Cited by 110Pituitary Gland Disorders and TreatmentsAdrenal and Paraganglionic TumorsAdrenal Hormones and Disorders

Non-invasive Diagnostic Strategy in ACTH-dependent Cushing’s Syndrome

Open access
Frete, Caroline, Corcuff, Jean-Benoît, Kuhn, Emmanuelle, Salenave, Sylvie, Gaye, Delphine, Young, Jacques, Chanson, Philippe, Tabarin, Antoine·2020·The Journal of Clinical Endocrinology & Metabolism

Abstract

Context: Inferior petrosal sinus sampling (IPSS) is used to diagnose Cushing’s disease (CD) when dexamethasone-suppression and CRH tests, and pituitary magnetic resonance imaging (MRI), are negative or give discordant results. However, IPSS is an invasive procedure and its availability is limited. Objective: To test a noninvasive diagnostic strategy associated with 100% positive predictive value (PPV) for CD. Design: Retrospective study. Setting: Two university hospitals. Patients: A total of 167 patients with CD and 27 patients with ectopic ACTH-syndrome investigated between 2001 and 2016. Main Outcome Measure(s): Performance of a strategy involving the CRH and desmopressin tests with pituitary MRI followed by thin-slice whole-body computed tomography (CT) scan in patients with inconclusive results. Results: Using thresholds of a cortisol increase > 17% with an ACTH increase > 37% during the CRH test and a cortisol increase > 18% with an ACTH increase > 33% during the desmopressin test, the combination of both tests gave 73% sensitivity and 98% PPV of CD. The sensitivity and PPV for pituitary MRI were 71% and 99%, respectively. CT scan identified 67% EAS at presentation with no false-positives. The PPV for CD was 100% in patients with positive responses to both tests, with negative pituitary MRI and CT scan. The Negative Predictive Value was 100% in patients with negative responses to both tests, with negative pituitary MRI and positive CT scan. Using this strategy, IPPS could have been avoided in 47% of patients in whom it is currently recommended. Conclusions: In conjunction with expert radiologic interpretation, the non-invasive algorithm studied significantly reduces the need for IPSS in the investigation of ACTH-dependent Cushing’s syndrome.

Integrity signals

Registry

Crossref · 10.1210/clinem/dgaa409

Cites

45 of 45 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

We couldn’t retrieve this paper’s full text, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Using dynamic tests in combination with pituitary MRI can improve clinical accuracy, decreasing the need for BIPSS.

    “However, using these dynamic tests in combination with pituitary MRI can improve clinical accuracy, decreasing the need for BIPSS (9, 75).”

    From Approach to the Patient: Diagnosis of Cushing Syndrome (2022) · cites this paper as [75]

  • If a pituitary adenoma >6 mm is found on MRI, the need for further testing with BIPSS is not necessary.

    “If a pituitary adenoma > 6 mm is found on MRI, the need for further testing with bilateral inferior petrosal sinus sampling (BIPSS) is not necessary (1, 9, 74, 75).”

    From Approach to the Patient: Diagnosis of Cushing Syndrome (2022) · cites this paper as [75]

Cites

Flagged first, then by citations

2 of the 47 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Authors
Frete, C., Corcuff, J.-B., Kuhn, E., Salenave, S., Gaye, D., Young, J., Chanson, P., & Tabarin, A.
Affiliations
  • Department of Endocrinology, Diabetes and Nutrition, University Hospital of Bordeaux, Pessac, France
  • Université de Bordeaux (FR)
  • Assistance Publique – Hôpitaux de Paris (FR)
  • Centre Hospitalier Universitaire de Bordeaux (FR)
  • Université Paris-Sud (FR)
  • Inserm (FR)
Corresponding author
Tabarin, Antoine
Venue
The Journal of Clinical Endocrinology & Metabolism
Published
2020-06-27
Volume
105
Issue
10
Pages
3273-3284
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
OpenAlex
W3037218403
Cited by
110
References
47
Citations by year
2026: 12 · 2025: 12 · 2024: 19 · 2023: 27 · 2022: 21 · 2021: 17 · 2020: 2
FWCI
12.63
Type
journal article
Language
en
Open access
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
  • Oskar-Bordeaux (Universite de Bordeaux) (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords
Cushing's disease, ACTH-dependent Cushing's syndrome, ectopic ACTH syndrome, CRH stimulation test, desmopressin test, pituitary MRI, whole-body CT, inferior petrosal sinus sampling, positive predictive value
MeSH terms
ACTH Syndrome, Ectopic, Adolescent, Adrenocorticotropic Hormone, Adult, Aged, Aged, 80 and over, Algorithms, Decision Support Techniques, Deamino Arginine Vasopressin, Diagnosis, Differential, Female, Humans, Hydrocortisone, Magnetic Resonance Imaging, Male, Middle Aged, Pituitary Function Tests, Pituitary Gland, Predictive Value of Tests, Retrospective Studies, Tomography, X-Ray Computed, Petrosal Sinus Sampling, Neuroendocrine Tumors, Pituitary ACTH Hypersecretion, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review