Abstract
The differential diagnosis of ACTH dependent Cushing's syndrome (85% of patients) can be very difficult. Localization of an ACTH source is not always possible with CAT-scan and MRI imaging. A bilateral catheterization of the inferior petrosal sinus with blood sampling for ACTH/LPH during a CRH test has been used for localizing a pituitary adenoma. ACTH was measured with a solid-phase antiserum against the 11-24 sequence of ACTH (sensitivity 16-32 pg/ml). For β-LPH, the reagents of NIAMDD have been used. Samples were obtained before and at 5-min. intervals for up to 30 min. after injection of CRH, 100 ug/1.73 m2. In 18 of 21 patients, a pituitary ACTH source could be proven and in 16 an adenoma localized. In 12 of 18, peripheral ACTH levels were <100 pg/ml (6 <40 pg/ ml). Mean basal/peak ACTH (LPH) pg/ml: Periphery 87/256 (551/845), tumorside 899/1870 (3424/11572), contralateral 427/647 (1467/ 2034). In 6 of 18 patients, only CRH stimulated levels pointed to the correct side. The mean Δ ACTH (LPH)(ipsilateral to contralateral) increased from 172 (1957) before to 1223 (9529) after CRH. In conclusion, selective catheterization and ACTH/LPH assay after CRH is valuable for detecting the ACTH source and thus allows a selective surgery, preserving the pituitary tissue, which is of outmost importance, especially in the pediatric age group.
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Girard, J., Landolt, A., Valavanis, A. et al. CUSHING'S SYNDROME, IDENTIFICATION OF ACTH SOURCE BY SELECTIVE CATHETERIZATION AND ACTH AND β-LPH ASSAYS. Pediatr Res 23, 129 (1988). https://doi.org/10.1203/00006450-198801000-00167
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DOI: https://doi.org/10.1203/00006450-198801000-00167