ArticleJournal of endocrinological investigation2022
Indication to dynamic and invasive testing in Cushing's disease according to different neuroradiological findings.
Article in Journal of endocrinological investigation, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 24 citations in OpenAlex.
- Accuracy of the 10 μg desmopressin test for differential diagnosis of Cushing syndrome: a systematic review and meta-analysis.Frontiers in endocrinology · 2024Pooled it
- A positive corticotropin-releasing hormone test may obviate the need for petrosal sinus sampling in patients with cushing's disease.Journal of endocrinological investigation · 2026Observational
- Cushing syndrome in paediatric population: who and how to screen.Journal of endocrinological investigation · 2025Review
- Mutual associations among responsiveness to differential diagnostic tests for Cushing's disease, tumor size, and somatostatin receptor 5 expression in corticotroph tumors.Endocrine journal · 2025Article
- Unmet needs on the current medical management of Cushing's syndrome: results from a Delphi panel of Italian endocrinologists.Journal of endocrinological investigation · 2023Article
- Emerging diagnostic methods and imaging modalities in cushing's syndrome.Frontiers in endocrinology · 2023Review
- Enhancing Cushing's disease diagnosis: exploring the impact of desmopressin on ACTH gradient during BIPSS.Frontiers in endocrinology · 2023Article
- Bilateral inferior petrosal sinus sampling in the diagnosis of ACTH-dependent Cushing's syndrome: experience in a tertiary hospital.Advances in laboratory medicine · 2022Article
- Outcome of CRH stimulation test and overnight 8 mg dexamethasone suppression test in 469 patients with ACTH-dependent Cushing's syndrome.Frontiers in endocrinology · 2022Article
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Authors and funding
16 authors at 3 institutions in 1 country.
Funding
Abstract
purposeDynamic 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).
methodsRetrospective analysis on 148 patients with CD and 26 patients with ectopic ACTH syndrome.
resultsAmong 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).
conclusionsCRH, 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.
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