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.
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. 1981;94:647-652. doi: 10.7326/0003-4819-94-5-647
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Published: Ann Intern Med. 1981;94(5):647-652.
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.
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Endocrine and Metabolism, Hematology/Oncology, Adrenal Disorders, Endocrine Cancer.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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