Response to letter to the editor from Lu and Cong: “Is diagnosis of Cushing's disease moving beyond bilateral inferior petrosal sinus sampling?”

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ID: 337353
2026
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Abstract
To the Editor, We thank Lu and Cong for their critical analysis (1) of our study (2). We believe, however, that several points in their letter may result from a misunderstanding of our study methodology or conclusions. First, there appears to be some ambiguity: the authors state that bilateral inferior petrosal sinus sampling (BIPSS) is recommended for “high-risk patients with negative pituitary MRI, lesions <10 mm,” while also referring to typical microadenomas, by definition <10 mm, as a low-risk ectopic ACTH syndrome (EAS) subgroup that may be exempt from BIPSS. Thus, it remains unclear whether Lu and Cong propose BIPSS for microadenomas and whom they consider at “high risk” of EAS. The authors then state that “the decreased utilization of BIPSS merely reflects an increase in exempt cases, rather than validating MRI as a sufficient replacement for BIPSS in high-risk populations”: this is, in fact, consistent with our main conclusion. The increase in patients managed without BIPSS is linked to improved pituitary magnetic resonance imaging (MRI) performance, leading to better recognition of patients at low risk of EAS.
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openalex_W7223846851 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Justine Cristante, Louise Bouchard, Arnaud Lazard, Marie Muller, Olivier Heck, Emmanuel Gay, Olivier Chabre
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Journal the journal of clinical endocrinology & metabolism
Year 2026
DOI
10.1210/clinem/dgag424
URL
https://doi.org/10.1210/clinem/dgag424
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