[Simultaneous and bilateral catheterization of inferior petrosal sinuses in the diagnosis of Cushing's syndrome: basal multiple sampling and after ACTH-releasing hormone test].
In 22 patients with ACTH-dependent Cushing's syndrome we have performed multiple ACTH evaluations, baseline and after ACTH-releasing hormone (CRH), during simultaneous bilateral inferior petrosal sinus sampling. The basal inferior petrosal sinus/periphery ratio for ACTH was > 2 in 11/22 patients, CRH challenge caused the appearance of an inferior petrosal sinus/periphery ratio > 3 in 6 other patients. An ACTH-secreting adenoma was surgically proven in 17 patients with ACTH inferior petrosal sinus/periphery ratio > 2 basally or > 3 after CRH and in 1 patient with an inferior petrosal sinus/periphery ratio < 2 basally or 3 after CRH. In 4 patients the very high peripheral ACTH levels, the inferior petrosal sinus/periphery ratio and the lack of ACTH increase after CRH indicated the presence of an ectopic ACTH syndrome. An ACTH intersinus gradient > 1.4 was found in 11 patients. Among these patients the adenoma was correctly localised in 6 and wrongly in 5 patients. In conclusion, the diagnostic accuracy of the inferior petrosal sinus sampling was of 95.4% (21/22 cases) considering basal and CRH-stimulated ACTH levels. The multiple basal ACTH evaluation does not seem to be necessary associated with CRH-test, but may be helpful in some cases.
Zarrilli
S
S
Dipartimento di Endocrinologia ed Oncologia Molecolare e Clinica Università degli Studi di Napoli Federico II.
Filippella
M
M
Lucci
R
R
Esposito
P
P
Paesano
L
L
De Rosa
M
M
Colao
A
A
D000236:Adenoma / Q000175:diagnosis* / Q000601:surgery; D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000097:blood* / Q000378:metabolism*; D000328:Adult; D002276:Carcinoid Tumor / Q000175:diagnosis / Q000378:metabolism*; D003346:Corticotropin-Releasing Hormone; D003480:Cushing Syndrome / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006729:Hormones, Ectopic / Q000378:metabolism*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000378:metabolism*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017591:Petrosal Sinus Sampling; D010911:Pituitary Neoplasms / Q000175:diagnosis* / Q000601:surgery; D011863:Radioimmunoassay
D006729:Hormones, Ectopic; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone
Cateterismo simultaneo e bilaterale dei seni petrosi inferiori per la diagnosi della Sindrome di Cushing: prelievo multiplo basale e dopo test all'ACTH-releasing hormone.