Indian Journal of Endocrinology and Metabolism (Jan 2013)

Internal jugular vein: Peripheral vein adrenocorticotropic hormone ratio in patients with adrenocorticotropic hormone-dependent Cushing′s syndrome: Ratio calculated from one adrenocorticotropic hormone sample each from right and left internal jugular vein during corticotrophin releasing hormone stimulation test

  • Sachin Chittawar,
  • Saptarshi Bhattacharya,
  • Jai Prakash Sahoo,
  • Siva Prakash,
  • Ashu Seith Bhalla,
  • Devasenathipathy Kandasamy,
  • Arundeep Arora,
  • Nandita Gupta,
  • Nikhil Tandon,
  • Ravinder Goswami,
  • Rajesh Khadgawat,
  • Viveka P Jyotsna,
  • Ashish Kumar Karak,
  • Chandra Sekhar Bal,
  • Ravindra Mohan Pandey,
  • Guresh Kumar,
  • Ariachery C Ammini

DOI
https://doi.org/10.4103/2230-8210.107843
Journal volume & issue
Vol. 17, no. 1
pp. 128 – 132

Abstract

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Background: Demonstration of central: Peripheral adrenocorticotropic hormone (ACTH) gradient is important for diagnosis of Cushing′s disease. Aim: The aim was to assess the utility of internal jugular vein (IJV): Peripheral vein ACTH ratio for diagnosis of Cushing′s disease. Materials and Methods: Patients with ACTH-dependent Cushing′s syndrome (CS) patients were the subjects for this study. One blood sample each was collected from right and left IJV following intravenous hCRH at 3 and 5 min, respectively. A simultaneous peripheral vein sample was also collected with each IJV sample for calculation of IJV: Peripheral vein ACTH ratio. IJV sample collection was done under ultrasound guidance. ACTH was assayed using electrochemiluminescence immunoassay (ECLIA). Results: Thirty-two patients participated in this study. The IJV: Peripheral vein ACTH ratio ranged from 1.07 to 6.99 ( n = 32). It was more than 1.6 in 23 patients. Cushing′s disease could be confirmed in 20 of the 23 cases with IJV: Peripheral vein ratio more than 1.6. Four patients with Cushing′s disease and 2 patients with ectopic ACTH syndrome had IJV: Peripheral vein ACTH ratio less than 1.6. Six cases with unknown ACTH source were excluded for calculation of sensitivity and specificity of the test. Conclusion: IJV: Peripheral vein ACTH ratio calculated from a single sample from each IJV obtained after hCRH had 83% sensitivity and 100% specificity for diagnosis of CD.

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