Latest diagnostic approaches to determine the cause of ACTH-dependent Cushing’s syndrome, in the South African setting

  • Elmo Pretorius Stellenbosch University
  • Razaan Davis Stellenbosch University
  • Alexander Doruyter Stellenbosch University
  • Brynne Ascott-Evans Stellenbosch University
Keywords: ACTH, cushing’s disease, pituitary

Abstract

A case of a 50-year-old woman who was referred for the evaluation of possible ACTH-dependent Cushing’s syndrome (CS) is described. The localisation of ACTH-dependent CS remains difficult despite many advances in diagnostic approaches. No single test can accurately determine the location of ACTH excess and therefore a combination of non-invasive imaging, stimulation and suppression tests are advised. The recent advances, current utility and pitfalls of each of these tests are reviewed. If non-invasive tests fail to confidently localise the source of ACTH excess, inferior petrosal sinus sampling (IPSS) should follow. Recent advances improving the diagnostic accuracy of IPSS, such as DDAVP stimulation and simultaneous sampling for prolactin is discussed. Where ectopic ACTH production is suspected, newer nuclear medicine techniques, such as somatostatin receptor imaging that recently became available in South Africa, can be utilised. The role of nuclear medicine imaging in identifying ectopic ACTH production is discussed briefly. (Full text available online at www.medpharm.tandfonline.com/oemd) Journal of Endocrinology, Metabolism and Diabetes of South Africa 2016; DOI: 10.1080/16089677.2016.1212965

Author Biographies

Elmo Pretorius, Stellenbosch University
Division of Endocrinology Department of Medicine Faculty of Medicine and Health Sciences Stellenbosch University and Tygerberg Academic Hospital
Razaan Davis, Stellenbosch University
Division of Radiodiagnosis Department of Medical Imaging and Clinical Oncology Faculty of Medicine and Health Sciences Stellenbosch University and Tygerberg Academic Hospital
Alexander Doruyter, Stellenbosch University
Division of Nuclear Medicine Department of Medical Imaging and Clinical Oncology Faculty of Medicine and Health Science Stellenbosch University and Tygerberg Academic Hospital
Brynne Ascott-Evans, Stellenbosch University
Division of Endocrinology Department of Medicine Faculty of Medicine and Health Sciences Stellenbosch University and Tygerberg Academic Hospital
Published
2016-11-29
Section
Research Articles