Desmopressin test during petrosal sinus sampling: a valuable tool to discriminate pituitary or ectopic ACTH-dependent Cushing’s syndrome

Castinetti, Frédéric; Morange, Isabelle; Dufour, Henry; Jaquet, P; Conte-Devolx, B.; Girard, Nadine; Brue, Thierry

doi:10.1530/eje-07-0215

Cited by 96 publications

(69 citation statements)

References 36 publications

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“…Desmopressin has been used alone for stimulation of corticotrophs during BIPSS with satisfactory results. 10 Neither CRH nor desmopressin is available in India.…”

Section: Discussionmentioning

confidence: 99%

Inferior petrosal sinus sampling: Final solution to a riddle called “Cushing's syndrome”

Kharb

Gundgurthi

Pandit

et al. 2013

Medical Journal Armed Forces India

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“…Desmopressin has been used alone for stimulation of corticotrophs during BIPSS with satisfactory results. 10 Neither CRH nor desmopressin is available in India.…”

Section: Discussionmentioning

confidence: 99%

Inferior petrosal sinus sampling: Final solution to a riddle called “Cushing's syndrome”

Kharb

Gundgurthi

Pandit

et al. 2013

Medical Journal Armed Forces India

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“…3 (poststimulation ACTH), suggesting excessive ACTH secretion may be from a pituitary tumor; right IPS: left IPS .1.4, suggesting the tumor was located in the right pituitary (table e-2). 7 Then, enhanced MRI of the pituitary showed abnormal signal lesions on the right side of the pituitary, suggesting a pituitary tumor ( figure, H and I); the enhanced adrenal CT image showed bilateral adrenal hyperplasia and multiple stones in the kidneys; PET-CT and chest CT revealed no ectopic ACTH tumors.…”

Section: Supplemental Data At Neurologyorgmentioning

confidence: 98%

Clinical Reasoning: A 43-year-old woman with right limb weakness

Zhang

Liu

et al. 2017

Neurology

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A 43-year-old woman presented with a 4-day history of right limb weakness. While biking 4 days earlier, she felt a weakness in her right hand and leg. She had a history of hypertension for more than 2 years, and was taking extended-release nifedipine tablets (40 mg) and perindopril (4 mg) daily, but her blood pressure was difficult to control (fluctuations of 150-180/90-115 mm Hg). The patient did not smoke or drink alcohol, and had no family history of similar diseases.Clinical examination revealed a blood pressure of 154/98 mm Hg, facial acne, abdominal obesity, and ecchymosis on the upper limbs (figure, A and B).The Medical Research Council power was 4/5 on the flexor and extensor of the right hip, knee, and ankle. No other nervous system abnormalities were observed. The random blood glucose level was 14.38 mmol/L. Brain MRI revealed acute infarctions in the left thalamus and right occipital lobe, subacute infarctions in the left cerebellum, and old infarctions in the periventricular and centrum semiovale (figure, C and D). A middle-aged woman presented with primary symptoms of right limb weakness. Brain MRI revealed multiple infarctions involving bilateral, anterior, and posterior cerebral circulation, as well as old and new lesions, suggesting recurrent cerebral infarction. Thorough examinations were needed to determine the cause of illness. According to the Trial of Org 10172 in Acute Stroke Treatment criteria, acute ischemic stroke is classified into the following 5 subtypes: (1) largeartery atherosclerosis, (2) cardioembolism, (3) small-artery occlusion (lacune), (4) stroke of other determined etiology, and (5) stroke of undetermined etiology.1 Ischemic stroke caused by atherosclerosis or heart disease comprises more than 60% of patients, and diagnosis is easily established by routine examinations, including basic laboratory testing, brain CT and MRI, echocardiogram, and ultrasonography of the carotid arteries. However, for young stroke patients (,50 years of age) without traditional vascular risk factors and a large clot burden, some relatively rare etiologies should be considered, such as thrombophilia, paradoxical embolism, arterial dissection, and unusual arteriopathies. [2][3][4] To exclude large-artery atherosclerosis, carotid artery CT angiography was utilized, which revealed no significant findings. Twenty-four-hour Holter cardiac rhythm monitoring indicated no atrial fibrillation. Transcranial Doppler (TCD) with saline contrast medium suggested a right-to-left shunt ( figure, E). Therefore, transesophageal echocardiography was conducted, revealing a small secundum atrial septal defect (ASD) in the patient's heart (figure, F and G). In patients with ischemic stroke of undetermined origin, cardiac right-to-left shunt occurs when there is a heart defect (i.e., patent foramen ovale or ASD), suggesting cerebral paradoxical embolism. 5Although the patient underwent an arteriovenous ultrasound scan of the 4 limbs, no embolism was found. However, CT image of the abdomen showed thrombosis in the left p...

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“…dependent CS [64][65][66]. On the other hand, all patients of ectopic Cushing's syndrome had a ratio of <2 with a specificity of 100%.…”

Section: /12mentioning

confidence: 99%

Endocrine Paraneoplastic Syndromes: A Review

Arabi¹

2015

EMIJ

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It is important for the endocrinologist and oncologist to recognize these paraneoplastic endocrine syndromes since this may help in defining the cancer type and hence lead to the appropriate management. In addition, these syndromes are a major cause of morbidity and mortality. Moreover, AbstractParaneoplastic endocrine syndromes result from ectopic production of hormones by different tumors. Hypercalcemia of malignancy is the most common, mostly caused by ectopic parathyroid hormone related peptide (PTHrP) production which increases bone resorption. Other causes include the rare ectopic parathyroid hormone (PTH) production, ectopic production of 1, 25-(OH)2 vitamin D by the tumor and its adjacent macrophages and bone metastasis which by itself in addition to the local production of PTHrP at the level of the bone lead to bone resorption and thus hypercalcemia. Treatment includes extracellular fluid volume repletion, bisphosphonates or denosumab and calcitonin. Ectopic Cushing's syndrome caused by ectopic ACTH production results in hypokalemia, proximal muscle weakness, easy bruisability, hypertension, diabetes and psychiatric abnormalities including depression and mood disorders. Different diagnostic measures help to differentiate Cushing's disease from ectopic Cushing's syndrome. Treatment includes surgical resection of tumor and medical therapy to suppress excess cortisol production. Ectopic secretion of ADH has been associated with different tumor types. The best treatment options include removal of the underlying tumor, chemotherapy, or radiotherapy in addition to free water restriction, demeclocycline and vaptans. Ectopic growth hormone releasing hormone secretion has been identified with carcinoids, phechromocytoma and other tumors. Surgery is the mainstay of therapy with systemic therapy used in metastatic disease. Other rare ectopic hormone syndromes have also been identified including ectopic prolactin, ectopic erythropoietin, and thrombopoetin in addition to others. Keywords 2/12paraneoplastic endocrine syndromes may be the first presenting feature of malignancy [2,3]. This paper provides an overview on the common PNES, their prevalence, diagnosis, prognosis and response to treatment (Table 1). Methodology of Literature SearchEligible studies were identified by a search, from year 1920 up till February 2014, in Medline, PUBMED and EMBASE using a refined search strategy with several terms used including "endocrine paraneoplastic syndromes", "ectopic hormones", "humoral hypercalcemia of malignancy", "ectopic parathyroid hormone related peptide", "ectopic ACTH", "ectopic Cushing syndrome", "ectopic antidiuretic hormone", "syndrome of inappropriate ADH", "ectopic growth hormone releasing hormone", "ectopic growth hormone", "ectopic prolactin", "ectopic thyroid stimulating hormone" in addition to several others. In addition, searches of personal collections and the reference lists of eligible studies were identified with their full text papers being retrieved. A-Hypercalcemia of MalignancyHistorical Perspec...

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Desmopressin test during petrosal sinus sampling: a valuable tool to discriminate pituitary or ectopic ACTH-dependent Cushing’s syndrome

Cited by 96 publications

References 36 publications

Inferior petrosal sinus sampling: Final solution to a riddle called “Cushing's syndrome”

Inferior petrosal sinus sampling: Final solution to a riddle called “Cushing's syndrome”

Clinical Reasoning: A 43-year-old woman with right limb weakness

Endocrine Paraneoplastic Syndromes: A Review

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