The DOI matches its Crossref record; 45 of the 47 references it cites were found in a registry or an index.
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]
Citations
Cites
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Treatment of Cushing's syndrome: an Endocrine Society clinical practice guideline
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Diagnosis and Management of Cushing's Syndrome: Results of an Italian Multicentre Study
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Diagnosis and Management of Cushing’s Syndrome: Results of an Italian Multicentre Study 1
Invitti, C., Giraldi, F. P., De Martin, M., & Cavagnini, F. (1999) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.84.2.5465 · Cited by 336
Cushing’s Syndrome: important issues in diagnosis and management
Findling, J. W., & Raff, H. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2006-0997 · Cited by 294
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Young, J., Haissaguerre, M., Viera-Pinto, O., Chabre, O., Baudin, E., & Tabarin, A. (2020) · European Journal of Endocrinology · doi:10.1530/eje-19-0877 · Cited by 232
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Consensus on diagnosis and management of Cushing's disease: a guideline update
Fleseriu, M., Auchus, R., Bancos, I., Ben-Shlomo, A., Bertherat, J., Biermasz, N. R., Boguszewski, C. L., Bronstein, M. D., Buchfelder, M., Carmichael, J. D., et al. (2021) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(21)00235-7 · Cited by 953
“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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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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