Korean J Med.  2002 May;62(5):557-565.

Two cases of Cushing's syndrome diagnosed by IPSS with normal or low plasma ACTH

• Moon TG
• Nam DG
• Moon JH
• Hwang JY
• Kim JH
• An JK
• Son SM
• Kim IJ
• Kim YK
• Kim HJ
• Cho YG

Abstract

Cushing's syndrome results from prolonged exposure to high levels of glucocorticoid hormones. ACTH-dependent Cushing's syndrome accounts for about 85% of endogenous causes. Autonomous pituitary ACTH secretion, called Cushing's disease, is responsible for 80% of these causes, whereas ectopic ACTH secretion is responsible for 20% of them. Appropriate therapy of patients with Cushing's syndrome depends on accurate diagnosis and classification of the disorder. In addition to the history and clinical evaluation, the laboratory evaluation of a patient with Cushingoid appearance is necessary to establish the diagnosis and determine the cause of hypercortisolism. A major problem in the differential diagnosis of ACTH-dependent Cushing's syndrome is distinguishing Cushing's disease from the ectopic ACTH syndrome. Both entities can have similar clinical and laboratory features. In addition, both pituitary microadenoma and ectopic ACTH-secreting tumors may be radiologically occult. Bilateral inferior petrosal sinus and peripheral vein catheterization with simultaneous collection of samples for measurement of ACTH is one of the most specific tests available to localize the source of ACTH production. We report two cases of Cushing's syndrome diagnosed by inferior petrosal sinus sampling associated with normal or low ACTH levels on routine basal hormone assay.

Keyword

Cushing syndrome; Petrosal sinus sampling; Corticotropin

MeSH Terms

ACTH Syndrome, Ectopic
Adrenocorticotropic Hormone*
Catheterization
Catheters
Classification
Cushing Syndrome*
Diagnosis
Diagnosis, Differential
Humans
Petrosal Sinus Sampling
Plasma*
Veins
Adrenocorticotropic Hormone