{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T20:21:24Z","timestamp":1790713284889,"version":"4.1.0"},"reference-count":20,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2004,3,25]],"date-time":"2004-03-25T00:00:00Z","timestamp":1080172800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2004,4]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p><jats:bold><jats:sc>objective\u2002<\/jats:sc><\/jats:bold> Distinguishing between pituitary\u2010dependent Cushing's syndrome (CS) and occult ectopic ACTH syndrome can be extremely difficult. Bilateral inferior petrosal sinus sampling has been shown to have the highest diagnostic accuracy in this subtype evaluation. Internal jugular vein sampling (IJVS) has been reported as a potentially safer invasive alternative, but data are limited. Our objective was to compare the sensitivity and specificity of bilateral IJVS and bilateral inferior petrosal sinus sampling (IPSS) in patients with ACTH\u2010dependent CS.<\/jats:p><jats:p><jats:bold><jats:sc>design\u2002<\/jats:sc><\/jats:bold> We prospectively collected blood samples from the inferior petrosal sinus and internal jugular vein of consecutive patients with ACTH\u2010dependent CS.<\/jats:p><jats:p><jats:bold><jats:sc>patients\u2002<\/jats:sc><\/jats:bold> The study group included 35 patients: 32 with pituitary\u2010dependent CS (positive immunohistochemical findings for ACTH pituitary tumour or biochemical cure after pituitary surgery) and three with histologically proven ectopic ACTH syndrome.<\/jats:p><jats:p><jats:bold><jats:sc>measurements\u2002<\/jats:sc><\/jats:bold> Inferior petrosal sinus sampling and bilateral IJVS were performed simultaneously before and after administration of corticotropin\u2010releasing hormone (CRH), and ratios of central\u2010to\u2010peripheral ACTH concentrations were calculated.<\/jats:p><jats:p><jats:bold><jats:sc>results\u2002<\/jats:sc><\/jats:bold> The basal IJVS central\u2010to\u2010peripheral ACTH ratios were diagnostic for pituitary\u2010dependent CS (&gt;\u00a02) in 15 patients (46\u00b79%), as were basal inferior petrosal sinus sampling central\u2010to\u2010peripheral ACTH ratios in 29 patients (90\u00b76%). The post\u2010CRH IJVS central\u2010to\u2010peripheral ACTH ratios were diagnostic for pituitary\u2010dependent disease (&gt;\u00a03) in 24 patients (75%), as were post\u2010CRH inferior petrosal sinus sampling central\u2010to\u2010peripheral ACTH ratios in 28 patients (87\u00b75%). In the three patients with ectopic ACTH CS, the IJVS and inferior petrosal sinus sampling pre\u2010 and post\u2010CRH ACTH ratios were correctly negative. The overall sensitivity of combined pre\u2010 or post\u2010CRH was 81\u00b73% for IJVS and 93\u00b78% for inferior petrosal sinus sampling<jats:italic>.<\/jats:italic> Because of the difference between mean ratios in the two techniques, new criteria for IJVS were mathematically calculated: a pre\u2010CRH central\u2010to\u2010peripheral ACTH ratio of 1\u00b759 and a post\u2010CRH central\u2010to\u2010peripheral ACTH ratio of 2\u00b747 maximized sensitivity and specificity when both of these are equally taken into consideration.<\/jats:p><jats:p><jats:bold><jats:sc>conclusion\u2002<\/jats:sc><\/jats:bold> In conclusion, IJVS is not superior to inferior petrosal sinus sampling for establishing the cause of ACTH\u2010dependent CS. When new criteria of basal (&gt;\u00a01\u00b76) and post\u2010CRH (&gt;\u00a02\u00b75) central\u2010to\u2010peripheral ACTH gradients were applied to ACTH ratios from IJVS, the sensitivity of this test was maximized. However, confirmatory inferior petrosal sinus sampling is recommended when there is a lack of a central\u2010to\u2010peripheral ACTH gradient and when there is only a gradient above the cut\u2010off on basal (pre\u2010CRH) sampling.<\/jats:p>","DOI":"10.1111\/j.1365-2265.2004.01990.x","type":"journal-article","created":{"date-parts":[[2004,12,21]],"date-time":"2004-12-21T20:29:39Z","timestamp":1103660979000},"page":"413-419","source":"Crossref","is-referenced-by-count":36,"title":["Internal jugular vein sampling in adrenocorticotropic hormone\u2010dependent Cushing's syndrome: a comparison with inferior petrosal sinus sampling"],"prefix":"10.1111","volume":"60","author":[{"given":"Dana","family":"Erickson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"John","family":"Huston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"William 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