{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T19:33:30Z","timestamp":1790969610376,"version":"4.1.0"},"reference-count":33,"publisher":"Georg Thieme Verlag KG","issue":"09","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Horm Metab Res"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>We aimed to evaluate the utility of simple, cost-effective, and non-invasive\n                    strategies alternative to BIPSS and peripheral CRH stimulation in differential\n                    diagnosis of ACTH-dependent CS. First, we performed ROC analysis to evaluate the\n                    performance of various tests for differential diagnosis of ACTH-dependent CS in\n                    our cohort (CD, n=76 and EAS, n=23) and derived their optimal\n                    cut-offs. Subsequently, combining various demographic (gender), clinical\n                    (hypokalemia), biochemical (plasma ACTH, HDDST, peripheral CRH stimulation) and\n                    imaging (MRI pituitary) parameters, we derived non-invasive models with\n                    100% PPV for CD. Patients with pituitary macroadenoma (n=14)\n                    were excluded from the analysis involving non-invasive models. Relative percent\n                    ACTH (AUC: 0.933) and cortisol (AUC: 0.975) increase on peripheral CRH\n                    stimulation demonstrated excellent accuracy in discriminating CD from EAS. Best\n                    cut-offs for CD were plasma ACTH&lt;97.3\u2009pg\/ml,\n                    HDDST\u226557% cortisol suppression, CRH\n                    stimulation\u226577% ACTH increase and\u226511% cortisol\n                    increase. We derived six models that provided 100% PPV for CD and\n                    precluded the need for BIPPS in 35\/85 (41.2%) patients with\n                    ACTH-dependent CS and no macroadenoma (in whom BIPSS would have otherwise been\n                    recommended). The first three models included basic parameters and avoided both\n                    peripheral CRH stimulation and BIPSS in 19 (22.4%) patients, while the\n                    next three models included peripheral CRH stimulation and avoided BIPSS in\n                    another 16 (18.8%) patients. Using simple and non-invasive alternative\n                    strategies, BIPSS can be avoided in 41% and peripheral CRH stimulation\n                    in 22% of patients with ACTH-dependent CS and no macroadenoma; such\n                    patients can be directly referred for a pituitary surgery.<\/jats:p>","DOI":"10.1055\/a-2236-0864","type":"journal-article","created":{"date-parts":[[2023,12,28]],"date-time":"2023-12-28T23:52:47Z","timestamp":1703807567000},"page":"633-640","source":"Crossref","is-referenced-by-count":1,"title":["Utility of Simple and Non-Invasive Strategies Alternative to Inferior\n                    Petrosal Sinus Sampling and Peripheral CRH Stimulation in Differential Diagnosis\n                    of ACTH-Dependent Cushing Syndrome"],"prefix":"10.1055","volume":"56","author":[{"given":"Bhawna","family":"Attri","sequence":"first","affiliation":[{"name":"Endocrinology and Metabolism, All India Institute of Medical Sciences,\n                    New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alpesh","family":"Goyal","sequence":"first","affiliation":[{"name":"Endocrinology and Metabolism, All India Institute of Medical Sciences,\n                    New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mani","family":"Kalaivani","sequence":"additional","affiliation":[{"name":"Biostatistics, All India Institute of Medical Sciences, New Delhi,\n                    India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devasenathipathy","family":"Kandasamy","sequence":"additional","affiliation":[{"name":"Radiodiagnosis, All India Institute of Medical Sciences, New Delhi,\n                    India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yashdeep","family":"Gupta","sequence":"additional","affiliation":[{"name":"Endocrinology and Metabolism, All India Institute of Medical Sciences,\n                    New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shipra","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Pathology, All India Institute of Medical Sciences, New Delhi,\n                    India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamim A.","family":"Shamim","sequence":"additional","affiliation":[{"name":"Nuclear Medicine, All India Institute of Medical Sciences, New Delhi,\n                    India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishikant","family":"Damle","sequence":"additional","affiliation":[{"name":"Nuclear Medicine, All India Institute of Medical Sciences, New Delhi,\n                    India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehar Chand","family":"Sharma","sequence":"additional","affiliation":[{"name":"Pathology, All India Institute of Medical Sciences, New Delhi,\n                    India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viveka P.","family":"Jyotsna","sequence":"additional","affiliation":[{"name":"Endocrinology and Metabolism, All India Institute of Medical Sciences,\n                    New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Suri","sequence":"additional","affiliation":[{"name":"Neurosurgery, All India Institute of Medical Sciences, New Delhi,\n                    India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikhil","family":"Tandon","sequence":"additional","affiliation":[{"name":"Endocrinology and Metabolism, All India Institute of Medical Sciences,\n                    New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,2,16]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1210\/endrev\/bnab046","article-title":"Molecular derangements and the diagnosis of ACTH-dependent Cushing's\n                    syndrome","volume":"43","author":"L K Nieman","year":"2022","journal-title":"Endocr Rev"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1007\/s40618-021-01695-1","article-title":"Indication to dynamic and invasive testing in Cushing's disease\n                    according to different neuroradiological findings","volume":"45","author":"E Ferrante","year":"2022","journal-title":"J Endocrinol Invest"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"2807","DOI":"10.1210\/jc.2015-1818","article-title":"Treatment of Cushing\u2019s syndrome: an endocrine society clinical practice\n                    guideline","volume":"100","author":"L K Nieman","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.ecl.2018.01.005","article-title":"The ectopic adrenocorticotropic hormone syndrome: rarely easy, always\n                    challenging","volume":"47","author":"A R Hayes","year":"2018","journal-title":"Endocrinol Metab Clin North Am"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"R12","DOI":"10.1530\/EC-16-0029","article-title":"Bilateral inferior petrosal sinus sampling","volume":"5","author":"B Zampetti","year":"2016","journal-title":"Endocr Connect"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/S2213-8587(21)00235-7","article-title":"Consensus on diagnosis and management of Cushing's disease: a guideline\n                    update","volume":"9","author":"M Fleseriu","year":"2021","journal-title":"Lancet Diabetes Endocrinol"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"99","DOI":"10.4103\/2230-8210.126586","article-title":"Etiology and clinical profile of patients with Cushing's syndrome: A\n                    single center experience","volume":"18","author":"A C Ammini","year":"2014","journal-title":"Indian J Endocrinol Metab"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.3390\/jcm8111951","article-title":"Cushing's disease","volume":"8","author":"H Nishioka","year":"2019","journal-title":"J Clin Med"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"3752","DOI":"10.1210\/jc.2003-032249","article-title":"Diagnostic errors after inferior petrosal sinus sampling","volume":"89","author":"B Swearingen","year":"2004","journal-title":"J Clin Endocrinol Metab"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1093\/ejendo\/lvad050","article-title":"Bilateral inferior petrosal sinus sampling with human CRH stimulation in\n                    ACTH-dependent Cushing\u2019s syndrome: results from a retrospective\n                    multicenter study","volume":"188","author":"M Detomas","year":"2023","journal-title":"Eur J Endocrinol"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"2189","DOI":"10.1007\/s40618-023-02113-4","article-title":"Shortage of hCRH for the diagnosis of endogenous CS: the end of an era or the\n                    beginning of a new journey?","volume":"46","author":"F Ceccato","year":"2023","journal-title":"J Endocrinol Invest"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1007\/s12020-022-03298-z","article-title":"Clinical profile and treatment outcomes of patients with ectopic ACTH syndrome\n                    compared to Cushing disease: a single-center experience","volume":"80","author":"B Attri","year":"2023","journal-title":"Endocrine"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/S0889-8529(05)70280-2","article-title":"Clinical and biochemical evaluation of Cushing's syndrome","volume":"26","author":"C A Meier","year":"1997","journal-title":"Endocrinol Metab Clin North Am"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"dgaa409","DOI":"10.1210\/clinem\/dgaa409","article-title":"Non-invasive diagnostic strategy in ACTH-dependent Cushing's\n                    syndrome","volume":"105","author":"C Frete","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1007\/s12020-022-03081-0","article-title":"A noninvasive scoring model for the differential diagnosis of ACTH-dependent\n                    Cushing's syndrome: a retrospective analysis of 311 patients based on\n                    easy-to-use parameters","volume":"78","author":"X Lyu","year":"2022","journal-title":"Endocrine"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1007\/s11154-022-09723-y","article-title":"Diagnostic accuracy of bilateral inferior petrosal sinus sampling using\n                    desmopressin or corticotropic- releasing hormone in ACTH-dependent\n                    Cushing's syndrome: a systematic review and meta-analysis","volume":"23","author":"M Valizadeh","year":"2022","journal-title":"Rev Endocr Metab Disord"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"dgz194","DOI":"10.1210\/clinem\/dgz194","article-title":"The optimal cut-off of BIPSS in differential diagnosis of ACTH-dependent\n                    Cushing's syndrome: is stimulation necessary?","volume":"105","author":"S Chen","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"e178","DOI":"10.1210\/clinem\/dgac686","article-title":"Dynamic testing for differential diagnosis of ACTH-dependent Cushing syndrome: a\n                    systematic review and meta-analysis","volume":"108","author":"F Ceccato","year":"2023","journal-title":"J Clin Endocrinol Metab"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"R201","DOI":"10.1530\/EJE-18-0007","article-title":"Diagnosis of endocrine disease: the role of the desmopressin test in the\n                    diagnosis and follow-up of Cushing's syndrome","volume":"178","author":"D A Vassiliadi","year":"2018","journal-title":"Eur J Endocrinol"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1046\/j.1365-2265.2001.01260.x","article-title":"The limited value of the desmopressin test in the diagnostic approach to\n                    Cushing's syndrome","volume":"54","author":"M Terzolo","year":"2001","journal-title":"Clin Endocrinol (Oxf)"},{"key":"ref22","first-page":"1780","article-title":"Effectiveness versus efficacy: the limited value in clinical practice of high\n                    dose dexamethasone suppression testing in the differential diagnosis of\n                    adrenocorticotropin-dependent Cushing's syndrome","volume":"82","author":"D C Aron","year":"1997","journal-title":"J Clin Endocrinol Metab"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"S317","DOI":"10.4103\/2230-8210.86974","article-title":"Cushing's syndrome: Stepwise approach to diagnosis","volume":"15","author":"A R Lila","year":"2011","journal-title":"Indian J Endocrinol Metab"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/j.eprac.2022.04.013","article-title":"Limited invasive protocol: optimizing diagnostic modalities in corticotropin\n                    mediated Cushing syndrome","volume":"28","author":"R Gupta","year":"2022","journal-title":"Endocr Pract"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"R29","DOI":"10.1530\/EJE-19-0877","article-title":"Management of endocrine disease: Cushing's syndrome due to ectopic ACTH\n                    secretion: an expert operational opinion","volume":"182","author":"J Young","year":"2020","journal-title":"Eur J Endocrinol"},{"key":"ref26","first-page":"647","article-title":"The diagnosis and differential diagnosis of Cushing\u2019s syndrome and\n                    pseudo-Cushing\u2019s states","volume":"19","author":"J Newell- Price","year":"1998","journal-title":"Endocr Rev"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1172\/JCI118547","article-title":"The pituitary V3 vasopressin receptor and the corticotroph phenotype in ectopic\n                    ACTH syndrome","volume":"97","author":"Y de Keyzer","year":"1996","journal-title":"J Clin Invest"},{"key":"ref28","first-page":"1640","article-title":"Optimal response criteria for the human CRH test in the differential diagnosis\n                    of ACTH-dependent Cushing\u2019s syndrome","volume":"87","author":"J Newell-Price","year":"2002","journal-title":"J Clin Endocrinol Metab"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"955945","DOI":"10.3389\/fendo.2022.955945","article-title":"Outcome of CRH stimulation test and overnight 8 mg dexamethasone suppression\n                    test in 469 patients with ACTH-dependent Cushing\u2019s syndrome","volume":"13","author":"M Detomas","year":"2022","journal-title":"Front Endocrinol"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"dgaa564","DOI":"10.1210\/clinem\/dgaa564","article-title":"Human corticotropin-releasing hormone tests: 10 years of real-life experience in\n                    pituitary and adrenal disease","volume":"105","author":"F Ceccato","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"1230447","DOI":"10.3389\/fendo.2023.1230447","article-title":"Emerging diagnostic methods and imaging modalities in cushing's\n                    syndrome","volume":"14","author":"K Wright","year":"2023","journal-title":"Front Endocrinol (Lausanne)"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"e1816","DOI":"10.1210\/clinem\/dgaa755","article-title":"Molecular imaging targeting corticotropin-releasing hormone receptor for\n                    corticotropinoma: a changing paradigm","volume":"106","author":"R Walia","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-023-02128-x","article-title":"Erythropoiesis in Cushing syndrome: sex-related and subtype-specific\n                    differences. Results from a monocentric study","author":"M Detomas","year":"2023","journal-title":"J Endocrinol Invest"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1530\/EJE-22-0211","article-title":"Subtype-specific pattern of white blood cell differential in endogenous\n                    hypercortisolism","volume":"187","author":"M Detomas","year":"2022","journal-title":"Eur J Endocrinol"}],"container-title":["Hormone and Metabolic Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2236-0864.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T10:27:00Z","timestamp":1730802420000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2236-0864"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,28]]},"references-count":33,"journal-issue":{"issue":"09","published-online":{"date-parts":[[2024,9,3]]},"published-print":{"date-parts":[[2024,9]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2236-0864","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0018-5043","1439-4286"],"issn-type":[{"value":"0018-5043","type":"print"},{"value":"1439-4286","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,12,28]]},"published":{"date-parts":[[2023,12,28]]}}}