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Objective <p>Distinguishing between pituitary corticotropin (ACTH)-dependent Cushing disease (CD) and ectopic ACTH-dependent Cushing syndrome (EADCS) is diagnostically challenging. This study compared the diagnostic performance of bilateral inferior petrosal sinus sampling (BIPSS) and bilateral internal jugular vein sampling (BIJVS).</p> Methods <p>We retrospectively reviewed 109 patients at Mayo Clinic (1998–2018) who underwent simultaneous BIPSS and BIJVS. Eighty-four patients proceeded to pituitary surgery based on BIPSS results, and 81 ultimately received confirmed diagnoses: 74 with CD and 7 with EADCS. Sensitivity and specificity were calculated using pre- and post-corticotropin-releasing hormone (CRH) stimulation criteria.</p> Results <p>BIJVS was positive in 35/74 CD patients at baseline and 59/74 post-CRH, compared with 68/74 and 72/74, respectively, for BIPSS. Combined pre- and post-CRH criteria yielded 82% sensitivity and 86% specificity for BIJVS, compared with 100% sensitivity and specificity for BIPSS.</p> Conclusion <p>BIPSS is superior to BIJVS for establishing the source of ACTH hypersecretion in ACTH-dependent Cushing syndrome. BIJVS demonstrates limited diagnostic utility in clinical practice.</p>

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A comparison of bilateral internal jugular vein sampling with bilateral inferior petrosal sinus sampling at Mayo Clinic for the subtype evaluation of corticotropin-dependent cushing syndrome

  • 期刊论文

  • 发表日期：

    2025年10月22日

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  • Derek T. O’Keeffe,
  • Spyridoula Maraka,
  • Anupam Kotwal,
  • Harry Cloft,
  • David F. Kallmes,
  • Irina Bancos,
  • Alice Y. Chang,
  • Dana Erickson,
  • William F. Young

摘要

Objective

Distinguishing between pituitary corticotropin (ACTH)-dependent Cushing disease (CD) and ectopic ACTH-dependent Cushing syndrome (EADCS) is diagnostically challenging. This study compared the diagnostic performance of bilateral inferior petrosal sinus sampling (BIPSS) and bilateral internal jugular vein sampling (BIJVS).

Methods

We retrospectively reviewed 109 patients at Mayo Clinic (1998–2018) who underwent simultaneous BIPSS and BIJVS. Eighty-four patients proceeded to pituitary surgery based on BIPSS results, and 81 ultimately received confirmed diagnoses: 74 with CD and 7 with EADCS. Sensitivity and specificity were calculated using pre- and post-corticotropin-releasing hormone (CRH) stimulation criteria.

Results

BIJVS was positive in 35/74 CD patients at baseline and 59/74 post-CRH, compared with 68/74 and 72/74, respectively, for BIPSS. Combined pre- and post-CRH criteria yielded 82% sensitivity and 86% specificity for BIJVS, compared with 100% sensitivity and specificity for BIPSS.

Conclusion

BIPSS is superior to BIJVS for establishing the source of ACTH hypersecretion in ACTH-dependent Cushing syndrome. BIJVS demonstrates limited diagnostic utility in clinical practice.