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Endocrine Abstracts (2023) 90 EP686 | DOI: 10.1530/endoabs.90.EP686

1Gregorio Marañón Hospital, Endocrinology and Nutrition, Madrid, Spain; 2Rey Juan Carlos Hospital, Endocrinology and Nutrition, Móstoles, Spain

Background: Inferior petrosal sinus sampling (IPSS) is indicated in the diagnosis of adrenocor-ticotropic hormone (ACTH)-dependent Cushing’s syndrome (CS), especially when the results of the initial diagnostic tests are discordant.

Objective: To describe the patients who underwent this invasive functional test in a tertiary hospital.

Methods: This was an observational study of a retrospective cohort of patients with ACTH- dependent CS and IPSS between 2004 and 2022. We determined their epidemiological, hormonal, radiological and functional characteristics, and evaluated their diagnostic capacity and optimal cut-off points to differentiate between Cushing’s disease (CD) and ectopic Cushing’s syndrome (ECS).

Results: 31 patients were evaluated. It was observed an ACTH secretion of a pituitary origin in 80% of cases and an ectopic origin in 20%. Patients with CD were more frequent female (64%) and those with ECS were mostly male (83.3%). There were no differences between age of diagnosis. Plasma cortisol, urinary free cortisol, and ACTH levels were higher in patients with ECS. Most IPSS were done before going to a definitive surgical treatment, so only 12.9% IPSS were done after surgery, meaning that persistence or recurrence of hypercortisolisim was detected during follow-up. Regarding radiological findings, patients with IPSS gradient ACTH C/P compatible with CD (>2 basal or >3 after CRH stimulation) had a visible adenoma in 40% of cases, with a median size of 4 (2.5–5.0) mm. On the other hand, patients with a IPSS gradient of ECS had 33% cases of MRI positive, with a median adenoma size of 7 (7.0–7.0) mm.

Conclusion: ACTH-dependent CS can be a difficult entity to diagnose for clinicians. Clinical, biochemical and radiological characteristics of patients provide an approach to etiologic diagnosis but not in all cases. IPSS with CRH stimulation is a test with a high diagnostic accuracy and it is particularly recommended in patients with negative MRI or with adenoma smaller than 6–10 mm.

Volume 90

25th European Congress of Endocrinology

Istanbul, Turkey
13 May 2023 - 16 May 2023

European Society of Endocrinology 

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