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Selective Venous Sampling for ACTH in Cushing's Syndrome: Differentiation Between Cushing's Disease and the Ectopic ACTH Syndrome

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.; and PETER H. FORSHAM, M.D.
[+] Article and Author Information

Grant support: in part by a grant from the Levi J. and Mary Skaggs Foundation, Oakland, California, and by grant RR-79 (at the General Clinical Research Center of the University of California) from the Division of Research Resources, U.S. Department of Health and Human Services.

Presented in part at the 23rd Annual International Symposium on Clinical Endocrinology: Lipo-corticotropic Peptides and Cushing's Disease, 31 May 1980, in Paris, France.

▸Requests for reprints should be addressed to James W. Findling, M.D.; Metabolic Research Unit, 1143 HSW, University of California; San Francisco, CA 94143.


San Francisco, California


© 1981 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1981;94(5):647-652. doi:10.7326/0003-4819-94-5-647
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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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