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Fig. 5 —Flow diagram displaying diagnostic approach we used in 78 patients with Cushing's syndrome (CS). Actual biochemical investigation preceded both MRI and bilateral inferior petrosal sinuses sampling (BIPSS) (single asterisk). Diagnostic confirmation was performed as described in detail in text (double asterisk).

ACTH = adrenocorticotropic hormone; BCh = biochemical investigation; TSS = transsphenoidal surgery.