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

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

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

DOI 10.1210/clinem/dgaa409

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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.

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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
ORCID: Corcuff, Jean-Benoît
Kuhn, Emmanuelle
Young, Jacques
Chanson, Philippe
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
DOI: 10.1210/clinem/dgaa409
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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Non-invasive Diagnostic Strategy in ACTH-dependent Cushing’s Syndrome

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