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Differentiating among pituitary\u2010dependent CS, Cushing's disease (CD) and an ectopic source can be problematic. Because non\u2010invasive tests in the evaluation of CS patients often lack adequate sensitivity and specificity, bilateral inferior petrosal sinus sampling (BIPSS), a minimally invasive procedure performed during the investigation of ACTH\u2010dependent CS, can be extremely helpful. BIPSS is considered to be the gold standard for differentiating CD from the EAS. Furthermore, although such differentiation may indeed be challenging, BIPSS is itself a complex investigation, especially in recent times due to the widespread withdrawal of corticotrophin\u2010releasing hormone and its replacement by desmopressin. We review current published data on this investigation and, in the light of this and our own experience, discuss its appropriate use in diagnostic algorithms.<\/jats:p>","DOI":"10.1111\/joim.13789","type":"journal-article","created":{"date-parts":[[2024,4,12]],"date-time":"2024-04-12T12:39:49Z","timestamp":1712925589000},"page":"2-23","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Bilateral inferior petrosal sinus sampling in the differential diagnosis of ACTH\u2010dependent Cushing's syndrome: A reappraisal"],"prefix":"10.1111","volume":"296","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4995-625X","authenticated-orcid":false,"given":"Majid","family":"Valizadeh","sequence":"first","affiliation":[{"name":"Obesity Research Center Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences  Tehran 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