| dc.creator | Belli,Susana | |
| dc.creator | Oneto,Adriana | |
| dc.creator | Mendaro,Esteban | |
| dc.date | 2007-09-01 | |
| dc.date.accessioned | 2017-03-07T16:00:53Z | |
| dc.date.available | 2017-03-07T16:00:53Z | |
| dc.identifier | http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007000900001 | |
| dc.identifier.uri | http://repositorioslatinoamericanos.uchile.cl/handle/2250/394582 | |
| dc.description | Background: The features of pituitary ACTH-dependent Cushing syndrome are often indistinguishable from those of occult ectopic ACTH-dependent Cushing syndrome (CS). Aim: To assess the diagnostic accuracy of bilateral inferior petrosal sinus sampling (BIPSS) in the differential diagnosis of ACTH-dependent Cushing's syndrome as compared with ACTH levels and the overnight high dose dexamethasone suppression test (HDDST). Material and methods: Retrospective review of medical records of 23 patients (aged 19 to 63 years, 16 women) with surgically proven CS, 20 pituitarymicroadenomas (CD) and 3 with occult ectopic ACTH secretion (EAS). Results: No tumor was identifiable by imaging techniques. Mean plasma ACTH values were higher in patients with EAS than in CD (103± 110.2 and 73.1±41.98 pg/mL respectively, p=NS). Three patients with EAS and 3 patients with CD did not suppress cortisol with the HDDST. The sensitivity of the test was 86% and the specificity 100%. To improve the diagnostic outcome of BIPSS, an stimulation with Desmopressin (9 fig i.v) was performed in 9 patients. The threshold for a pituitary source, was defined as an inferior petrosal sinus to peripheral ACTH basal and post Desmopression ratio >2. BIPSS was successfully carried out in 22 patients and no complications occurred. In 6 patients BIPSS failed to meet the threshold criteria. In 3 patients, bronchial carcinoid tumors which proved to synthesize ACTH, were removed. The diagnostic sensitivity of BIPSS greatly improved from 86% to 100% after Desmopressin stimulation. BIPSS accurately predicted the ¡ateralization of the microadenoma in 8 of 12 patients (66%). Conclusions: The combination of Desmopressin stimulation with BIPSS was useful for the differential diagnosis of ACTH-dependent Cushing's Syndrome. However, the preoperative location of pituitary microadenomas was poorly predicted by BIPSS | |
| dc.format | text/html | |
| dc.language | es | |
| dc.publisher | Sociedad Médica de Santiago | |
| dc.source | Revista médica de Chile v.135 n.9 2007 | |
| dc.subject | Adrenocorticotropic hormone | |
| dc.subject | Cushing syndrome | |
| dc.subject | Deamino arginine vasopressin (Desmopressin) | |
| dc.subject | Petrosal sinus sampling | |
| dc.title | El cateterismo bilateral y simultáneo de los senos petrosos inferiores en el diagnóstico diferencial del síndrome de Cushing | |
| dc.type | Artículos de revistas | |
