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Non-invasive Diagnostic Strategy in ACTH-dependent Cushing’s Syndrome
Open accessAbstract
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.
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“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]
In the citing paper
“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]
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“When prompt access to brain MRI is not available, necktopelvis thinslice CT scan is useful if suspicion is high for ectopic ACTH syndrome, such as in a male patient with very high UFC, profound hypokalaemia, or both 81 (low quality, discretionary recommendation).”
Self-citationReincke, M., & Fleseriu, M. (2023) · JAMA · doi:10.1001/jama.2023.11305 · Cited by 273
Approach to the Patient: Diagnosis of Cushing Syndrome
Savas, M., Mehta, S., Agrawal, N., van Rossum, E. F. C., & Feelders, R. A. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac492 · Cited by 91
“However, using these dynamic tests in combination with pituitary MRI can improve clinical accuracy, decreasing the need for BIPSS (9, 75).”
BackgroundMethodInfluentialNieman, L. K., Castinetti, F., Newell-Price, J. D. C., Valassi, E., Drouin, J., Takahashi, Y., & Lacroix, A. (2025) · Nature Reviews Disease Primers · doi:10.1038/s41572-024-00588-w · Cited by 78
“A non-invasive strategy using a combination of CT imaging of the body, MRI imaging of the pituitary and both CRH analogue and desmopressin stimulation tests suggested that BIPSS could be avoided in nearly half of the patients with ACTH-dependent CS 114 .”
Tabarin, A., Assié, G., Barat, P., Bonnet, F., Bonneville, J. F., Borson-Chazot, F., Bouligand, J., Boulin, A., Brue, T., Caron, P., et al. (2022) · Annales d Endocrinologie · doi:10.1016/j.ando.2022.02.001 · Cited by 59
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“Whole-body imaging by CT or MRI, with or without functional imaging using (68)Ga DOTA-somatostatin analogues-PET, may also be considered to differentiate Cushing’s disease from ectopic Cushing’s syndrome [156,157].”
MethodSelf-citationCeccato, F., Barbot, M., Mondin, A., Boscaro, M., Fleseriu, M., & Scaroni, C. M. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac686 · Cited by 50
Hayes, A. R., & Grossman, A. B. (2022) · Journal of Neuroendocrinology · doi:10.1111/jne.13137 · Cited by 45
“stimulation test or the desmopressin stimulation test clearly shift the probability in favour of Cushing's disease.(27,34,35)”
BackgroundResultDiagnostic workup of Cushing’s syndrome
Balomenaki, M., Margaritopoulos, D., Vassiliadi, D. A., & Tsagarakis, S. (2022) · Journal of Neuroendocrinology · doi:10.1111/jne.13111 · Cited by 41
Inferior petrosal sinus sampling in Cushing’s syndrome: usefulness and pitfalls
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Lavoillotte, J., Mohammedi, K., Salenave, S., Furnica, R. M., Maiter, D. M., Chanson, P., Young, J., & Tabarin, A. (2024) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgae258 · Cited by 32
Self-citationFerrante, E., Barbot, M., Serban, A., Ceccato, F., Carosi, G., Lizzul, L., Sala, E., Daniele, A., Indirli, R., Cuman, M., et al. (2021) · Journal of Endocrinological Investigation · doi:10.1007/s40618-021-01695-1 · Cited by 18
Elenius, H., McGlotten, R., & Nieman, L. K. (2023) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgad454 · Cited by 26
Emerging diagnostic methods and imaging modalities in cushing’s syndrome
Wright, K. E., van Rossum, E. F. C., Zan, E., Werner, N. L., Harris, A. G., Feelders, R. A., & Agrawal, N. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1230447 · Cited by 27
“Studies have demonstrated high sensitivity and speci fi city, allowing for the avoidance of BIPSS in up to 47% of patients with ACTH-dependent Cushing ’ s syndrome (86).”
BackgroundSecond-Line Tests in the Diagnosis of Adrenocorticotropic Hormone-Dependent Hypercortisolism
Pinelli, S., Barbot, M., Scaroni, C. M., & Ceccato, F. (2021) · Annals of Laboratory Medicine · doi:10.3343/alm.2021.41.6.521 · Cited by 23
Recognition and Management of Ectopic ACTH Secreting Tumors
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Ferrière, A., & Tabarin, A. (2021) · La Presse Médicale · doi:10.1016/j.lpm.2021.104091 · Cited by 20
Self-citationCeccato, F., & Dalmazi, G. D. (2023) · Journal of Endocrinological Investigation · doi:10.1007/s40618-023-02113-4 · Cited by 19
“A more prominent role of BIPSS without CRH stimulation or under desmopressin stimulation is thus foresee-able; however, it must be considered that the reliability of this test seems to be comparable with or without desmo-pressin administration [14].”
BackgroundInfluentialImpact of Cushing’s syndrome on the gonadotrope axis and testicular functions in men
Papadakis, G. E., de Kalbermatten, B., Dormoy, A., Salenave, S., Trabado, S., Vieira-Pinto, O., Richa, C., Kamenický, P., Chanson, P., Maione, L., et al. (2023) · Human Reproduction · doi:10.1093/humrep/dead187 · Cited by 20
“Bilateral inferior petrosal sinus sampling (IPSS) was performed when the previous explorations did not allow definitive diagnosis (Frete et al. , 2020; Tabarin et al. , 2022).”
MethodSelf-citationDetomas, M., Ritzel, K., Nasi‐Kordhishti, I., Wolfsberger, S., Quinkler, M. O., Losa, M., Tröger, V., Kroiß, M., Faßnacht, M., Vila, G., et al. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.955945 · Cited by 18
Qiao, J., Li, J., Zhang, W., Wang, C., Li, J., Jiang, S., Tan, H., Chen, Y., Liu, H., Cai, B., et al. (2021) · Endocrine Journal · doi:10.1507/endocrj.ej20-0837 · Cited by 16
Lyu, X., Zhang, D., Pan, H., Zhu, H., Chen, S., & Lü, L. (2023) · Endocrine · doi:10.1007/s12020-023-03341-7 · Cited by 17
“Some noninvasive approaches used a combination of three or four tests, speci fi cally corticotropin-releasing hormone (CRH) and desmopressin stimulation plus magnetic resonance imaging (MRI) [3, 4].”
MethodIs Desmopressin Useful in the Evaluation of Cushing Syndrome?
Castinetti, F., & Lacroix, A. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac533 · Cited by 15
Paediatric Cushing syndrome: a prospective cohort study
Tatsi, C., Kamilaris, C. D. C., Keil, M. F., Saidkhodjaeva, L., Faucz, F. R., Chittiboina, P., & Stratakis, C. A. (2023) · The Lancet Child & Adolescent Health · doi:10.1016/s2352-4642(23)00264-x · Cited by 16
Is it Time for a New Approach to the Differential Diagnosis of ACTH-Dependent Cushing Syndrome?
Nieman, L. K. (2020) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaa493 · Cited by 13
Wu, Y., Cai, Y., Rui, W., Tang, Y., Yang, Z., He, M., Ye, H., Wang, Y.-F., Zhao, Y., Ma, Z.-Y., et al. (2021) · Clinical Endocrinology · doi:10.1111/cen.14574 · Cited by 11
“Magnetic resonance imaging (MRI) is one of the most common noninvasive methods to localize the pituitary adenoma after the diagnosis of Cushing disease is established.(4) However, ACTH‐secreting pituitary tumours are predominantly microadenomas that are difficult to detect on imaging studies.”
Methodde Almeida, T. S., Rodrigues, T. D. C., Costenaro, F., Scaffaro, L. A., Farenzena, M., Gastaldo, F., & Czepielewski, M. A. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1224001 · Cited by 12
“Strategies that resulted in a positive predictive value of 100%, however, included t-CRH as part of the diagnostic process (42, 43), which makes adherence to this diagnostic modality inapplicable in many countries due to the unavailability of CRH.”
Li, Y., Li, C., Qi, X., Yu, L. D., & Lin, L. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1177125 · Cited by 12
“Moreover, emerging data have suggested that the CRH/desmopressin stimulation test in collaboration with pituitary MRI, subsequently followed by a whole-body computed tomography scan, could be a reliable alternative (77, 82, 83).”
BackgroundBiochemical testing to differentiate Cushing’s disease from ectopic ACTH syndrome
Ferrière, A., & Tabarin, A. (2022) · Pituitary · doi:10.1007/s11102-022-01241-z · Cited by 13
Self-citationPaepegaey, A. C., Dot, J.-M., Beauvy, J., Juttet, P., & Berre, J. P. L. (2021) · Annales d Endocrinologie · doi:10.1016/j.ando.2021.11.007 · Cited by 11
Slagboom, T. N. A., Stenvers, D., van de Giessen, E. M., Roosendaal, S., de Win, M. D., Bot, J., Aronica, E., Post, R., Hoogmoed, J., Drent, M., et al. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12082919 · Cited by 6
“be omitted in about half of the patients [35].”
BackgroundCommon Pitfalls in the Interpretation of Endocrine Tests
Álvarez-Payares, J. C., Bello-Simanca, J. D., Peña-Arrieta, E. D. J. D. L., Agamez-Gomez, J. E., García-Rueda, J. E., Rodriguez-Arrieta, A., & Arrieta, L. A. R. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.727628 · Cited by 11
“Therefore, plasmatic cortisol values should be interpreted carefully in situations that could alter CBG concentrations (21, 23).”
BackgroundInfluentialLyu, X., Zhang, D., Pan, H., Zhu, H., Chen, S., & Lü, L. (2022) · Endocrine · doi:10.1007/s12020-022-03081-0 · Cited by 10
Paediatric and adolescent ectopic Cushing's syndrome: systematic review
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Valizadeh, M., Abiri, B., Hosseinpanah, F., & Grossman, A. B. (2024) · Journal of Internal Medicine · doi:10.1111/joim.13789 · Cited by 9
“However, using a combination of non-invasive tests, one group in a retrospective study including a large number of EAS patients showed that this resulted in the correct diagnosis in half of the patients, eliminating the need for BIPSS [159].”
BackgroundMethodColao, A., Scaroni, C. M., Mezősi, E., Saiegh, L., Puig‐Domingo, M., Marques, P., & Deutschbein, T. (2024) · European Journal of Endocrinology · doi:10.1093/ejendo/lvae073 · Cited by 9
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“…the presence of a focal lesion (at least 2-3 mm) on CEMRI in a patient with a characteristic clinical presentation and concordant biochemical data in defining the ACTH-dependent form after dynamic tests suggests a definitive diagnosis and does not require any further investigation (as BIPSS) [35].”
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Smushkin, G., Phillips, R., & Chaussé, G. (2022) · JCEM Case Reports · doi:10.1210/jcemcr/luac035 · Cited by 8
“The role of noninvasive diagnostic tests such as the peripheral corticotropin releasing hormone (CRH) and desmopressin tests has been studied in an effort to differentiate, in combination with imaging, Cushing disease from EAS without the use of IPSS [3].”
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Courcelles, L., Stoenoiu, M. S., Haufroid, V., Lopez‐Sublet, M., Boland, L., Wauthier, L., Beauloye, C., Maiter, D. M., Januszewicz, A., Kreutz, R. H., et al. (2024) · Clinical Chemistry · doi:10.1093/clinchem/hvae022 · Cited by 8
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“BIPSS is recommended according to the currently recommended algorithms.”
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Miao, H., Lü, L., Zhu, H., Du, H., Xing, X., Zhang, X., Song, L., Song, W., Liu, Q., Cheng, X., et al. (2021) · Endocrine Practice · doi:10.1016/j.eprac.2021.02.015 · Cited by 9
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Cushing syndrome in paediatric population: who and how to screen
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“The CRH test has been suggested as the best non-invasive tool for diagnosing CD. Sensitivity and specificity are reported to be around 80 and 92% (according to study in adults) [17, 58–60 ].”
Zhao, Y. X., Ma, W. L., Jiang, Y., Zhang, G. N., Wang, L. J., Gong, F., Zhu, H. J., & Lü, L. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.808199 · Cited by 7
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“[ 68 Ga]Ga-DOTA-NOC positron emission tomography-computed tomography (PET/CT) is usefulinidentifyingectopictumorsexpressingsomatostatinreceptors,butit doesnotaidindiagnosingCD 10,11 .”
Limited Invasive Protocol: Optimizing Diagnostic Modalities in ACTH Mediated Cushing's Syndrome.
Gupta, R., Walia, R., Ahuja, C., Dutta, A., Bhadada, S., Bhansali, A., Chhabra, R., Singh, M. A., & Dhandapani, S. (2022) · Endocrine Practice · doi:10.1016/j.eprac.2022.04.013 · Cited by 5
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Does concomitant prolactin measurement ıncrease the accuracy of ınferior petrosal sinus sampling?
Apaydin, T., Yasar, M., Baltacioglu, F., Haklar, G., & Gogas Yavuz, D. (2022) · Neuroradiology · doi:10.1007/s00234-021-02886-6 · Cited by 6
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“…with a negative pituitary MRI plus a positive CT scan of neck to pelvis, and negative responses to CRH and desmopressin tests, using the thresholds of a cortisol increase of > 17% and > 18, and an ACTH increase of > 37% and > 33% respectively, the negative predictive value was 100% for CD [5].”
BackgroundIs the diagnosis of Cushing disease moving beyond bilateral inferior petrosal sinus sampling?
Bouchard, L., Lazard, A., Jean, C., Heck, O., Lefournier, V., Stürm, N., Chovelon, B., Faure, P., Muller, M., Gay, E., et al. (2026) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgag265 · Cited by 4
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Alternative Approach to BIPSS in the Differential Diagnosis of ACTH-Dependent Cushing Syndrome
Gadelha, M. R., & Wildemberg, L. E. (2023) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgad676 · Cited by 4
Biagetti, B., Marques, P., Soto‐Moreno, A., García-Centeno, R., Fernández, L. G., García, M. D. O., Echarri, A. I., Cardona-Arias, A., Rodríguez, M. D. M., Paja, M., et al. (2026) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgag187 · Cited by 3
Natan, D. B., Serebro, M., Ram, Z., Grossman, R., Even-Zohar, N., Sofer, Y., Yaish, I., Greenman, Y., & Tordjman, K. M. (2025) · Endocrine · doi:10.1007/s12020-025-04304-w · Cited by 3
“…imaging and testing modalities were used to exclude ectopic ACTH sources with high reliability, as proposed by others as an alternative to IPSS [23], lack of inferior petrosal sinus sampling (IPSS) at out center until recently might have led to mis-classi fi cation of some ectopic ACTH cases as…”
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Alcohol-induced Cushing syndrome: report of eight cases and review of the literature
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Ectopic ACTH Syndrome: Possibilities of Modern Diagnostics
Grineva, E. N., Tsoy, U. A., & Рыжкова, Д. В. (2024) · Annals of the Russian academy of medical sciences · doi:10.15690/vramn12677 · Cited by 2
Current challenges in Cushing's syndrome testing: blood, saliva, urine, or hair?
Ferrière, A., & Tabarin, A. (2025) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0000000000000923 · Cited by 2
Self-citationClinical management of ectopic Cushing Syndrome in neuroendocrine neoplasms: a national survey
Laffi, A., Prinzi, A., di Dato, C., Feola, T., Medici, M., Colao, A., Faggiano, A., & Lania, A. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1690837 · Cited by 2
Balderrama-Soto, A., Rivera-Hernández, A. D. J., Reza-Albarrán, A. A., la Vega, A. N.-D., Vergara-López, A., Monteros-Sánchez, A. L. E. D. L., Navas-Minero, C. E., Abreu-Rosario, C., Cuevas-Ramos, D., Espinosa-Cárdenas, E., et al. (2023) · Revista Mexicana de Endocrinología Metabolismo y Nutrición · doi:10.24875/rme.m23000025 · Cited by 2
Valizadeh, M., Rahmani, F., Nikoohemmat, M., Ahmadi, A. R., Hosseinpanah, F., Niroomand, M., Bagheri, A. K., Grossman, A. B., & Abiri, B. (2024) · Endocrine Research · doi:10.1080/07435800.2024.2381720 · Cited by 2
“In our investigation of 22 patients with remitted CD who underwent TSS, positive DST results were detected in 17 patients with confirmed CD.”
InfluentialPolycystic Ovarian Syndrome: A Diagnosis of Exclusion
Aubuchon, M. (2022) · Springer eBooks · doi:10.1007/978-3-030-92589-5_3 · Cited by 2
False-Negative Inferior Petrosal Sinus Sampling in Young-Onset Cushing Disease: What Happens Next
Maschio, C., Weinberg, J., Keil, M., Saidkhodjaeva, L., Chittiboina, P., Chang, R., Stratakis, C. A., & Tatsi, C. (2023) · Hormone Research in Paediatrics · doi:10.1159/000533338 · Cited by 2
“Frete et al. [12] investigated a diagnostic algorithm including CRH and DDAVP stimulation tests, pituitary MRI, and whole body CT as an alternative to IPSS, reporting 100% positive predictive value for patients with positive responses to CRH/DDAVP and negative CT for ectopic sources.”
Qiu, Y., Zhao, H., Pan, H., Guo, L., Du, S., Qiu, M., Wu, C., Han, J., Zhang, X., Zhou, Z., et al. (2022) · Annals of Palliative Medicine · doi:10.21037/apm-22-1177 · Cited by 1
Attri, B., Goyal, A., Kalaivani, M., Kandasamy, D., Gupta, Y., Agarwal, S., Shamim, S. A., Damle, N., Sharma, M. C., Jyotsna, V. P., et al. (2023) · Hormone and Metabolic Research · doi:10.1055/a-2236-0864 · Cited by 1
“It is well known that some neuroendocrine tumors causing EAS express functional CRH receptors, resulting in false positive response to CRH stimulation [15, 27].”
Larose, S., Rioux, D., Albadine, R., & Lacroix, A. (2023) · Endocrine Oncology · doi:10.1530/eo-23-0002 · Cited by 1
“…MRI was negative, a CT scan was positive for a potential source of EAS, and both a desmopressin test and a CRH test were negative (less than 33% increase in ACTH and less than 18% increase in cortisol for the former), and then the negative predictive value for CD was 100% (Frete et al. 2020).”
BackgroundResultInfluentialA Review of Pituitary Gland for General Physicians
Boutrus, T. S. (2024) · Journal of Internal Medicine and Emergency Research · doi:10.37191/mapsci-2582-7367-5(2)-076
“Ectopic ACTH-secreting tumours (mostly in chest) are usually diagnosed with (CT or positron emission tomography) [143].”
BackgroundKakizawa, K., Yamashita, M., Kawauchi, Y., Ikeya, A., Ohba, K., & Matsushita, A. (2024) · Endocrine Journal · doi:10.1507/endocrj.ej24-0128 · Cited by 1
Meyers, M., Awada, A. H., Karfis, I., de Roodenbeke, D. '. K., Couvert, H. P. V., Hanssens, C., Hendlisz, A., & Driessens, N. (2024) · Case Reports in Oncology · doi:10.1159/000540707 · Cited by 2
“After con fi rming the presence of a severe endogenous ACTH-dependent CS by biological testing, we conducted a noninvasive diagnostic strategy to determine its etiology [13, 14].”
Recent developments in the management of Cushing's syndrome.
Galiana, P. A. (2021) · Endocrinología Diabetes y Nutrición · doi:10.1016/j.endinu.2021.01.002
Recent developments in the management of Cushing's syndrome.
Galiana, P. A. (2021) · Endocrinología Diabetes y Nutrición · doi:10.1016/j.endien.2021.01.001
Cushing’s Disease of Unknown Etiology: A Clinical Case Report
Martins, J. M., Maia, C. M., Miguéns, J., & Lopéz‐Presa, D. (2022) · Journal of Endocrinology and Metabolism · doi:10.14740/jem784
“…seem to explain discrepancies; free cortisol is increased as evaluated by the 24-h urinary cortisol excluding cortisol-binding globulin (CBG) increase induced by pill; no drugs were used that could increase the metabolism of dexamethasone or present anti-glucocorticoid effects [12, 16, 22, 23, 37].”
Der Desmopressintest in der differenzialdiagnostischen Abklärung des Cushing-Syndroms
Wolf, P. S., & Schernthaner-Reiter, M. H. (2022) · Journal für Klinische Endokrinologie und Stoffwechsel · doi:10.1007/s41969-022-00157-0
Feocromocitomi ACTH secernenti
Voltan, G., Pinelli, S., Scaroni, C. M., & Ceccato, F. (2022) · L Endocrinologo · doi:10.1007/s40619-022-01067-8
“Secondo un recente studio di Frete [14], il criterio associato a un miglior compromesso tra sensibilità e specificità è un aumento del cortisolo di almeno il 17% e dell’ACTH di almeno il 37% (sensibilità 83% e specificità 85%).”
BackgroundNoriega, P. E. P., de Oliveira, R., Guerrero, D. G. Z., Carrijo, M. D. P., Musolino, N. R. D. C., Cescato, V. Â. S., da Silva, G. O., Fragoso, M. C. B. V., Bronstein, M. D., & Machado, M. C. (2022) · Research Square · doi:10.21203/rs.3.rs-2167447/v1
Khalil, S. S., Sheikh‐Ahmad, M., Sarah-Hefer, T., Yovanovich, E., Reut, M., Chen‐Konak, L., Khazen, N. S., & Saiegh, L. (2023) · Endocrine Research · doi:10.1080/07435800.2023.2176869
“A comparative evaluation of desmopressin and CRH stimulation tests suggests that CRH test may be more reliable in determining the etiology of CS,(19) and a combination of CRH and desmopressin stimulation tests can perform better than either of the tests separately.(20,21)”
MethodFurnica, R. M., NACHIT, M., Collard, A., Cornélis, F., Alexopoulou, O., & Maiter, D. M. (2023) · Research Square · doi:10.21203/rs.3.rs-2674724/v1
Consensus della Pituitary Society su diagnosi e gestione della Malattia di Cushing
Mondin, A., & Scaroni, C. M. (2023) · L Endocrinologo · doi:10.1007/s40619-023-01308-4
“Un approccio non invasivo che si avvale di test dinamici (CRH e desmopressina), RM ipofisi e TC total-body potrebbe costituire un’alternativa in setting multidisciplinare, evitando il ricorso al cateterismo dei seni petrosi in quasi la metà dei casi (VL,D) [3].”
BackgroundRobert, M., Douane, F., Toulgoat, F., Bach‐Ngohou, K., & Drui, D. (2023) · Annales d Endocrinologie · doi:10.1016/j.ando.2023.09.001
Espinosa-Cárdenas, E., García-Sáenz, M. R., Espinosa-de-los-Monteros, A. L., & Sosa, E. (2023) · Archives of Medical Research · doi:10.1016/j.arcmed.2023.102882
Adenomi ipofisari o tumori neuroendocrini ipofisari: attualità e consenso
Jouanneau, E., Manet, R., Vasiljevic, A., & Raverot, G. (2023) · EMC - Neurologia · doi:10.1016/s1634-7072(23)48432-2
Piazzola, C., & Castinetti, F. (2023) · European Journal of Endocrinology · doi:10.1093/ejendo/lvad155
Refractory Hyperglycemia and Hypokalemic Paralysis: Rare Initial Presentation of Cushing Disease
Gomes, R. R., & Habiba, A. (2023) · International Archives of Endocrinology Clinical Research · doi:10.23937/2572-407x.1510035
Синдром ектопічної АКТГ (огляд літератури та випадок із прак тики)
Guda, B. B., Tarashchenko, Y. М., Komisarenko, І. І., & Оstafiichuk, M. V. (2023) · Endokrynologia · doi:10.31793/1680-1466.2023.28-4.363
Adrenal Multidisipliner Güncel Yaklaşım
Özen, F. Z., Özer, M., Özsoy, Ç., Binnetoğlu, E., Alparslan, A. Ş., Budak, E. S., Kök, E. V., Çetinkaya, G. S., Durmuş, M. E., Köker, G., et al. (2024) · Akademisyen Kitabevi eBooks · doi:10.37609/akya.2992
Adenomas hipofisarios y adenomas funcionantes
García-Centeno, R., González, G., Goñi, J., & González-Albarrán, O. (2024) · Medicine - Programa de Formación Médica Continuada Acreditado · doi:10.1016/j.med.2024.08.011
Channaiah, C. Y., Lila, A. R., & Bandgar, T. (2024) · Annales d Endocrinologie · doi:10.1016/j.ando.2024.10.001
Pituitary tumors, ACTH-secreting
Pivonello, R., Larocca, A., Simeoli, C., Paola, N. D., Crescenzo, E. M., & Colao, A. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-13825-6.00122-9
Tatsi, C., Keil, M. F., & Stratakis, C. A. (2024) · Springer eBooks · doi:10.1007/978-3-031-66296-6_12
Cushing's syndrome screening and differential diagnosis
Lacroix, A., & Nieman, L. K. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-13825-6.00233-8
Aljabrain, F., Strobelt, C., Cu, B., & Huntsman, A. (2025) · Cureus · doi:10.7759/cureus.82689
“…a sensitivity of 50-67% in identifying the source of ectopic ACTH production, and when the findings are negative, a variety of nuclear medicine functional imaging techniques (Octreoscan, fluorine-18 fluorodeoxyglucose PET/CT, and gallium-68 somatostatin receptor-targeted PET/CT) can be used [6].”
Campion, T., Voltani, G., Tizianel, I., & Ceccato, F. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-27354-4.00004-1
Lyu, X., Liu, J., Zhang, D., Zhang, X., Zhu, H., Chen, S., Lü, L., & Pan, H. (2025) · BMC Endocrine Disorders · doi:10.1186/s12902-025-02092-y
“Although there is a noninvasive approach using a combination of three or four tests, specifically CRH and desmopressin stimulation plus MRI (very low quality, discretionary recommendation) [3, 6–12], BIPSS remains an essential diagnostic step for ACTH-dependent CS with MRI-detected lesions ≤ 6 mm.”
Diagnostic performance of desmopressin stimulation test in pediatric cushing’s disease
Omotosho, Y. B., Chang, R., Kassin, M. T., Groat, E., Quillian, A., Parker, R., & Tatsi, C. (2025) · Pituitary · doi:10.1007/s11102-025-01610-4
“In a recent study on a non-invasive approach to differential diagnosis of ACTH-dependent CS, Frete et al. incorporated the CRH or DDAVP stimulation test in their diagnostic algorithm [12].”
Influential
Metadata
- 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
- Publisher
- The Endocrine Society
- 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
- green
- hal.science
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- 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
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