{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T03:24:55Z","timestamp":1793157895510,"version":"4.5.0"},"reference-count":45,"publisher":"The Endocrine Society","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and objective<\/jats:title>\n                    <jats:p>Bilateral inferior petrosal sinus sampling (BIPSS) is the gold standard for distinguishing Cushing disease (CD) from ectopic ACTH syndrome (EAS). It is, however, rarely evaluated in an intent-to-diagnose analysis, even though the final diagnosis remains inconclusive in 7% to 39% of patients in published series. It has been suggested that BIPSS use may be reduced in patients explored by modern imaging and hormonal testing. We tested this hypothesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and methods<\/jats:title>\n                    <jats:p>Evolution of BIPSS use and diagnostic outcomes over time in a single-center retrospective study of 229 consecutive patients with ACTH-dependent Cushing syndrome without evident endocrine tumors, explored from 1992 to 2021 with hormonal testing (n = 229), pituitary magnetic resonance imaging (MRI; n = 226) or computed tomography (CT; n = 3), chest\/abdominal CT scan (n = 114), and BIPSS (n=113). In an intent-to-diagnose analysis, we classified outcomes as confirmed CD (cCD) or confirmed ectopic ACTH syndrome (cEAS) if there was post therapeutic evidence of an ACTH-secreting tumor and as suspected CD (sCD) or suspected ectopic ACTH syndrome (sEAS) if not, resulting in 196 cCD (86%), 24 sCD (10%), 5 cEAS (2%), and 4 sEAS (2%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Comparing the 3 decades 1992-2001, 2002-2011, and 2012-2021, the use of BIPSS decreased from 68% to 49% and 26%, while the frequency of a typical adenoma image at MRI increased from 40% to 58% and 69%. The proportion of patients with cCD (83%, 81%, and 93%, respectively) remained stable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study demonstrates a decrease over time in the use of BIPSS without loss of efficacy in the diagnosis of CD, suggesting that advances in imaging allow for a safe reduction in the indications for BIPSS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgag265","type":"journal-article","created":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T11:35:09Z","timestamp":1783251309000},"source":"Crossref","is-referenced-by-count":4,"title":["Is the diagnosis of Cushing disease moving beyond bilateral inferior petrosal sinus sampling?"],"prefix":"10.1210","author":[{"given":"Louise","family":"Bouchard","sequence":"first","affiliation":[{"name":"University Grenoble Alpes, CHU Grenoble Alpes, Endocrinology Unit , Grenoble 38000 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2787-2636","authenticated-orcid":false,"given":"Arnaud","family":"Lazard","sequence":"additional","affiliation":[{"name":"University Grenoble Alpes, CHU Grenoble Alpes, Neurosurgery Unit , Grenoble 38000 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cl\u00e9ment","family":"Jean","sequence":"additional","affiliation":[{"name":"University Grenoble Alpes, CHU Grenoble Alpes, Neuroradiology Unit , Grenoble 38000 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Heck","sequence":"additional","affiliation":[{"name":"University Grenoble Alpes, CHU Grenoble Alpes, Neuroradiology Unit , Grenoble 38000 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Lefournier","sequence":"additional","affiliation":[{"name":"Clinique du Mail , Grenoble 38000 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Sturm","sequence":"additional","affiliation":[{"name":"Pathology Department, University Grenoble Alpes, CHU Grenoble Alpes , Grenoble 38000 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benoit","family":"Chovelon","sequence":"additional","affiliation":[{"name":"IBP, University of Grenoble Alpes, CHU Grenoble Alpes , Hormonal Biochemistry Unit, Grenoble 38000 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0963-6932","authenticated-orcid":false,"given":"Patrice","family":"Faure","sequence":"additional","affiliation":[{"name":"IBP, University of Grenoble Alpes, CHU Grenoble Alpes , Hormonal Biochemistry Unit, Grenoble 38000 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4854-834X","authenticated-orcid":false,"given":"Marie","family":"Muller","sequence":"additional","affiliation":[{"name":"University Grenoble Alpes, CHU Grenoble Alpes, Endocrinology Unit , Grenoble 38000 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Gay","sequence":"additional","affiliation":[{"name":"University Grenoble Alpes, CHU Grenoble Alpes, Neurosurgery Unit , Grenoble 38000 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8756-7218","authenticated-orcid":false,"given":"Olivier","family":"Chabre","sequence":"additional","affiliation":[{"name":"University Grenoble Alpes, CHU Grenoble Alpes, Endocrinology Unit , Grenoble 38000 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0489-8914","authenticated-orcid":false,"given":"Justine","family":"Cristante","sequence":"additional","affiliation":[{"name":"University Grenoble Alpes, CHU Grenoble Alpes, Endocrinology Unit , Grenoble 38000 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"issue":"1","key":"2026100711264524800_dgag265-B1","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1148\/120.1.91","article-title":"Evaluation of sellar and parasellar masses by computed tomography","volume":"120","author":"Naidich","year":"1976","journal-title":"Radiology"},{"issue":"15","key":"2026100711264524800_dgag265-B2","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1056\/NEJM197704142961508","article-title":"Selective venous sampling to differentiate ectopic ACTH secretion from pituitary 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