Is diagnosis of Cushing’s disease moving beyond Bilateral inferior petrosal sinus sampling?

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ID: 320193
2026
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Abstract
BACKGROUND AND OBJECTIVE: Bilateral inferior petrosal sinus sampling (BIPSS) is the gold standard for distinguishing Cushing's Disease (CD) from Ectopic ACTH syndrome (EAS). It is however rarely evaluated in an intention-to diagnose-analysis, even though final diagnosis remains inconclusive in 7 to 39% of patients in published series. It has been suggested that BIPSS use may be reduced in patients explored by modern imaging and hormonal testing. We tested this hypothesis. DESIGN AND METHODS: Evolution of BIPSS use and diagnostic outcomes over time in a single-center retrospective study of 229 consecutive patients with ACTH-dependent-Cushing's syndrome (ACTH-CS) without evident endocrine tumors, explored from 1992 to 2021 with hormonal testing (n = 229); pituitary MRI (n = 226) or CT (n = 3); chest/abdominal CT scan (n = 114) and BIPSS (n = 113).In an intention-to-diagnose analysis, we classified outcomes as confirmed CD (cCD) or EAS (cEAS) if there was post-therapeutic evidence of an ACTH-secreting tumor, and suspected CD (sCD) or EAS (sEAS) if not, resulting in 196 cCD (86%), 24 sCD (10%), 5 cEAS (2%), 4 sEAS (2%). RESULTS: Comparing the 3 decades 1992-2001; 2002-2011; 2012-2021, the use of BIPSS decreased from 68% to 49% and 26%, while the frequency of a typical adenoma image at MRI increased from 40% to 58% and 69%. The proportion of patients with cCD (83%; 81%; 93%) remained stable. CONCLUSION: Our study demonstrates a decrease over time in the use of BIPSS without loss of efficacy in diagnosis of CD, suggesting that advances in imaging allow for a safe reduction in the indications for BIPSS.
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Authors Louise Bouchard, Arnaud Lazard, C Jean, Olivier Heck, V. Lefournier, Nathalie Stürm, Benoît Chovelon, Patrice Faure, Marie muller, Emmanuel Gay, Olivier Chabre, Justine Cristante
Journal the journal of clinical endocrinology & metabolism
Year 2026
DOI
10.1210/clinem/dgag265
URL
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