Experience with selective venous sampling in diagnosis of ACTH-dependent Cushing's syndrome.

Abstract

Twenty-three patients with adrenocorticotrophichormone-(ACTH)-dependent Cushing's syndrome were subjected to selective venous catheterisation and sampling for ACTH on a total of 26 occasions. Out of 10 patients with pituitary-dependent disease, nine had raised ACTH concentrations in one or both high internal jugular vein samples. Eight patients had 11 proved sites of ectopic hormone production: of these, six were correctly identified by the sampling technique, and in four of them this was the only accurate method of localisation. The results of one catheterisation were misleading, and on 10 occasions they were inconclusive; five patients remained undiagnosed by any method. Overall, 15 of the 26 catheterisations provided diagnostically valuable information.Selective venous catheterisation and sampling for ACTH is effective in confirming a pituitary source of the hormone and may be valuable in locating the source of ectopic ACTH production in some cases.

ACTH Determination in a Petrosal Sinus Venous Specimen after Corticotrophin Releasing Factor Provides the Best Clue on the Laterality of Microadenoma in Cushing's Disease.

“…Early works on unilateral inferior petrosal sinus and jugular vein sampling (Corrigan et al, 1977;Findling et al, 1981;Drury et al, 1982) have emphasized the importance of bilateral simultaneous inferior petrosal venous sampling which should be performed if more reliance is to be placed on the results (Manni et al, 1983;Doppman et al, 1984;Oldfield et al, 1985;Zovickian et al, 1988). It has also been reported subsequently that bilateral inferior venous sampling may give rise to false negatives (Cuneo et al, 1985;Kageyama et al, 1985).…”

“…Selective venous sampling from the inferior petrosal sinus has been reported as a reliable and useful method to establish the presence and laterality of ACTH-secreting microadenomas (Corrigan et al, 1977;Findling et al, 1981;Drury et al, 1982;Manni et al, 1983;Doppman et al, 1984Zovickian et al, 1988). However, there is still uncertainty regarding the interpretation of the data obtained by this technique Cuneo et al, 1985;Kageyama et al, 1985;Ludeck 1988).…”

Successful localization of ectopic ACTH-secreting bronchial carcinoid by selective pulmonary arterial sampling

“…In fact, pulmonary venous sampling and/or biopsy of the lung tumor have been attempted in certain EAS patients to confirm the ectopic ACTH source [2, 7-9, 14, 15]. However, selective blood sampling from the pulmonary vein via left-sided heart catheterization failed to localize the ectopic ACTH source in many EAS cases with bronchial carcinoids [7][8][9]. In addition, pulmonary venous sampling intraoperatively [16] or via thoracoscopic approach [17] is considered too invasive maneuvers to perform for the localization of the ectopic ACTH source in such patients with the suspected bronchial carcinoid tumors.…”

“…However, preoperative venous sampling from the effluent veins of the culprit tumors has not been successful for localization of occult EAS in most cases thus far reported [7][8][9]. We herein describe for the first time a case of EAS caused by a small bronchial carcinoid tumor, which could not be confirmed by any functional imaging tests, but was successfully localized by a selective pulmonary arterial sampling by demonstration of a marked ACTH gradient in the "wedged" blood in the branch of a pulmonary artery affecting the culprit lesion.…”

Is it Possible to Diagnose Pituitary-Dependent Cushing's Disease?

“…11,12,48,49 A sampling catheter is introduced via the femoral vein and manipulated under radiological control through the great veins to take samples for ACfH (or any other 'tumour marker') at a number of selected sites in an attempt to demonstrate a gradient of ACTH concentration. Samples are taken from the proximal internal jugular vein, or better still, inferior petrosal sinus, to detect pituitary ACfH production; samples are also taken from many other veins draining the neck, mediastinum, liver and adrenals, and those near any suspicious lesion identified radiologically previously.…”