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Jugular Vein Sampling in Cushing Disease
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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TO THE EDITOR:
Doppman and colleagues [1] describe a potentially valuable diagnostic tool for characterizing adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome. However, apparent inconsistencies between the data described in the text and the figure cause confusion. The Results section reports that the range for pre-corticotropin-releasing hormone (CRH) ratios of central to peripheral ACTH in the jugular vein samples is 2.1 to 3.7. However, the figure and Discussion section indicate that several values are less than 2.0. Likewise, the range for post-CRH ratios in the jugular vein samples is noted to be 3.24 to 14.9, with evidence from the figure indicating several values less than 3.0. A similar discrepancy exists for the petrosal sinus samples. Ranges for pre- and post-CRH ACTH are reported to be 2.2 to 110.5 and 12.7 to 407.1, respectively, but the figure shows one value for pre-CRH ACTH that is less than 2.0 and one for post-CRH that is less than 3.0. According to the ranges provided in the Results section, all samples would indicate an ACTH-secreting pituitary adenoma, but this is obviously not the case.
Another error is noted in the Discussion section. Here, the sensitivity for jugular vein samples is noted to be 80% (95% CI, 75% to 99%). However, this CI is intended for the sensitivity of the petrosal sinus samples (which has a sensitivity of 95%); the correct CI for the jugular vein samples is 56% to 96%. Precision in reporting is necessary if others are to consider applying the proposed techniques.
The authors may want to consider applying different criteria for the jugular vein samples than for the petrosal vein samples. One would expect lower ratios of central to peripheral ACTH with the jugular vein technique. Receiver-operating characteristic curves may be one method to optimize sensitivity and specificity.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
