BACKGROUND. Measurement of adrenocorticotropin levels in plasma from the inferior petrosal sinuses of patients with Cushing's syndrome can distinguish adrenocorticotropin-secreting pituitary tumors (Cushing's disease) from other causes of the syndrome, principally ectopic adrenocorticotropin secretion from an occult tumor. However, it is unknown whether such measurement consistently identifies patients with Cushing's disease and whether testing with corticotropin-releasing hormone (CRH) enhances the value of the procedure. METHODS. We prospectively studied 281 patients with Cushing's syndrome to evaluate the diagnostic efficacy of the procedure. Bilateral sampling was successfully accomplished in 278 patients, with no major morbidity; 262 of these patients underwent sampling before and after administration of ovine CRH. The adrenocorticotropin levels in the samples were used to calculate the ratio of the concentration in plasma from the inferior petrosal sinuses to the concentration in peripheral-blood plasma (the IPS:P ratio). RESULTS. The diagnosis of 246 patients was confirmed surgically as Cushing's disease in 215, as ectopic adrenocorticotropin syndrome in 20, and as primary adrenal disease in 11. An IPS:P ratio greater than or equal to 2.0 in basal samples identified 205 of the 215 patients with Cushing's disease (sensitivity, 95 percent), with no false positive results (specificity, 100 percent). A peak IPS:P ratio greater than or equal to 3.0 after CRH administration identified all 203 of the patients with Cushing's disease who received CRH (sensitivity, 100 percent), with no false positive results (specificity, 100 percent). The sensitivity was much lower when the adrenocorticotropin concentrations in the samples from one sinus were considered alone. In patients with Cushing's disease a difference of greater than or equal to 1.4-fold between the concentrations in the two sinuses (the adrenocorticotropin gradient) predicted the location of the microadenoma in 68 percent of 104 patients during basal sampling and in 71 percent of 105 patients after CRH administration. CONCLUSIONS. Simultaneous bilateral sampling of plasma from the inferior petrosal sinuses, with the adjunctive use of CRH, distinguishes patients with Cushing's disease from those with ectopic adrenocorticotropin secretion with high diagnostic accuracy.
Source Information
Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md 20892.
This article has been cited by other articles:
Zemskova, M. S., Nylen, E. S., Patronas, N. J., Oldfield, E. H., Becker, K. L., Nieman, L. K.
(2009). Diagnostic Accuracy of Chromogranin A and Calcitonin Precursors Measurements for the Discrimination of Ectopic ACTH Secretion from Cushing's Disease. J. Clin. Endocrinol. Metab.
94: 2962-2965
[Abstract][Full Text]
Wians, F. H. Jr
(2009). Use of Excel Spreadsheets to Create Interpretive Reports for Laboratory Tests Requiring Complex Calculations. Lab Med
40: 5-12
[Full Text]
Jehle, S., Walsh, J. E., Freda, P. U., Post, K. D.
(2008). Selective Use of Bilateral Inferior Petrosal Sinus Sampling in Patients with Adrenocorticotropin-Dependent Cushing's Syndrome Prior to Transsphenoidal Surgery. J. Clin. Endocrinol. Metab.
93: 4624-4632
[Abstract][Full Text]
Burman, P., Lethagen, A., Ivancev, K., Johansson, L., Sundin, A.
(2008). Dual bronchial carcinoids and Cushing's syndrome with a paradoxical response to dexamethasone and a false positive outcome of inferior petrosal sinus sampling. Eur J Endocrinol
159: 483-488
[Abstract][Full Text]
Machado, M. C., Valeria de Sa, S., Correa-Giannella, M. L., Giorgi, R. R., Pereira, M. A. A., Cescato, V. A. S, Giannella-Neto, D., Salgado, L. R.
(2008). Association between tumoral GH-releasing peptide receptor type 1a mRNA expression and in vivo response to GH-releasing peptide-6 in ACTH-dependent Cushing's syndrome patients. Eur J Endocrinol
158: 605-613
[Abstract][Full Text]
Gandhi, C.D., Meyer, S.A., Patel, A.B., Johnson, D.M., Post, K.D.
(2008). Neurologic Complications of Inferior Petrosal Sinus Sampling. Am. J. Neuroradiol.
29: 760-765
[Abstract][Full Text]
Hayashi, N., Kurimoto, M., Kubo, M., Kuwayama, N., Kurosaki, K., Nagai, S., Endo, S.
(2008). The Impact of Cavernous Sinus Drainage Pattern on the Results of Venous Sampling in Patients With Suspected Cushing Syndrome. Am. J. Neuroradiol.
29: 69-72
[Abstract][Full Text]
Castinetti, F, Morange, I, Dufour, H, Jaquet, P, Conte-Devolx, B, Girard, N, Brue, T
(2007). Desmopressin test during petrosal sinus sampling: a valuable tool to discriminate pituitary or ectopic ACTH-dependent Cushing's syndrome. Eur J Endocrinol
157: 271-277
[Abstract][Full Text]
Tsagarakis, S., Vassiliadi, D., Kaskarelis, I. S., Komninos, J., Souvatzoglou, E., Thalassinos, N.
(2007). The Application of the Combined Corticotropin-Releasing Hormone plus Desmopressin Stimulation during Petrosal Sinus Sampling Is Both Sensitive and Specific in Differentiating Patients with Cushing's Disease from Patients with the Occult Ectopic Adrenocorticotropin Syndrome. J. Clin. Endocrinol. Metab.
92: 2080-2086
[Abstract][Full Text]
Salgado, L. R., Fragoso, M. C. B V., Knoepfelmacher, M., Machado, M. C., Domenice, S., Pereira, M. A. A., de Mendonca, B. B.
(2006). Ectopic ACTH syndrome: our experience with 25 cases.. Eur J Endocrinol
155: 725-733
[Abstract][Full Text]
Peters, C J, Storr, H L, Grossman, A B, Savage, M O
(2006). The role of corticotrophin-releasing hormone in the diagnosis of Cushing's syndrome. Eur J Endocrinol
155: S93-S98
[Abstract][Full Text]
Findling, J. W., Raff, H.
(2006). Cushing's Syndrome: Important Issues in Diagnosis and Management. J. Clin. Endocrinol. Metab.
91: 3746-3753
[Abstract][Full Text]
Kaskarelis, I. S., Tsatalou, E. G., Benakis, S. V., Malagari, K., Komninos, I., Vasiliadou, D., Tsagarakis, S., Thalassinos, N.
(2006). Bilateral inferior petrosal sinuses sampling in the routine investigation of Cushing's syndrome: a comparison with MRI.. Am. J. Roentgenol.
187: 562-570
[Abstract][Full Text]
Netea-Maier, R T, van Lindert, E J, den Heijer, M, van der Eerden, A, Pieters, G F F M, Sweep, C G J, Grotenhuis, J A, Hermus, A R M M
(2006). Transsphenoidal pituitary surgery via the endoscopic technique: results in 35 consecutive patients with Cushing's disease.. Eur J Endocrinol
154: 675-684
[Abstract][Full Text]
Isidori, A. M., Kaltsas, G. A., Pozza, C., Frajese, V., Newell-Price, J., Reznek, R. H., Jenkins, P. J., Monson, J. P., Grossman, A. B., Besser, G. M.
(2006). The Ectopic Adrenocorticotropin Syndrome: Clinical Features, Diagnosis, Management, and Long-Term Follow-Up. J. Clin. Endocrinol. Metab.
91: 371-377
[Abstract][Full Text]
Esposito, F., Dusick, J. R., Cohan, P., Moftakhar, P., McArthur, D., Wang, C., Swerdloff, R. S., Kelly, D. F.
(2006). Early Morning Cortisol Levels as a Predictor of Remission After Transsphenoidal Surgery for Cushing's Disease. J. Clin. Endocrinol. Metab.
91: 7-13
[Abstract][Full Text]
Lindsay, J. R., Nieman, L. K.
(2005). The Hypothalamic-Pituitary-Adrenal Axis in Pregnancy: Challenges in Disease Detection and Treatment. Endocr. Rev.
26: 775-799
[Abstract][Full Text]
Locatelli, M., Vance, M. L., Laws, E. R.
(2005). CLINICAL REVIEW: The Strategy of Immediate Reoperation for Transsphenoidal Surgery for Cushing's Disease. J. Clin. Endocrinol. Metab.
90: 5478-5482
[Abstract][Full Text]
Batista, D., Courkoutsakis, N. A., Oldfield, E. H., Griffin, K. J., Keil, M., Patronas, N. J., Stratakis, C. A.
(2005). Detection of Adrenocorticotropin-Secreting Pituitary Adenomas by Magnetic Resonance Imaging in Children and Adolescents with Cushing Disease. J. Clin. Endocrinol. Metab.
90: 5134-5140
[Abstract][Full Text]
Ilias, I., Torpy, D. J., Pacak, K., Mullen, N., Wesley, R. A., Nieman, L. K.
(2005). Cushing's Syndrome Due to Ectopic Corticotropin Secretion: Twenty Years' Experience at the National Institutes of Health. J. Clin. Endocrinol. Metab.
90: 4955-4962
[Abstract][Full Text]
Storr, H. L, Afshar, F., Matson, M., Sabin, I., Davies, K. M, Evanson, J., Plowman, P N., Besser, G M., Monson, J. P, Grossman, A. B, Savage, M. O
(2005). Factors influencing cure by transsphenoidal selective adenomectomy in paediatric Cushing's disease. Eur J Endocrinol
152: 825-833
[Abstract][Full Text]
Lindsay, J. R., Jonklaas, J., Oldfield, E. H., Nieman, L. K.
(2005). Cushing's Syndrome during Pregnancy: Personal Experience and Review of the Literature. J. Clin. Endocrinol. Metab.
90: 3077-3083
[Abstract][Full Text]
Markou, A., Manning, P., Kaya, B., Datta, S. N, Bomanji, J. B, Conway, G. S
(2005). [18F]fluoro-2-deoxy-D-glucose ([18F]FDG) positron emission tomography imaging of thymic carcinoid tumor presenting with recurrent Cushing's syndrome. Eur J Endocrinol
152: 521-525
[Abstract][Full Text]
Findling, J. W., Kehoe, M. E., Raff, H.
(2004). Identification of Patients with Cushing's Disease with Negative Pituitary Adrenocorticotropin Gradients during Inferior Petrosal Sinus Sampling: Prolactin as an Index of Pituitary Venous Effluent. J. Clin. Endocrinol. Metab.
89: 6005-6009
[Abstract][Full Text]
Terzolo, M., Allasino, B., Bosio, S., Brusa, E., Daffara, F., Ventura, M., Aroasio, E., Sacchetto, G., Reimondo, G., Angeli, A., Camaschella, C.
(2004). Hyperhomocysteinemia in Patients with Cushing's Syndrome. J. Clin. Endocrinol. Metab.
89: 3745-3751
[Abstract][Full Text]
Swearingen, B., Katznelson, L., Miller, K., Grinspoon, S., Waltman, A., Dorer, D. J., Klibanski, A., Biller, B. M. K.
(2004). Diagnostic Errors after Inferior Petrosal Sinus Sampling. J. Clin. Endocrinol. Metab.
89: 3752-3763
[Abstract][Full Text]
Ilias, I., Chang, R., Pacak, K., Oldfield, E. H., Wesley, R., Doppman, J., Nieman, L. K.
(2004). Jugular Venous Sampling: An Alternative to Petrosal Sinus Sampling for the Diagnostic Evaluation of Adrenocorticotropic Hormone-Dependent Cushing's Syndrome. J. Clin. Endocrinol. Metab.
89: 3795-3800
[Abstract][Full Text]
Salenave, S., Gatta, B., Pecheur, S., San-Galli, F., Visot, A., Lasjaunias, P., Roger, P., Berge, J., Young, J., Tabarin, A., Chanson, P.
(2004). Pituitary Magnetic Resonance Imaging Findings Do Not Influence Surgical Outcome in Adrenocorticotropin-Secreting Microadenomas. J. Clin. Endocrinol. Metab.
89: 3371-3376
[Abstract][Full Text]
Arnaldi, G., Angeli, A., Atkinson, A. B., Bertagna, X., Cavagnini, F., Chrousos, G. P., Fava, G. A., Findling, J. W., Gaillard, R. C., Grossman, A. B., Kola, B., Lacroix, A., Mancini, T., Mantero, F., Newell-Price, J., Nieman, L. K., Sonino, N., Vance, M. L., Giustina, A., Boscaro, M.
(2003). Diagnosis and Complications of Cushing's Syndrome: A Consensus Statement. J. Clin. Endocrinol. Metab.
88: 5593-5602
[Abstract][Full Text]
Isidori, A. M., Kaltsas, G. A., Mohammed, S., Morris, D. G., Jenkins, P., Chew, S. L., Monson, J. P., Besser, G. M., Grossman, A. B.
(2003). Discriminatory Value of the Low-Dose Dexamethasone Suppression Test in Establishing the Diagnosis and Differential Diagnosis of Cushing's Syndrome. J. Clin. Endocrinol. Metab.
88: 5299-5306
[Abstract][Full Text]
Raff, H., Findling, J. W.
(2003). A Physiologic Approach to Diagnosis of the Cushing Syndrome. ANN INTERN MED
138: 980-991
[Full Text]
Patronas, N., Bulakbasi, N., Stratakis, C. A., Lafferty, A., Oldfield, E. H., Doppman, J., Nieman, L. K.
(2003). Spoiled Gradient Recalled Acquisition in the Steady State Technique Is Superior to Conventional Postcontrast Spin Echo Technique for Magnetic Resonance Imaging Detection of Adrenocorticotropin-Secreting Pituitary Tumors. J. Clin. Endocrinol. Metab.
88: 1565-1569
[Abstract][Full Text]
Lefournier, V., Martinie, M., Vasdev, A., Bessou, P., Passagia, J.-G., Labat-Moleur, F., Sturm, N., Bosson, J.-L., Bachelot, I., Chabre, O.
(2003). Accuracy of Bilateral Inferior Petrosal or Cavernous Sinuses Sampling in Predicting the Lateralization of Cushing's Disease Pituitary Microadenoma: Influence of Catheter Position and Anatomy of Venous Drainage. J. Clin. Endocrinol. Metab.
88: 196-203
[Abstract][Full Text]
Sugawara, T., Sato, M., Itoi, K., Sugawara, A., Matsuda, Y., Shimada, K., Sado, T., Wu, S., Kondo, T.
(2002). Successful localization and treatment for ectopic adrenocorticotrophic hormone secretion in a rare case of possible Tx N2 M0 carcinoid tumor with Cushing syndrome. J. Thorac. Cardiovasc. Surg.
124: 1237-1238
[Full Text]
de Perrot, M., Spiliopoulos, A., Fischer, S., Totsch, M., Keshavjee, S.
(2002). Neuroendocrine carcinoma (carcinoid) of the thymus associated with Cushing's syndrome. Ann. Thorac. Surg.
73: 675-681
[Abstract][Full Text]
Dall'Asta, C., Santambrogio, L., Castellani, M., Ambrosi, B.
(2002). Difficulties in diagnosis and treatment of ectopic ACTH-producing tumors of the chest. Eur. J. Cardiothorac. Surg.
21: 149-151
[Abstract][Full Text]
Lienhardt, A., Grossman, A. B., Dacie, J. E., Evanson, J., Huebner, A., Afshar, F., Plowman, P. N., Besser, G. M., Savage, M. O.
(2001). Relative Contributions of Inferior Petrosal Sinus Sampling and Pituitary Imaging in the Investigation of Children and Adolescents with ACTH-Dependent Cushing's Syndrome. J. Clin. Endocrinol. Metab.
86: 5711-5714
[Abstract][Full Text]
Coffin, C., Lireux, B., Le Rochais, J. P., Raux-Demay, M. C., Girard, F., Galateau, F., Reznik, Y., Mahoudeau, J.
(2001). Elevated Plasma Level of Lipotropin Revealing an Occult Carcinoid Tumor with Normal Plasma Adrenocorticotropin. J. Clin. Endocrinol. Metab.
86: 2997-3000
[Abstract][Full Text]
Amer, K M A, Ibrahim, N B N, Forrester-Wood, C P, Saad, R A, Scanlon, M
(2001). Lung carcinoid related Cushing's syndrome: report of three cases and review of the literature. Postgrad. Med. J.
77: 464-467
[Abstract][Full Text]
Vogeser, M., Engelhardt, D., Jacob, K.
(2000). Comparison of Two Automated Adrenocorticotropic Hormone Assays. Clin. Chem.
46: 1998-2000
[Full Text]
Boscaro, M., Barzon, L., Sonino, N.
(2000). The Diagnosis of Cushing's Syndrome: Atypical Presentations and Laboratory Shortcomings. Arch Intern Med
160: 3045-3053
[Abstract][Full Text]
Bonelli, F. S., Huston III, J., Carpenter, P. C., Erickson, D., Young, W. F. Jr., Meyer, F. B.
(2000). Adrenocorticotropic hormone-dependent Cushing's Syndrome: Sensitivity and Specificity of Inferior Petrosal Sinus Sampling. Am. J. Neuroradiol.
21: 690-696
[Abstract][Full Text]
Wiggam, M. I., Heaney, A. P., McIlrath, E. M., McCance, D. R., Sheridan, B., Hadden, D. R., Atkinson, A. B.
(2000). Bilateral Inferior Petrosal Sinus Sampling in the Differential Diagnosis of Adrenocorticotropin-Dependent Cushing's Syndrome: A Comparison with Other Diagnostic Tests. J. Clin. Endocrinol. Metab.
85: 1525-1532
[Abstract][Full Text]
Sarlis, N. J., Chanock, S. J., Nieman, L. K.
(2000). Cortisolemic Indices Predict Severe Infections in Cushing Syndrome Due to Ectopic Production of Adrenocorticotropin. J. Clin. Endocrinol. Metab.
85: 42-47
[Abstract][Full Text]
Choyke, P. L., Doppman, J. L.
(2000). Case 18: Adrenocorticotropic Hormone-dependent Cushing Syndrome1. Radiology
214: 195-198
[Full Text]
Freda, P. U., Wardlaw, S. L.
(1999). Diagnosis and Treatment of Pituitary Tumors. J. Clin. Endocrinol. Metab.
84: 3859-3866
[Full Text]
Lefournier, V., Gatta, B., Martinie, M., Vasdev, A., Tabarin, A., Bessou, P., Berge, J., Bachelot, I., Chabre, O.
(1999). One Transient Neurological Complication (Sixth Nerve Palsy) in 166 Consecutive Inferior Petrosal Sinus Samplings for the Etiological Diagnosis of Cushing's Syndrome. J. Clin. Endocrinol. Metab.
84: 3401-3402
[Full Text]
Pluta, R. M., Nieman, L., Doppman, J. L., Watson, J. C., Tresser, N., Katz, D. A., Oldfield, E. H.
(1999). Extrapituitary Parasellar Microadenoma in Cushing's Disease. J. Clin. Endocrinol. Metab.
84: 2912-2923
[Abstract][Full Text]
Klee, G. G.
(1999). Maximizing Efficacy of Endocrine Tests: Importance of Decision-focused Testing Strategies and Appropriate Patient Preparation. Clin. Chem.
45: 1323-1330
[Abstract][Full Text]
Anderson, J R, Antoun, N, Burnet, N, Chatterjee, K, Edwards, O, Pickard, J D, Sarkies, N
(1999). Neurology of the pituitary gland. J. Neurol. Neurosurg. Psychiatry
66: 703-721
[Full Text]
Heaney, A., Loughrey, G., McCance, D., Mcilrath, E., Hadden, D., Kennedy, L., Sheridan, B., Atkinson, A.B.
(1999). Is whole-lung CT scanning still necessary in all cases of ACTH-dependent Cushing's syndrome in the era of petrosal sinus sampling?. QJM
92: 335-340
[Abstract][Full Text]
Graham, K. E., Samuels, M. H., Nesbit, G. M., Cook, D. M., O’Neill, O. R., Barnwell, S. L., Loriaux, D. L.
(1999). Cavernous Sinus Sampling Is Highly Accurate in Distinguishing Cushing's Disease from the Ectopic Adrenocorticotropin Syndrome and in Predicting Intrapituitary Tumor Location. J. Clin. Endocrinol. Metab.
84: 1602-1610
[Abstract][Full Text]
TORPY, D. J., CHEN, C. C., MULLEN, N., DOPPMAN, J. L., CARRASQUILLO, J. A., CHROUSOS, G. P., NIEMAN, L. K.
(1999). Lack of Utility of 111In-Pentetreotide Scintigraphy in Localizing Ectopic ACTH Producing Tumors: Follow-Up of 18 Patients. J. Clin. Endocrinol. Metab.
84: 1186-1192
[Abstract][Full Text]
Doppman, J. L.
(1999). There Is No Simple Answer to a Rare Complication of Inferior Petrosal Sinus Sampling. Am. J. Neuroradiol.
20: 191-192
[Full Text]
Bonelli, F. S., Huston III, J., Meyer, F. B., Carpenter, P. C.
(1999). Venous Subarachnoid Hemorrhage after Inferior Petrosal Sinus Sampling for Adrenocorticotropic Hormone. Am. J. Neuroradiol.
20: 306-307
[Abstract][Full Text]
Invitti, C., Giraldi, F. P., De Martin, M., Cavagnini, F.
(1999). Diagnosis and Management of Cushing's Syndrome: Results of an Italian Multicentre Study. J. Clin. Endocrinol. Metab.
84: 440-448
[Abstract][Full Text]
Kaltsas, G. A., Giannulis, M. G., Newell-Price, J. D. C., Dacie, J. E., Thakkar, C., Afshar, F., Monson, J. P., Grossman, A. B., Besser, G. M., Trainer, P. J.
(1999). A Critical Analysis of the Value of Simultaneous Inferior Petrosal Sinus Sampling in Cushing's Disease and the Occult Ectopic Adrenocorticotropin Syndrome. J. Clin. Endocrinol. Metab.
84: 487-492
[Abstract][Full Text]
Doppman, J. L., Chang, R., Oldfield, E. H., Chrousos, G., Stratakis, C. A., Nieman, L. K.
(1999). The Hypoplastic Inferior Petrosal Sinus: A Potential Source of False-Negative Results in Petrosal Sampling for Cushing's Disease. J. Clin. Endocrinol. Metab.
84: 533-540
[Abstract][Full Text]
Newell-Price, J., Trainer, P., Besser, M., Grossman, A.
(1998). The Diagnosis and Differential Diagnosis of Cushing's Syndrome and Pseudo-Cushing's States. Endocr. Rev.
19: 647-672
[Abstract][Full Text]
Booth, G. L., Redelmeier, D. A., Grosman, H., Kovacs, K., Smyth, H. S., Ezzat, S.
(1998). Improved Diagnostic Accuracy of Inferior Petrosal Sinus Sampling over Imaging for Localizing Pituitary Pathology in Patients with Cushing's Disease. J. Clin. Endocrinol. Metab.
83: 2291-2295
[Abstract][Full Text]
Yanovski, J. A., Nieman, L. K., Doppman, J. L., Chrousos, G. P., Wilder, R. L., Gold, P. W., Kalogeras, K. T.
(1998). Plasma Levels of Corticotropin-Releasing Hormone in the Inferior Petrosal Sinuses of Healthy Volunteers, Patients with Cushing's Syndrome, and Patients with Pseudo-Cushing States. J. Clin. Endocrinol. Metab.
83: 1485-1488
[Abstract][Full Text]
Young, J., Deneux, C., Grino, M., Oliver, C., Chanson, P., Schaison, G.
(1998). Pitfall of Petrosal Sinus Sampling in a Cushing's Syndrome Secondary to Ectopic Adrenocorticotropin-Corticotropin Releasing Hormone (ACTH-CRH) Secretion. J. Clin. Endocrinol. Metab.
83: 305-308
[Full Text]
Shrager, J. B., Wright, C. D., Wain, J. C., Torchiana, D. F., Grillo, H. C., Mathisen, D. J.
(1997). BRONCHOPULMONARY CARCINOID TUMORS ASSOCIATED WITH CUSHING'S SYNDROME: A MORE AGGRESSIVE VARIANT OF TYPICAL CARCINOID. J. Thorac. Cardiovasc. Surg.
114: 367-375
[Abstract][Full Text]
Massoud, A F, Powell, M, Williams, R A, Hindmarsh, P C, Brook, C G D
(1997). Transsphenoidal surgery for pituitary tumours. Arch. Dis. Child.
76: 398-404
[Abstract][Full Text]
Estrada, J., Boronat, M., Mielgo, M., Magallon, R., Millan, I., Diez, S., Lucas, T., Barcelo, B.
(1997). The Long-Term Outcome of Pituitary Irradiation after Unsuccessful Transsphenoidal Surgery in Cushing's Disease. NEJM
336: 172-177
[Abstract][Full Text]
Mizokami, T., Okamura, K., Sato, K., Kuroda, T., Sadoshima, S., Fujishima, M.
(1996). Risk Factors for Brain Infarction in Patients with Cushing's Disease: Case Reports. ANGIOLOGY
47: 1011-1017
[Abstract]
Reid, M. C., Lachs, M. S., Feinstein, A. R.
(1995). Use of Methodological Standards in Diagnostic Test Research: Getting Better but Still Not Good. JAMA
274: 645-651
[Abstract]
Orth, D. N.
(1995). Cushing's Syndrome. NEJM
332: 791-803
[Full Text]
Magiakou, M. A., Mastorakos, G., Oldfield, E. H., Gomez, M. T., Doppman, J. L., Cutler, G. B., Nieman, L. K., Chrousos, G. P.
(1994). Cushing's Syndrome in Children and Adolescents -- Presentation, Diagnosis, and Therapy. NEJM
331: 629-636
[Abstract][Full Text]
Kreisberg, R.
(1994). Half a Loaf. NEJM
330: 1295-1299
[Full Text]
Loriaux, D. L.
(1992). Endocrinology. JAMA
268: 352-354
[Abstract]
(1991). AN ACCURATE BUT INVASIVE TEST FOR CUSHING'S SYNDROME. JWatch General
1991: 5-5
[Full Text]
