The difficulty in establishing the diagnosis of Cushing's disease is well known, given the inability to biopsy ACTH-secreting pituitary adenomas due to their extremely small size. This obstacle can be overcome if we observe the results obtained by Oklu R and co [A] in his metabolomics study conducted in 2013. Therefore, he evaluated 8 patients suspected of Cushing's disease, who presented clinical manifestations suggestive of hypercorticism (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 dosing with 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 1 patient the diagnosis was excluded. Plasma obtained after centrifugation of central blood samples from the inferior petrosal sinus ipsilateral to ACTH-secreting adenomas (7 samples) was compared with contralateral plasma samples and two samples from the patient for whom ACTH secretion was not documented (9 samples). no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay Postoperative follow-up showed an improvement in symptoms in 4 patients and a remission of symptoms in the remaining 3 patients. Using three LC-MS methods (hydrophilic interaction liquid chromatography method for the analysis of polar metabolites in positive and negative ion mode respectively and a reversed phase method for profiling lipids in positive ion mode) 12 significant metabolites were initially identified 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. After Bonferroni adjustment, only 3-methyladipate, deoxycholic acid, and pyridoxate are statistically significant. Furthermore, using the KEGG pathway database, the author identified 8 major pathways: alanine, aspartate and glutamate metabolism (the most affected), vitamin B metabolism, lysine biosynthesis, purine metabolism, amino sugars and nucleotide sugars, glycolysis or gluconeogenesis and starch and sucrose metabolism. The first metabolomic study on pituitary adenomas was implemented by Oklu R and co [A] in 2013. It evaluated the metabolomic profile in seven patients with ACTH-secreting pituitary adenomas using plasma from the inferior petrosal sinus compared to nine contralateral plasma samples. Reference Biological sample analyzed from pituitary adenomas Analytical technique Results Oklu R [A] 16 central blood (plasma) samples from 7 patients with ACTH-secreting pituitary adenomas undergoing bilateral inferior petrosal sinus compared to 9 control plasma samples LC-MS/ MS Metabolites: deoxycholic acid, 3-methyladipate, pyridoxate – significantly altered Pathways: alanine, aspartate and glutamate metabolism (the most affected), vitamin B metabolism, lysine biosynthesis, purine metabolism, amino sugar metabolism and of sugars nucleortides, glycolysis or gluconeogenesis and metabolism of starch and sucrose Calligaris D [B] MALDI mass spectrometry Ijare O [X] postoperative pituitary tissue from 3 FSH/LH-secreting pituitary adenomas and 3 PRL-secreting pituitary adenomas NMR spectrometry.