scholarly journals Selective blood sampling from the inferior petrosal sinuses for differential diagnostics of ACTH-dependent hypercortisolism (the original clinical experience)

2012 ◽  
Vol 58 (2) ◽  
pp. 29-33 ◽  
Author(s):  
A V Dreval' ◽  
I V Komerdus ◽  
A V Murzina ◽  
O A Nechaeva ◽  
I N Demidov ◽  
...  
Keyword(s):  
Clinical Experience ◽  
Primary Diagnosis ◽  
Dexamethasone Suppression Test ◽  
Blood Sampling ◽  
Immunohistochemical Method ◽  
Differential Diagnostics ◽  
High Dose ◽  
High Dose Dexamethasone ◽  
Suppression Test ◽  
Dexamethasone Suppression

This paper summarizes the original clinical experience of the authors concerning differential diagnostics of ACTH-dependent hypercortisolism. A total of 8 patients were available for the estimation of the potential of such diagnostics with the use of the high-dose dexamethasone suppression test, pituitary MRI, and selective blood sampling from the inferior petrosal sinuses for the determination of the ACTH concentration gradient between central and peripheral compartments. It turned out that neither the high-dose dexamethasone suppression test nor pituitary MRI provided unambiguous information about the source of ACTH hypersecretion whereas the use of selective blood sampling allowed to confirm the primary diagnosis of Cushing's disease in 4 patients and revise it in 2 others. In all the patients having the diagnosis established based on the results of selective blood sampling, it was confirmed after transsphenoidal adenomectomy. At the same time, the diagnosis of ACTH-ectopic syndrome was confirmed by an immunohistochemical method only in 1 of the 2 patients. Thus, the results of the present study indicate that selective blood sampling from the inferior petrosal sinuses is a valuable diagnostic tool which should be recommended for a wider application in endocrinological practice. However, this method failed to reveal lateralization of the tumours in all the examined patients.

scholarly journals The high-dose dexamethasone suppression test is inferior to pituitary dynamic enhanced MRI in the differential diagnosis of ACTH-dependent Cushing's syndrome

2021 ◽  
Author(s):  
Xiaoli Shi ◽  
Tingting Du ◽  
Dan Zhu ◽  
Delin Ma ◽  
Kun Dong ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Positive Predictive Value ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Dexamethasone Suppression Test ◽  
High Dose ◽  
Positive Finding ◽  
High Dose Dexamethasone ◽  
Suppression Test ◽  
Dexamethasone Suppression

Abstract Purpose The differential diagnosis of ACTH-dependent Cushing’s syndrome remains a challenge in clinical practice. The aim of the present study was to assess the diagnostic performance of pituitary dynamic enhanced MRI(dMRI), high-dose dexamethasone suppression test༈HDDST༉and combination of both tests in patients with ACTH-dependent Cushing’s syndrome. Methods 119 consecutive cases with surgery confirmed ACTH-dependent Cushing’s syndrome were enrolled: 101 patients with proven Cushing’s disease and 18 patients with proven ectopic ACTH syndrome. All patients underwent pituitary dMRI and HDDST. The sensitivity and the specificity of pituitary dMRI, HDDST, and combination of both tests were calculated. Results The sensitivity and specificity of the pituitary dMRI for the diagnosis of Cushing’s disease was 80.2% and 83.3% respectively, and the positive predictive value was 96.4%. The sensitivity and specificity of HDDST was 70.3% and 77.8%, and the positive predictive value was 94.7%. Regarding the combination of both tests, the combined criteria of a more than 50% suppression of serum cortisol in HDDST and a positive finding in pituitary dMRI had given a high specificity of 94.4% and a sensitivity of 59.4%. The combined criteria of a greater than 68% suppression in HDDST and/or a positive finding in pituitary dMRI, provide a sensitivity of 86.1% and a specificity of 83.3%. Conclusions Pituitary dMRI was superior to HDDST in the differential diagnosis of ACTH-dependent Cushing’s syndrome. HDDST was recommended to combined with pituitary dMRI in the diagnosis process because of the significantly increased specificity of the combination.

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