Pituitary corticotroph adenoma diagnosis

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Pituitary MRI can localize microadenoma in only 50–60% of the cases as the size of the lesion is very small ¹⁾.

Although, dynamic studies have improved the sensitivity of MRI, it still fails to localize the adenoma in many cases ²⁾.

High Dose Dexamethasone suppression test (HDDST) has low sensitivity (65%) and specificity (60%) in predicting Cushing's disease ³⁾.

Bilateral inferior petrosal sinus sampling (BIPSS) series has shown the sensitivity of 88–100% and specificity of 67–100% in the localization of the Cushing's disease ⁴⁾.

The prediction BIPSS of for lateralization of the lesion in Cushing's disease has been questioned, with accuracies ranging from 50% to 100% ⁵⁾.

Bilateral inferior petrosal sinus sampling (IPSS) with corticotropin-releasing hormone (CRH) is currently the gold standard in the diagnosis of Cushing's disease (CD) and has also been used in tumour lateralization.

To establish a definitive Pituitary corticotroph adenoma diagnosis in the context of pre-existing chronic kidney disease, the absence of circadian rhythms of cortisol and ACTH is a more sensitive indicator than 24-hour urinary free cortisol (24-UFC) and low-dose dexamethasone suppression test ⁶⁾.

¹⁾

Hall WA, Luciano MG, Doppman JL, Patronas NJ, Oldfield EH. Pituitary magnetic resonance imaging in normal human volunteers: Occult adenomas in the general population. Ann Intern Med. 1994;120:817–20.

²⁾

Kaskarelis IS, Tsatalou EG, Benakis SV, Malagari K, Komninos I, Vassiliadi D, et al. Bilateral inferior petrosal sinuses sampling in the routine investigation of Cushing's syndrome: A comparison with MRI. AJR Am J Roentgenol. 2006;187:562–70.

³⁾

Aron DC, Raff H, Findling JW. Effectiveness versus efficacy: The limited value in clinical practice of high dose dexamethasone suppression testing in the differential diagnosis of adrenocorticotropin-dependent Cushing's syndrome. J Clin Endocrinol Metab. 1997;82:1780–5.

⁴⁾

Swearingen B, Katznelson L, Miller K, Grinspoon S, Waltman A, Dorer DJ, et al. Diagnostic errors after inferior petrosal sinus sampling. J Clin Endocrinol Metab. 2004;89:3752–63.

⁵⁾

Newell-Price J, Trainer P, Besser M, Grossman A. The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states. Endocr Rev. 1998;19:647–72.

⁶⁾

Stroud A, Zhang J, McCormack AI. Diagnosing Cushing's disease in the context of chronic kidney disease: A case report and literature review. Eur J Endocrinol. 2019 Aug 1. pii: EJE-19-0326.R2. doi: 10.1530/EJE-19-0326. [Epub ahead of print] PubMed PMID: 31382242.