscopic technique: a good therapeutic option for recurrent or persistent Cushing's disease (CD)

Repeated transsphenoidal pituitary surgery (TS) via the endoscopic technique: a good therapeutic option for recurrent or persistent Cushing's disease (CD)

Reduction of a Pancreatic Tumor after Total Removal of an ACTH Secreting Pituitary Tumor: Differential Diagnosis of Cushing's Syndrome

Recommendations of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism for the diagnosis of Cushing’s disease in Brazil

Contact Info

Product

Resources

About