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Selective venous sampling in diagnosing ACTH-dependent hypercortisolism
Valentina Martines1, Giancarlo Mansueto, Flavia Tosi
1Istituto di Radiologia, Policlinico G. B. Rossi, Università degli Studi di Verona, Verona, Italy.
La Radiologia Medica
|July 2, 2003
Summary
Selective inferior petrosal sinus sampling is a highly sensitive method for diagnosing ACTH-dependent hypercortisolism when pituitary imaging is inconclusive. This procedure accurately identifies the source of excess adrenocorticotropic hormone (ACTH) without complications.
Area of Science:
- Endocrinology
- Diagnostic Imaging
- Interventional Radiology
Background:
- ACTH-dependent hypercortisolism presents diagnostic challenges, especially with non-diagnostic pituitary imaging.
- Accurate localization of the ACTH source is crucial for effective treatment of Cushing's disease.
Purpose of the Study:
- To assess the sensitivity of bilateral inferior petrosal sinus sampling (BIPSS) for diagnosing ACTH-dependent hypercortisolism.
- To differentiate pituitary ACTH sources from ectopic sources in patients with inconclusive imaging.
Main Methods:
- Seventeen patients with ACTH-dependent hypercortisolism and negative pituitary imaging underwent simultaneous bilateral inferior petrosal sinus sampling for ACTH.
- Sampling was performed at baseline and after corticotropin-releasing hormone (CRH) stimulation.
- Central-to-peripheral ACTH gradients were analyzed to determine the source of hypercortisolism.
Main Results:
- Twelve patients showed ACTH gradients indicative of pituitary origin, confirmed surgically in 10.
- One patient had an adrenal metastasis, and another had a hepatic CRHoma.
- Three cases remained indeterminate regarding the source of hypercortisolism.
Conclusions:
- Bilateral simultaneous selective inferior petrosal sinus sampling is a highly sensitive and safe diagnostic tool.
- This method is effective in the differential diagnosis of ACTH-dependent hypercortisolism, particularly when pituitary imaging is non-diagnostic.