Indication to dynamic and invasive testing in Cushing’s disease according to different neuroradiological findings
Purpose Dynamic testing represents the mainstay in the differential diagnosis of ACTH-dependent Cushing’s syndrome. However, in case of undetectable or detectable lesion
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| Veröffentlicht in: | Journal of endocrinological investigation 2022-03, Vol.45 (3), p.629-637 |
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| creator | Ferrante, E. Barbot, M. Serban, A. L. Ceccato, F. Carosi, G. Lizzul, L. Sala, E. Daniele, A. Indirli, R. Cuman, M. Locatelli, M. Manara, R. Arosio, M. Boscaro, M. Mantovani, G. Scaroni, C. |
| description | Purpose
Dynamic testing represents the mainstay in the differential diagnosis of ACTH-dependent Cushing’s syndrome. However, in case of undetectable or detectable lesion |
| doi_str_mv | 10.1007/s40618-021-01695-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8850245</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2586450530</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-393f663d738465bade0d874c6956761333ffb1929e62e040c404750b5b4b8a7f3</originalsourceid><addsrcrecordid>eNp9kUtuFDEQhluIiITABVggS2zYNCm_3RskNCIQKVI2YW25_Zg46rGD3T1SdrkG1-Mk8TAhBBasXHJ99dfj77o3GD5gAHlSGQiseiC4BywG3uNn3RGWBHpFlXj-JD7sXtZ6DUAlVfJFd0iZGAZg7KirZ8lFa-aYE5ozcrfJbKJFJjkU09bUuPVo9nWOad0-0GqpVy38efejIherN9UjY20ubgfsBGIIvvg0o-SXkotxMU953VpMKMS0w-qr7iCYqfrXD-9x9-308-Xqa39-8eVs9em8t0yyuacDDUJQ12Zmgo_GeXBKMts2FVJgSmkIIx7I4AXxwMAyYJLDyEc2KiMDPe4-7nVvlnHjnW1TFTPpmxI3ptzqbKL-O5PilV7nrVaKA2G8Cbx_ECj5-9KuoDexWj9NJvm8VE24EowDp9DQd_-g13kpqa2niSADg6HpNYrsKVtyrcWHx2Ew6J2neu-pbp7qX55q3IrePl3jseS3iQ2ge6C2VFr78qf3f2TvARmCr3g</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2629409453</pqid></control><display><type>article</type><title>Indication to dynamic and invasive testing in Cushing’s disease according to different neuroradiological findings</title><source>MEDLINE</source><source>SpringerLink (Online service)</source><creator>Ferrante, E. ; Barbot, M. ; Serban, A. L. ; Ceccato, F. ; Carosi, G. ; Lizzul, L. ; Sala, E. ; Daniele, A. ; Indirli, R. ; Cuman, M. ; Locatelli, M. ; Manara, R. ; Arosio, M. ; Boscaro, M. ; Mantovani, G. ; Scaroni, C.</creator><creatorcontrib>Ferrante, E. ; Barbot, M. ; Serban, A. L. ; Ceccato, F. ; Carosi, G. ; Lizzul, L. ; Sala, E. ; Daniele, A. ; Indirli, R. ; Cuman, M. ; Locatelli, M. ; Manara, R. ; Arosio, M. ; Boscaro, M. ; Mantovani, G. ; Scaroni, C.</creatorcontrib><description>Purpose
Dynamic testing represents the mainstay in the differential diagnosis of ACTH-dependent Cushing’s syndrome. However, in case of undetectable or detectable lesion < 6 mm on MRI, bilateral inferior petrosal sinus sampling (BIPSS) is suggested by current guidelines. Aim of this study was to analyze the performance of CRH, desmopressin and high-dose dexamethasone suppression test (HDDST) in the differential diagnosis of ACTH-dependent Cushing’s syndrome as well as the impact of invasive and noninvasive tests on surgical outcome in patients affected by Cushing’s disease (CD).
Methods
Retrospective analysis on 148 patients with CD and 26 patients with ectopic ACTH syndrome.
Results
Among CD patients, negative MRI/lesion < 6 mm was detected in 97 patients (Group A); 29 had a 6–10 mm lesion (Group B) and 22 a macroadenoma (Group C). A positive response to CRH test, HDSST and desmopressin test was recorded in 89.4%, 91·4% and 70.1% of cases, respectively. Concordant positive response to both CRH/HDDST and CRH/desmopressin tests showed a positive predictive value of 100% for the diagnosis of CD. Among Group A patients with concordant CRH test and HDDST, no difference in surgical outcome was found between patients who performed BIPSS and those who did not (66.6% vs 70.4%,
p
= 0.78).
Conclusions
CRH, desmopressin test and HDDST have high accuracy in the differential diagnosis of ACTH-dependent CS. In patients with microadenoma < 6 mm or non-visible lesion, a concordant positive response to noninvasive tests seems sufficient to diagnose CD, irrespective of MRI finding. In these patients, BIPSS should be reserved to discordant tests.</description><identifier>ISSN: 1720-8386</identifier><identifier>ISSN: 0391-4097</identifier><identifier>EISSN: 1720-8386</identifier><identifier>DOI: 10.1007/s40618-021-01695-1</identifier><identifier>PMID: 34699044</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adrenocorticotropic hormone ; Adrenocorticotropic Hormone - blood ; Adult ; Cushing Syndrome - diagnosis ; Cushing Syndrome - epidemiology ; Desmopressin ; Dexamethasone ; Diagnosis, Differential ; Diagnostic Techniques, Endocrine ; Differential diagnosis ; Endocrinology ; Female ; Humans ; Hypophysectomy - methods ; Hypophysectomy - statistics & numerical data ; Internal Medicine ; Italy - epidemiology ; Lesions ; Magnetic resonance imaging ; Magnetic Resonance Imaging - methods ; Male ; Medicine ; Medicine & Public Health ; Metabolic Diseases ; Nervous system diseases ; Original ; Original Article ; Petrosal Sinus Sampling - methods ; Pituitary ; Pituitary ACTH Hypersecretion - blood ; Pituitary ACTH Hypersecretion - diagnosis ; Pituitary ACTH Hypersecretion - epidemiology ; Pituitary ACTH Hypersecretion - surgery ; Pituitary Function Tests - methods ; Pituitary Neoplasms - diagnostic imaging ; Pituitary Neoplasms - pathology ; Pituitary Neoplasms - surgery ; Retrospective Studies ; Surgical outcomes</subject><ispartof>Journal of endocrinological investigation, 2022-03, Vol.45 (3), p.629-637</ispartof><rights>The Author(s) 2021</rights><rights>2021. The Author(s).</rights><rights>The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-393f663d738465bade0d874c6956761333ffb1929e62e040c404750b5b4b8a7f3</citedby><cites>FETCH-LOGICAL-c474t-393f663d738465bade0d874c6956761333ffb1929e62e040c404750b5b4b8a7f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40618-021-01695-1$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40618-021-01695-1$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34699044$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ferrante, E.</creatorcontrib><creatorcontrib>Barbot, M.</creatorcontrib><creatorcontrib>Serban, A. L.</creatorcontrib><creatorcontrib>Ceccato, F.</creatorcontrib><creatorcontrib>Carosi, G.</creatorcontrib><creatorcontrib>Lizzul, L.</creatorcontrib><creatorcontrib>Sala, E.</creatorcontrib><creatorcontrib>Daniele, A.</creatorcontrib><creatorcontrib>Indirli, R.</creatorcontrib><creatorcontrib>Cuman, M.</creatorcontrib><creatorcontrib>Locatelli, M.</creatorcontrib><creatorcontrib>Manara, R.</creatorcontrib><creatorcontrib>Arosio, M.</creatorcontrib><creatorcontrib>Boscaro, M.</creatorcontrib><creatorcontrib>Mantovani, G.</creatorcontrib><creatorcontrib>Scaroni, C.</creatorcontrib><title>Indication to dynamic and invasive testing in Cushing’s disease according to different neuroradiological findings</title><title>Journal of endocrinological investigation</title><addtitle>J Endocrinol Invest</addtitle><addtitle>J Endocrinol Invest</addtitle><description>Purpose
Dynamic testing represents the mainstay in the differential diagnosis of ACTH-dependent Cushing’s syndrome. However, in case of undetectable or detectable lesion < 6 mm on MRI, bilateral inferior petrosal sinus sampling (BIPSS) is suggested by current guidelines. Aim of this study was to analyze the performance of CRH, desmopressin and high-dose dexamethasone suppression test (HDDST) in the differential diagnosis of ACTH-dependent Cushing’s syndrome as well as the impact of invasive and noninvasive tests on surgical outcome in patients affected by Cushing’s disease (CD).
Methods
Retrospective analysis on 148 patients with CD and 26 patients with ectopic ACTH syndrome.
Results
Among CD patients, negative MRI/lesion < 6 mm was detected in 97 patients (Group A); 29 had a 6–10 mm lesion (Group B) and 22 a macroadenoma (Group C). A positive response to CRH test, HDSST and desmopressin test was recorded in 89.4%, 91·4% and 70.1% of cases, respectively. Concordant positive response to both CRH/HDDST and CRH/desmopressin tests showed a positive predictive value of 100% for the diagnosis of CD. Among Group A patients with concordant CRH test and HDDST, no difference in surgical outcome was found between patients who performed BIPSS and those who did not (66.6% vs 70.4%,
p
= 0.78).
Conclusions
CRH, desmopressin test and HDDST have high accuracy in the differential diagnosis of ACTH-dependent CS. In patients with microadenoma < 6 mm or non-visible lesion, a concordant positive response to noninvasive tests seems sufficient to diagnose CD, irrespective of MRI finding. In these patients, BIPSS should be reserved to discordant tests.</description><subject>Adrenocorticotropic hormone</subject><subject>Adrenocorticotropic Hormone - blood</subject><subject>Adult</subject><subject>Cushing Syndrome - diagnosis</subject><subject>Cushing Syndrome - epidemiology</subject><subject>Desmopressin</subject><subject>Dexamethasone</subject><subject>Diagnosis, Differential</subject><subject>Diagnostic Techniques, Endocrine</subject><subject>Differential diagnosis</subject><subject>Endocrinology</subject><subject>Female</subject><subject>Humans</subject><subject>Hypophysectomy - methods</subject><subject>Hypophysectomy - statistics & numerical data</subject><subject>Internal Medicine</subject><subject>Italy - epidemiology</subject><subject>Lesions</subject><subject>Magnetic resonance imaging</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metabolic Diseases</subject><subject>Nervous system diseases</subject><subject>Original</subject><subject>Original Article</subject><subject>Petrosal Sinus Sampling - methods</subject><subject>Pituitary</subject><subject>Pituitary ACTH Hypersecretion - blood</subject><subject>Pituitary ACTH Hypersecretion - diagnosis</subject><subject>Pituitary ACTH Hypersecretion - epidemiology</subject><subject>Pituitary ACTH Hypersecretion - surgery</subject><subject>Pituitary Function Tests - methods</subject><subject>Pituitary Neoplasms - diagnostic imaging</subject><subject>Pituitary Neoplasms - pathology</subject><subject>Pituitary Neoplasms - surgery</subject><subject>Retrospective Studies</subject><subject>Surgical outcomes</subject><issn>1720-8386</issn><issn>0391-4097</issn><issn>1720-8386</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><recordid>eNp9kUtuFDEQhluIiITABVggS2zYNCm_3RskNCIQKVI2YW25_Zg46rGD3T1SdrkG1-Mk8TAhBBasXHJ99dfj77o3GD5gAHlSGQiseiC4BywG3uNn3RGWBHpFlXj-JD7sXtZ6DUAlVfJFd0iZGAZg7KirZ8lFa-aYE5ozcrfJbKJFJjkU09bUuPVo9nWOad0-0GqpVy38efejIherN9UjY20ubgfsBGIIvvg0o-SXkotxMU953VpMKMS0w-qr7iCYqfrXD-9x9-308-Xqa39-8eVs9em8t0yyuacDDUJQ12Zmgo_GeXBKMts2FVJgSmkIIx7I4AXxwMAyYJLDyEc2KiMDPe4-7nVvlnHjnW1TFTPpmxI3ptzqbKL-O5PilV7nrVaKA2G8Cbx_ECj5-9KuoDexWj9NJvm8VE24EowDp9DQd_-g13kpqa2niSADg6HpNYrsKVtyrcWHx2Ew6J2neu-pbp7qX55q3IrePl3jseS3iQ2ge6C2VFr78qf3f2TvARmCr3g</recordid><startdate>20220301</startdate><enddate>20220301</enddate><creator>Ferrante, E.</creator><creator>Barbot, M.</creator><creator>Serban, A. L.</creator><creator>Ceccato, F.</creator><creator>Carosi, G.</creator><creator>Lizzul, L.</creator><creator>Sala, E.</creator><creator>Daniele, A.</creator><creator>Indirli, R.</creator><creator>Cuman, M.</creator><creator>Locatelli, M.</creator><creator>Manara, R.</creator><creator>Arosio, M.</creator><creator>Boscaro, M.</creator><creator>Mantovani, G.</creator><creator>Scaroni, C.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20220301</creationdate><title>Indication to dynamic and invasive testing in Cushing’s disease according to different neuroradiological findings</title><author>Ferrante, E. ; Barbot, M. ; Serban, A. L. ; Ceccato, F. ; Carosi, G. ; Lizzul, L. ; Sala, E. ; Daniele, A. ; Indirli, R. ; Cuman, M. ; Locatelli, M. ; Manara, R. ; Arosio, M. ; Boscaro, M. ; Mantovani, G. ; Scaroni, C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-393f663d738465bade0d874c6956761333ffb1929e62e040c404750b5b4b8a7f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adrenocorticotropic hormone</topic><topic>Adrenocorticotropic Hormone - blood</topic><topic>Adult</topic><topic>Cushing Syndrome - diagnosis</topic><topic>Cushing Syndrome - epidemiology</topic><topic>Desmopressin</topic><topic>Dexamethasone</topic><topic>Diagnosis, Differential</topic><topic>Diagnostic Techniques, Endocrine</topic><topic>Differential diagnosis</topic><topic>Endocrinology</topic><topic>Female</topic><topic>Humans</topic><topic>Hypophysectomy - methods</topic><topic>Hypophysectomy - statistics & numerical data</topic><topic>Internal Medicine</topic><topic>Italy - epidemiology</topic><topic>Lesions</topic><topic>Magnetic resonance imaging</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metabolic Diseases</topic><topic>Nervous system diseases</topic><topic>Original</topic><topic>Original Article</topic><topic>Petrosal Sinus Sampling - methods</topic><topic>Pituitary</topic><topic>Pituitary ACTH Hypersecretion - blood</topic><topic>Pituitary ACTH Hypersecretion - diagnosis</topic><topic>Pituitary ACTH Hypersecretion - epidemiology</topic><topic>Pituitary ACTH Hypersecretion - surgery</topic><topic>Pituitary Function Tests - methods</topic><topic>Pituitary Neoplasms - diagnostic imaging</topic><topic>Pituitary Neoplasms - pathology</topic><topic>Pituitary Neoplasms - surgery</topic><topic>Retrospective Studies</topic><topic>Surgical outcomes</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ferrante, E.</creatorcontrib><creatorcontrib>Barbot, M.</creatorcontrib><creatorcontrib>Serban, A. L.</creatorcontrib><creatorcontrib>Ceccato, F.</creatorcontrib><creatorcontrib>Carosi, G.</creatorcontrib><creatorcontrib>Lizzul, L.</creatorcontrib><creatorcontrib>Sala, E.</creatorcontrib><creatorcontrib>Daniele, A.</creatorcontrib><creatorcontrib>Indirli, R.</creatorcontrib><creatorcontrib>Cuman, M.</creatorcontrib><creatorcontrib>Locatelli, M.</creatorcontrib><creatorcontrib>Manara, R.</creatorcontrib><creatorcontrib>Arosio, M.</creatorcontrib><creatorcontrib>Boscaro, M.</creatorcontrib><creatorcontrib>Mantovani, G.</creatorcontrib><creatorcontrib>Scaroni, C.</creatorcontrib><collection>Springer Nature Open Access Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of endocrinological investigation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ferrante, E.</au><au>Barbot, M.</au><au>Serban, A. L.</au><au>Ceccato, F.</au><au>Carosi, G.</au><au>Lizzul, L.</au><au>Sala, E.</au><au>Daniele, A.</au><au>Indirli, R.</au><au>Cuman, M.</au><au>Locatelli, M.</au><au>Manara, R.</au><au>Arosio, M.</au><au>Boscaro, M.</au><au>Mantovani, G.</au><au>Scaroni, C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Indication to dynamic and invasive testing in Cushing’s disease according to different neuroradiological findings</atitle><jtitle>Journal of endocrinological investigation</jtitle><stitle>J Endocrinol Invest</stitle><addtitle>J Endocrinol Invest</addtitle><date>2022-03-01</date><risdate>2022</risdate><volume>45</volume><issue>3</issue><spage>629</spage><epage>637</epage><pages>629-637</pages><issn>1720-8386</issn><issn>0391-4097</issn><eissn>1720-8386</eissn><abstract>Purpose
Dynamic testing represents the mainstay in the differential diagnosis of ACTH-dependent Cushing’s syndrome. However, in case of undetectable or detectable lesion < 6 mm on MRI, bilateral inferior petrosal sinus sampling (BIPSS) is suggested by current guidelines. Aim of this study was to analyze the performance of CRH, desmopressin and high-dose dexamethasone suppression test (HDDST) in the differential diagnosis of ACTH-dependent Cushing’s syndrome as well as the impact of invasive and noninvasive tests on surgical outcome in patients affected by Cushing’s disease (CD).
Methods
Retrospective analysis on 148 patients with CD and 26 patients with ectopic ACTH syndrome.
Results
Among CD patients, negative MRI/lesion < 6 mm was detected in 97 patients (Group A); 29 had a 6–10 mm lesion (Group B) and 22 a macroadenoma (Group C). A positive response to CRH test, HDSST and desmopressin test was recorded in 89.4%, 91·4% and 70.1% of cases, respectively. Concordant positive response to both CRH/HDDST and CRH/desmopressin tests showed a positive predictive value of 100% for the diagnosis of CD. Among Group A patients with concordant CRH test and HDDST, no difference in surgical outcome was found between patients who performed BIPSS and those who did not (66.6% vs 70.4%,
p
= 0.78).
Conclusions
CRH, desmopressin test and HDDST have high accuracy in the differential diagnosis of ACTH-dependent CS. In patients with microadenoma < 6 mm or non-visible lesion, a concordant positive response to noninvasive tests seems sufficient to diagnose CD, irrespective of MRI finding. In these patients, BIPSS should be reserved to discordant tests.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>34699044</pmid><doi>10.1007/s40618-021-01695-1</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1720-8386 |
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| subjects | Adrenocorticotropic hormone Adrenocorticotropic Hormone - blood Adult Cushing Syndrome - diagnosis Cushing Syndrome - epidemiology Desmopressin Dexamethasone Diagnosis, Differential Diagnostic Techniques, Endocrine Differential diagnosis Endocrinology Female Humans Hypophysectomy - methods Hypophysectomy - statistics & numerical data Internal Medicine Italy - epidemiology Lesions Magnetic resonance imaging Magnetic Resonance Imaging - methods Male Medicine Medicine & Public Health Metabolic Diseases Nervous system diseases Original Original Article Petrosal Sinus Sampling - methods Pituitary Pituitary ACTH Hypersecretion - blood Pituitary ACTH Hypersecretion - diagnosis Pituitary ACTH Hypersecretion - epidemiology Pituitary ACTH Hypersecretion - surgery Pituitary Function Tests - methods Pituitary Neoplasms - diagnostic imaging Pituitary Neoplasms - pathology Pituitary Neoplasms - surgery Retrospective Studies Surgical outcomes |
| title | Indication to dynamic and invasive testing in Cushing’s disease according to different neuroradiological findings |
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