JAMES W. FINDLING, M.D.; DAVID C. ARON, M.D.; J. BLAKE TYRRELL, M.D.; JEANETTE H. SHINSAKO, B.A.; PAUL A. FITZGERALD, M.D.; DAVID NORMAN, M.D.; CHARLES B. WILSON, M.D.; PETER H. FORSHAM, M.D.
We performed selective venous catheterization and sampling for ACTH in six patients with ACTH-secreting pituitary adenomas (Cushing's disease) and four patients with occult ectopic ACTH-secreting neoplasms. In five patients with Cushing's disease in whom the inferior petrosal sinus could be catheterized, ACTH levels were unequivocally higher than simultaneous peripheral values: The ratio was greater than 2. 0, with a range of 2.2 to 16.7. In contrast, the inferior petrosal sinus-to-peripheral ACTH ratio in three patients with ectopic ACTH secretion was less than 1.5. In the fourth patient, an arteriovenous gradient of 6.8 was shown 2 years before a bronchial carcinoid tumor was clinically apparent. Central-to-peripheral ACTH ratios at the level of the jugular bulb and jugular vein were not diagnostic. We conclude that selective venous ACTH sampling from the inferior petrosal sinus is a reliable and useful aid in the differential diagnosis of Cushing's syndrome when standard clinical and biochemical studies are inconclusive.
FINDLING JW, ARON DC, TYRRELL JB, SHINSAKO JH, FITZGERALD PA, NORMAN D, et al. Selective Venous Sampling for ACTH in Cushing's Syndrome: Differentiation Between Cushing's Disease and the Ectopic ACTH Syndrome. Ann Intern Med. ;94:647–652. doi: 10.7326/0003-4819-94-5-647
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Published: Ann Intern Med. 1981;94(5):647-652.
Adrenal Disorders, Endocrine and Metabolism, Endocrine Cancer, Hematology/Oncology.
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