Selective venous sampling for ACTH in Cushing's syndrome: differentiation between Cushing disease and the ectopic ACTH syndrome. Ann Intern Med 1981 May;94(5):647-52
Date
05/01/1981Pubmed ID
6263140DOI
10.7326/0003-4819-94-5-647Scopus ID
2-s2.0-0019460238 (requires institutional sign-in at Scopus site) 141 CitationsAbstract
We performed selective venous catheterization and sampling for ACTH in six patients with ACTH-secreting pituitary adenomas (Cushing's disease) and four patients with occult ectopic ACTH-secreting neoplasms. In five patients with Cushing's disease in whom the inferior petrosal sinus could be catheterized, ACTH levels were unequivocally higher than simultaneous peripheral values: The ratio was greater than 2.0, with a range of 2.2 to 16.7. In contrast, the inferior petrosal sinus-to-peripheral ACTH ratio in three patients with ectopic ACTH secretion was less than 1.5. In the fourth patient, an arteriovenous gradient of 6.8 was shown 2 years before a bronchial carcinoid tumor was clinically apparent. Central-to-peripheral ACTH ratios at the level of the jugular bulb and jugular vein were not diagnostic. We conclude that selective venous ACTH sampling from the inferior petrosal sinus is a reliable and useful aid in the differential diagnosis of Cushing's syndrome when standard clinical and biochemical studies are inconclusive.
Author List
Findling JW, Aron DC, Tyrrell JB, Shinsako JH, Fitzgerald PA, Norman D, Wilson CB, Forsham PHAuthor
James W. Findling MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
ACTH Syndrome, EctopicAdenoma
Adrenocorticotropic Hormone
Adult
Aged
Bronchial Neoplasms
Carcinoid Tumor
Catheterization
Cranial Sinuses
Cushing Syndrome
Diagnosis, Differential
Female
Humans
Male
Middle Aged
Paraneoplastic Endocrine Syndromes
Pituitary Neoplasms
