El cateterismo bilateral y simultáneo de los senos petrosos inferiores en el diagnóstico diferencial del síndrome de Cushing

Background: The features of pituitary ACTH-dependent Cushing syndrome are often indistinguishable from those of occult ectopic ACTH-dependent Cushing syndrome (CS). Aim: To assess the diagnostic accuracy of bilateral inferior petrosal sinus sampling (BIPSS) in the differential diagnosis of ACTH-depe...

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Autores principales:	Belli,Susana, Oneto,Adriana, Mendaro,Esteban
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 2007
Materias:	Adrenocorticotropic hormone Cushing syndrome Deamino arginine vasopressin (Desmopressin) Petrosal sinus sampling
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007000900001
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spelling	oai:scielo:S0034-988720070009000012008-05-30El cateterismo bilateral y simultáneo de los senos petrosos inferiores en el diagnóstico diferencial del síndrome de CushingBelli,SusanaOneto,AdrianaMendaro,Esteban Adrenocorticotropic hormone Cushing syndrome Deamino arginine vasopressin (Desmopressin) Petrosal sinus sampling Background: The features of pituitary ACTH-dependent Cushing syndrome are often indistinguishable from those of occult ectopic ACTH-dependent Cushing syndrome (CS). Aim: To assess the diagnostic accuracy of bilateral inferior petrosal sinus sampling (BIPSS) in the differential diagnosis of ACTH-dependent Cushing's syndrome as compared with ACTH levels and the overnight high dose dexamethasone suppression test (HDDST). Material and methods: Retrospective review of medical records of 23 patients (aged 19 to 63 years, 16 women) with surgically proven CS, 20 pituitarymicroadenomas (CD) and 3 with occult ectopic ACTH secretion (EAS). Results: No tumor was identifiable by imaging techniques. Mean plasma ACTH values were higher in patients with EAS than in CD (103± 110.2 and 73.1±41.98 pg/mL respectively, p=NS). Three patients with EAS and 3 patients with CD did not suppress cortisol with the HDDST. The sensitivity of the test was 86% and the specificity 100%. To improve the diagnostic outcome of BIPSS, an stimulation with Desmopressin (9 fig i.v) was performed in 9 patients. The threshold for a pituitary source, was defined as an inferior petrosal sinus to peripheral ACTH basal and post Desmopression ratio >2. BIPSS was successfully carried out in 22 patients and no complications occurred. In 6 patients BIPSS failed to meet the threshold criteria. In 3 patients, bronchial carcinoid tumors which proved to synthesize ACTH, were removed. The diagnostic sensitivity of BIPSS greatly improved from 86% to 100% after Desmopressin stimulation. BIPSS accurately predicted the ¡ateralization of the microadenoma in 8 of 12 patients (66%). Conclusions: The combination of Desmopressin stimulation with BIPSS was useful for the differential diagnosis of ACTH-dependent Cushing's Syndrome. However, the preoperative location of pituitary microadenomas was poorly predicted by BIPSSinfo:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.135 n.9 20072007-09-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007000900001es10.4067/S0034-98872007000900001
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
topic	Adrenocorticotropic hormone Cushing syndrome Deamino arginine vasopressin (Desmopressin) Petrosal sinus sampling
spellingShingle	Adrenocorticotropic hormone Cushing syndrome Deamino arginine vasopressin (Desmopressin) Petrosal sinus sampling Belli,Susana Oneto,Adriana Mendaro,Esteban El cateterismo bilateral y simultáneo de los senos petrosos inferiores en el diagnóstico diferencial del síndrome de Cushing
description	Background: The features of pituitary ACTH-dependent Cushing syndrome are often indistinguishable from those of occult ectopic ACTH-dependent Cushing syndrome (CS). Aim: To assess the diagnostic accuracy of bilateral inferior petrosal sinus sampling (BIPSS) in the differential diagnosis of ACTH-dependent Cushing's syndrome as compared with ACTH levels and the overnight high dose dexamethasone suppression test (HDDST). Material and methods: Retrospective review of medical records of 23 patients (aged 19 to 63 years, 16 women) with surgically proven CS, 20 pituitarymicroadenomas (CD) and 3 with occult ectopic ACTH secretion (EAS). Results: No tumor was identifiable by imaging techniques. Mean plasma ACTH values were higher in patients with EAS than in CD (103± 110.2 and 73.1±41.98 pg/mL respectively, p=NS). Three patients with EAS and 3 patients with CD did not suppress cortisol with the HDDST. The sensitivity of the test was 86% and the specificity 100%. To improve the diagnostic outcome of BIPSS, an stimulation with Desmopressin (9 fig i.v) was performed in 9 patients. The threshold for a pituitary source, was defined as an inferior petrosal sinus to peripheral ACTH basal and post Desmopression ratio >2. BIPSS was successfully carried out in 22 patients and no complications occurred. In 6 patients BIPSS failed to meet the threshold criteria. In 3 patients, bronchial carcinoid tumors which proved to synthesize ACTH, were removed. The diagnostic sensitivity of BIPSS greatly improved from 86% to 100% after Desmopressin stimulation. BIPSS accurately predicted the ¡ateralization of the microadenoma in 8 of 12 patients (66%). Conclusions: The combination of Desmopressin stimulation with BIPSS was useful for the differential diagnosis of ACTH-dependent Cushing's Syndrome. However, the preoperative location of pituitary microadenomas was poorly predicted by BIPSS
author	Belli,Susana Oneto,Adriana Mendaro,Esteban
author_facet	Belli,Susana Oneto,Adriana Mendaro,Esteban
author_sort	Belli,Susana
title	El cateterismo bilateral y simultáneo de los senos petrosos inferiores en el diagnóstico diferencial del síndrome de Cushing
title_short	El cateterismo bilateral y simultáneo de los senos petrosos inferiores en el diagnóstico diferencial del síndrome de Cushing
title_full	El cateterismo bilateral y simultáneo de los senos petrosos inferiores en el diagnóstico diferencial del síndrome de Cushing
title_fullStr	El cateterismo bilateral y simultáneo de los senos petrosos inferiores en el diagnóstico diferencial del síndrome de Cushing
title_full_unstemmed	El cateterismo bilateral y simultáneo de los senos petrosos inferiores en el diagnóstico diferencial del síndrome de Cushing
title_sort	el cateterismo bilateral y simultáneo de los senos petrosos inferiores en el diagnóstico diferencial del síndrome de cushing
publisher	Sociedad Médica de Santiago
publishDate	2007
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007000900001
work_keys_str_mv	AT bellisusana elcateterismobilateralysimultaneodelossenospetrososinferioreseneldiagnosticodiferencialdelsindromedecushing AT onetoadriana elcateterismobilateralysimultaneodelossenospetrososinferioreseneldiagnosticodiferencialdelsindromedecushing AT mendaroesteban elcateterismobilateralysimultaneodelossenospetrososinferioreseneldiagnosticodiferencialdelsindromedecushing
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El cateterismo bilateral y simultáneo de los senos petrosos inferiores en el diagnóstico diferencial del síndrome de Cushing

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