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However, in case of undetectable or detectable lesion\u2009&lt;\u20096\u00a0mm on MRI, bilateral inferior petrosal sinus sampling (BIPSS) is suggested by current guidelines. Aim of this study was to analyze the performance of CRH, desmopressin and high-dose dexamethasone suppression test (HDDST) in the differential diagnosis of ACTH-dependent Cushing\u2019s syndrome as well as the impact of invasive and noninvasive tests on surgical outcome in patients affected by Cushing\u2019s disease (CD).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Retrospective analysis on 148 patients with CD and 26 patients with ectopic ACTH syndrome.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Among CD patients, negative MRI\/lesion\u2009&lt;\u20096\u00a0mm was detected in 97 patients (Group A); 29 had a 6\u201310\u00a0mm lesion (Group B) and 22 a macroadenoma (Group C). A positive response to CRH test, HDSST and desmopressin test was recorded in 89.4%, 91\u00b74% and 70.1% of cases, respectively. Concordant positive response to both CRH\/HDDST and CRH\/desmopressin tests showed a positive predictive value of 100% for the diagnosis of CD. Among Group A patients with concordant CRH test and HDDST, no difference in surgical outcome was found between patients who performed BIPSS and those who did not (66.6% vs 70.4%, <jats:italic>p<\/jats:italic>\u2009=\u20090.78).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>CRH, desmopressin test and HDDST have high accuracy in the differential diagnosis of ACTH-dependent CS. In patients with microadenoma\u2009&lt;\u20096\u00a0mm or non-visible lesion, a concordant positive response to noninvasive tests seems sufficient to diagnose CD, irrespective of MRI finding. In these patients, BIPSS should be reserved to discordant tests.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s40618-021-01695-1","type":"journal-article","created":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T15:34:37Z","timestamp":1635262477000},"page":"629-637","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Indication to dynamic and invasive testing in Cushing\u2019s disease according to different neuroradiological findings"],"prefix":"10.1007","volume":"45","author":[{"given":"E.","family":"Ferrante","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Barbot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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