Bilateral inferior petrosal sinus sampling in adrenocorticotropin-dependent hypercortisolism: always, never, or sometimes?

  • M. Losa
  • A. Allora
  • P. Panni
  • C. Righi
  • P. Mortini


Adrenocorticotropin (ACTH)-dependent hypercortisolism is a rare but severe disease. If not adequately treated, hypercortisolism is associated with increased mortality and impaired quality of life. The annual incidence of hypercortisolism, excluding iatrogenic causes, is 1.2–2.4 cases per million inhabitants [1]. ACTH-dependent causes of endogenous hypercortisolism, accounting for 80% of all cases, include ACTH-secreting pituitary tumors, usually referred to as Cushing’s disease (CD), and ectopic ACTH-hypersecretion. The latter is due to neuroendocrine tumors located in the lungs, pancreas, or small bowel but they may also arise everywhere in the body.

Surgical removal of the ACTH-secreting tumor is the primary therapeutic option in most patients. It is evident that correct localization of the ACTH-secreting lesion is mandatory to plan the most appropriate surgical treatment. Imaging and hormonal studies can aid in the distinction between CD and an ectopic source of...


Pituitary neoplasm Cushing’s disease Adrenocorticotropin Pituitary surgery 



This study was not funded by any organization in the public or private sector.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.


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Copyright information

© Italian Society of Endocrinology (SIE) 2019

Authors and Affiliations

  • M. Losa
    • 1
  • A. Allora
    • 1
  • P. Panni
    • 1
  • C. Righi
    • 2
  • P. Mortini
    • 1
  1. 1.Department of Neurosurgery, IRCCS San RaffaeleUniversity Vita-SaluteMilanItaly
  2. 2.Department of Neuroradiology, IRCCS San RaffaeleUniversity Vita-SaluteMilanItaly

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