| Is whole-lung CT scanning still necessary in all cases of ACTH-dependent Cushing's syndrome in the era of petrosal sinus sampling? | |
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MedLine Citation:
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PMID: 10616709 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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We reviewed 31 patients in whom both bilateral inferior petrosal sinus sampling without CRH stimulation, and a CT scan of the lungs were done. Twenty-five had normal lung CT scans, of whom 23 had a higher inferior petrosal sinus: peripheral ACTH ratio > or = 1.5. After careful follow-up, none was subsequently shown to have ectopic ACTH syndrome. Six had abnormal lung CT scans, of whom two had ratios > or = 1.5. In these two patients, other investigations suggested pituitary disease, and pituitary surgery led to apparent cure. Of the remaining four patients, who had ratios < 1.5, two had incidental lung findings, and pituitary abnormalities were demonstrated at pituitary surgery. The third underwent bilateral adrenalectomy, and no evidence of ectopic ACTH syndrome has emerged as yet after 4 years follow-up. The fourth had a small-cell carcinoma of the lung, confirmed histologically. Our series suggests that whole-lung CT scanning is only necessary in cases of ACTH-dependent Cushing's syndrome where bilateral inferior petrosal sinus sampling has not demonstrated a significant increase in petrosal sinus ACTH levels as compared with the peripheral level. Thus, in our experience the test is now only necessary in those patients (approximately 25%) where the ratio is < or = 1.5. |
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Authors:
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A Heaney; G Loughrey; D McCance; E McIlrath; D Hadden; L Kennedy; B Sheridan; A B Atkinson |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: QJM : monthly journal of the Association of Physicians Volume: 92 ISSN: 1460-2725 ISO Abbreviation: QJM Publication Date: 1999 Jun |
Date Detail:
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Created Date: 2000-01-31 Completed Date: 2000-01-31 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9438285 Medline TA: QJM Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 335-40 Citation Subset: IM |
Affiliation:
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Sir George E. Clark Metabolic Unit, Royal Victoria Hospital, Belfast, UK. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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ACTH Syndrome, Ectopic
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diagnosis* Adrenocorticotropic Hormone / blood Adult Biological Markers / blood Cushing Syndrome / diagnosis* Female Humans Lung Diseases / blood, radiography* Male Petrosal Sinus Sampling* Tomography, X-Ray Computed* |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 9002-60-2/Adrenocorticotropic Hormone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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