The difficulty in establishing the diagnosis of Cushing's disease is well known, given the impossibility of biopsying ACTH-secreting pituitary adenomas due to their extremely large size. small. This obstacle can be overcome if we observe the results obtained by Oklu R and co [A] in his metabolomic study carried out in 2013. Thus, he evaluated 8 patients suspected of Cushing's disease, who presented clinical manifestations suggestive of hyperadrenocorticism (e.g. hypertension, osteoporosis, easy bruising, weight gain, fatigue, diabetes mellitus, hirsutism, moon face, etc.), but with indeterminate imaging. To confirm the diagnosis, these patients underwent bilateral inferior petrosal sinus with measurement of central blood samples at 0', 3', 5', 10' and 15' after intravenous CRH injection. ACTH-secreting pituitary adenomas were confirmed in 7 patients, while in one patient the diagnosis was excluded. Plasma obtained after centrifugation of central blood samples from the ipsilateral inferior petrosal sinus to ACTH-secreting adenomas (7 samples) was compared to contralateral plasma samples and to two samples from the patient for whom ACTH secretion ACTH was not documented (9 samples). no to plagiarism. Get a tailor-made essay on “Why Violent Video Games Should Not Be Banned”? Get the original essay Postoperative follow-up showed improvement in symptomatology in 4 patients and remission in the remaining 3 patients. Using three LC-MS methods (hydrophilic interaction liquid chromatography method for analyzing polar metabolites in positive and negative ion mode respectively and reversed phase method for profiling lipids in positive ion mode), we initially identified 12 significant metabolites in ACTH-pituitary adenomas compared with the control group (p < 0.05). These are represented by 2-hydroxybutyric acid, aminoadipic acid, L-aspartic acid, 3-hydroxyphenylacetic acid, hypoxanthine, 4-pyridoxic acid, quinolinic acid, sucrose , xanthine, glucose 6-phosphate, deoxycholic acid and 3-methyladipate. adjustment, only 3-methyladipate, deoxycholic acid and pyridoxate are statistically significant. Additionally, using the KEGG pathway database, the author identified 8 main pathways: alanine, aspartate and glutamate metabolism (the most affected), vitamin metabolism B, lysine biosynthesis, purine metabolism, metabolism of amino sugars and nucleotide sugars, glycolysis or gluconeogenesis and starch and sucrose metabolism. The first metabolomic study on pituitary adenomas was performed by Oklu R and co[A] in 2013. He evaluated the metabolomic profile of seven patients with ACTH-secreting pituitary adenomas using plasma from the inferior petrosal sinus in comparison with nine contralateral plasmas. samples. Reference Biological sample analyzed from pituitary adenomas Analytical technique Results Oklu R [A] 16 central blood samples (plasma) from 7 patients with ACTH-secreting pituitary adenomas who underwent bilateral inferior petrosal sinus versus 9 samples plasma controls LC-MS/MS Metabolites: deoxycholic acid, 3-methyladipate, pyridoxate – pathways significantly altered: metabolism of alanine, aspartate and glutamate (most affected), metabolism of vitamin B, biosynthesis of lysine, purine metabolism, metabolism of amino sugars and nucleortide sugars, glycolysis or gluconeogenesis and metabolism of starch and sucrose Calligaris D.