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Endocrine Abstracts (2019) 63 GP165 | DOI: 10.1530/endoabs.63.GP165

1Endocrinology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy; 2Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Policlinico, University of Milan, Milan, Italy; 3Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy; 4Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Policlinico, University of Milan, Milan, Italy.


Background: Differential diagnosis of ACTH-dependent hypercortisolism is crucial to indicate a proper treatment and is based on CRH-, high-dose dexamethasone suppression-test (HDDST) and pituitary MRI. However, up to 50% of cases of Cushing’s disease (CD) present a negative MRI or a visible lesion < 6 mm. In these patients, guidelines suggest to perform bilateral inferior petrosal sinus sampling (BIPSS) in order to establish a correct diagnosis. Aim of this study was to analyze the need of BIPSS in particular in those patients with inconclusive neuroradiological examination.

Materials and methods: We performed a retrospective analysis on 122 patients (F/M 93/29, mean age 43.9±14 yrs) affected by ACTH-dependent CS followed at two tertiary care centers in Italy. CRH test and HDDST were performed on the suspect of CD and all patients were submitted to pituitary MRI; the whole cohort underwent pituitary surgery (TSS). The pituitary origin of ACTH secretion was confirmed by biochemical remission after TSS, histology and/or hypoadrenalism (at least 6 months).

Results: A negative MRI or a lesion <6 mm were detected in 74 patients (60.7%, Group A); 26 patients had a pituitary adenoma between 6-10 mm (21.3%, Group B), 22 patients a macroadenoma (18%, Group C). Patients of Group C showed higher basal ACTH levels compared to patients with microadenomas (Group A+B) (116.8±107.2 vs 50.6±29.4 ng/L, P<0.05). No difference in basal cortisol, urinary free cortisol and late night salivary cortisol levels was found. A positive response to CRH test and HDSST was recorded in 92% and 93% of cases, respectively. The diagnosis of CD was confirmed by BIPSS in 24 patients. Overall, surgical remission was achieved in 90/122 (73.8%) patients, without differences between groups. Finally, considering patients of Group A with concordant positive HDDST and CRH test, no difference in surgical outcome was found between patients who performed BIPSS and those who did not (24/35 (68.6%) without BIPPS vs 13/19 (68.4%) with BIPSS, P=1).

Conclusion: Our study confirms that CRH test and HDDST have high accuracy in differential diagnosis of ACTH-dependent CS. In patients with negative MRI or with a microadenoma <6 mm, the presence of concordant positive noninvasive tests seems sufficient to establish the diagnosis of CD. BIPSS should be reserved to discordant cases.

Volume 63

21st European Congress of Endocrinology

Lyon, France
18 May 2019 - 21 May 2019

European Society of Endocrinology 

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