title: Internal jugular vein: Peripheral vein adrenocorticotropic hormone ratio in patients with adrenocorticotropic hormone-dependent Cushing's syndrome: Ratio calculated from one adrenocorticotropic hormone sample each from right and left internal jugular vein during corticotrophin releasing hormone stimulation test.
abstract: BACKGROUND
  DEMONSTRATION OF CENTRAL: Peripheral adrenocorticotropic hormone (ACTH) gradient is important for diagnosis of Cushing's disease.
  
  
  OBJECTIVE
  THE AIM WAS TO ASSESS THE UTILITY OF INTERNAL JUGULAR VEIN (IJV): Peripheral vein ACTH ratio for diagnosis of Cushing's disease.
  
  
  METHODS
  Patients with ACTH-dependent Cushing's syndrome (CS) patients were the subjects for this study. One blood sample each was collected from right and left IJV following intravenous hCRH at 3 and 5 min, respectively. A simultaneous peripheral vein sample was also collected with each IJV sample for calculation of IJV: Peripheral vein ACTH ratio. IJV sample collection was done under ultrasound guidance. ACTH was assayed using electrochemiluminescence immunoassay (ECLIA).
  
  
  RESULTS
  Thirty-two patients participated in this study. The IJV: Peripheral vein ACTH ratio ranged from 1.07 to 6.99 (n = 32). It was more than 1.6 in 23 patients. Cushing's disease could be confirmed in 20 of the 23 cases with IJV: Peripheral vein ratio more than 1.6. Four patients with Cushing's disease and 2 patients with ectopic ACTH syndrome had IJV: Peripheral vein ACTH ratio less than 1.6. Six cases with unknown ACTH source were excluded for calculation of sensitivity and specificity of the test.
  
  
  CONCLUSIONS
  IJV: Peripheral vein ACTH ratio calculated from a single sample from each IJV obtained after hCRH had 83% sensitivity and 100% specificity for diagnosis of CD.
authors.affiliation: Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sachin
authors.initials: S
authors.lastname: Chittawar
authors.forename: Saptarshi
authors.initials: S
authors.lastname: Bhattacharya
authors.forename: Jai Prakash
authors.initials: JP
authors.lastname: Sahoo
authors.forename: Siva
authors.initials: S
authors.lastname: Prakash
authors.forename: Ashu Seith
authors.initials: AS
authors.lastname: Bhalla
authors.forename: Devasenathipathy
authors.initials: D
authors.lastname: Kandasamy
authors.forename: Arundeep
authors.initials: A
authors.lastname: Arora
authors.forename: Nandita
authors.initials: N
authors.lastname: Gupta
authors.forename: Nikhil
authors.initials: N
authors.lastname: Tandon
authors.forename: Ravinder
authors.initials: R
authors.lastname: Goswami
authors.forename: Rajesh
authors.initials: R
authors.lastname: Khadgawat
authors.forename: Viveka P
authors.initials: VP
authors.lastname: Jyotsna
authors.forename: Ashish Kumar
authors.initials: AK
authors.lastname: Karak
authors.forename: Chandra Sekhar
authors.initials: CS
authors.lastname: Bal
authors.forename: Ravindra Mohan
authors.initials: RM
authors.lastname: Pandey
authors.forename: Guresh
authors.initials: G
authors.lastname: Kumar
authors.forename: Ariachery C
authors.initials: AC
authors.lastname: Ammini
keywords: Cushing's disease; cushing's syndrome; internal jugular vein sampling