| Prolactin as a marker of successful catheterization during IPSS in patients with ACTH-dependent Cushing's syndrome. | |
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MedLine Citation:
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PMID: 22031511 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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CONTEXT: Anomalous venous drainage can lead to false-negative inferior petrosal sinus sampling (IPSS) results. Baseline inferior petrosal sinus to peripheral (IPS/P) prolactin ratio higher than 1.8 ipsilateral to the highest ACTH ratio has been proposed to verify successful catheterization. Prolactin-normalized ACTH IPS/P ratios may differentiate Cushing's disease (CD) from ectopic ACTH syndrome (EAS). OBJECTIVE: Our objective was to examine the utility of prolactin measurement during IPSS. DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective analysis of prolactin levels in basal and CRH-stimulated IPSS samples in ACTH-dependent Cushing's syndrome (2007-2010). RESULTS: Twenty-five of 29 patients had a pathologically proven diagnosis (17 CD and eight EAS). IPSS results were partitioned into true positive for CD (n = 16), true negative (n = 7), false negative (n = 1), and false positive (n = 1). Prolactin IPS/P ratio suggested successful IPSS in eight of 11 with abnormal venograms. Baseline prolactin IPS/P ratio was helpful in two patients with abnormal venograms and false-negative (catheterization unsuccessful) or true-negative (catheterization successful) IPSS results; the normalized ratio correctly diagnosed their disease. Normalized ACTH IPS/P ratio was at least 1.3 in all with CD, but prolactin IPS/P ratios were misleadingly low in two. One patient with cyclic EAS had a false-positive IPSS when eucortisolemic (baseline prolactin IPS/P = 1.7; normalized ratio = 5.6). All other EAS patients had normalized ratios no higher than 0.7. CONCLUSION: Prolactin measurement and evaluation of the venogram can improve diagnostic accuracy when IPSS results suggest EAS but is not necessary with positive IPSS results. Confirmation of hypercortisolemia remains a prerequisite for IPSS. A normalized ratio of 0.7-1.3 was not diagnostic. |
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Authors:
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S T Sharma; H Raff; L K Nieman |
Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Intramural Date: 2011-10-26 |
Journal Detail:
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Title: The Journal of clinical endocrinology and metabolism Volume: 96 ISSN: 1945-7197 ISO Abbreviation: J. Clin. Endocrinol. Metab. Publication Date: 2011 Dec |
Date Detail:
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Created Date: 2011-12-06 Completed Date: 2012-02-09 Revised Date: 2013-02-19 |
Medline Journal Info:
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Nlm Unique ID: 0375362 Medline TA: J Clin Endocrinol Metab Country: United States |
Other Details:
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Languages: eng Pagination: 3687-94 Citation Subset: AIM; IM |
Affiliation:
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Program on Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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ACTH Syndrome, Ectopic
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blood,
diagnosis* Adult Aged Cushing Syndrome / blood, diagnosis* Diagnosis, Differential Female Humans Male Middle Aged Petrosal Sinus Sampling / methods* Prolactin / blood* Retrospective Studies |
| Chemical | |
Reg. No./Substance:
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9002-62-4/Prolactin |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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