Selective Venous Sampling for ACTH in Cushing’s Syndrome: Differentiation Between Cushing’s Disease and the Ectopic ACTH Syndrome

Combined Reserpine and Pituitary Irradiation Therapy for Cushing's Disease Patients Following Unsuccessful Transsphenoidal Microsurgery.

“…This time, although the basal urinary 17-OHCS level was still above normal and 2mg of DEX did not result in sufficient suppression (3.5 to 2.7mg/day/10kg), 8 mg of DEX reduced it to 1.4mg/day/10kg (60%). The ACTH level in plasma from the pertosal sinus after the second TPM was definitely high compared to that from the peripheral veins (376 v. s. 9.8pg/ml), indicating that a residual adenoma was present (Findling et al, 1981;Oldfield et al, 1985). Therefore, low dose pituitary irradiation (Linac x-ray, 2 Gy/day, 20 Gy altogether) was performed according to Ahmed et al (1984) and the patient began receiving reserpine (1.0-2.0 mg per day) orally.…”

“…They were diagnosed as Cushing's syndrome by the following criteria: urinary excretion of 17-OHCS above 1.1mg/day/ 10kg, increased level and absence of diurnal rhythm of plasma ACTH and serum cortisol (serum F), and diminished suppressibility of urinary 17-OHCS in response to 2mg of dexamethasone (DEX). The diagnosis of Cushing's disease was confirmed by a suppression test with a higher dose of oral or intravenous DEX, metyrapone test , measuring plasma ACTH from peripheral vein and petrosal vein (Findling et al, 1981 Based on these results, TPM was carried out in all cases (Case 1, May 8, 1979;Cass 2, November 6, 1984 andMay 7, 1985;and Case 3, October 30, 1984). Histological examination revealed a chromophobe adenoma in cases 1 and 3, and an eosinophilic adenoma in case 2.…”

The role of bilateral inferior petrosal sinus sampling in the diagnostic evaluation of cushing’s disease

“…A case report in 1977 was the first to describe catheterization of and sampling of ACTH from the IPS to diagnose Cushing syndrome in a patient with perplexing clinical and laboratory features (35). This was followed by a case series in 1981 demonstrating the safety and efficacy of BIPSS in distinguishing Cushing syndrome from ectopic ACTH production, highlighting the importance of selecting the IPS, because measurements from the jugular veins were nondiagnostic (36).…”

Das okkulte ektope Cushing-Syndrom

“…Die einzige Möglichkeit, ein zentrales Cushing-Syndrom sicher zu diagnostizieren oder auszuschließen, besteht in der simultanen bilateralen Sinus-petrosus-inferior-Katheterisierung (10,32). Hierbei wird beiderseits im Abfluß-gebiet der Hypophyse die Plasma-ACTH-Konzentration bestimmt und mit simultan gemessenen peripheren Plasma-ACTH-Werten verglichen.…”