%0 Journal Article
%T Inferior petrosal sinus sampling and stimulation with CRH: 15 years of experience in a tertiary hospital.
%A González Fernández L
%A Añez Ramos RJ
%A Rivas Montenegro AM
%A Brox Torrecilla N
%A Miguélez González M
%A Muñoz Moreno D
%A Atencia Goñi J
%A Weber B
%A López Guerra A
%A Olmedilla Ishishi YL
%A Percovich Hualpa JC
%A González Albarrán O
%A García Centeno R
%J Endocrinol Diabetes Nutr (Engl Ed)
%V 68
%N 6
%D Jun-Jul 2021
%M 34742471
%F 1.833
%R 10.1016/j.endien.2021.10.006
%X BACKGROUND: Inferior petrosal sinus sampling (IPSS) is indicated in the diagnosis of adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (CS), especially when the results of the initial diagnostic tests are discordant.
OBJECTIVE: To describe the patients who underwent this invasive functional test in a tertiary hospital.
METHODS: This was an observational study of a retrospective cohort of patients with ACTH-dependent CS and IPSS between 2004 and 2019. We determined their epidemiological, hormonal, radiological and functional characteristics, and evaluated their diagnostic capacity and optimal cut-off points to differentiate between Cushing's disease (CD) and ectopic Cushing's syndrome (ECS).
RESULTS: 23 patients were evaluated, of which 65.2% were women with the average age of 42 (36-62) years. ACTH secretion of pituitary origin was evident in 82.6% of the patients and of ectopic origin in 17.4%. Plasma cortisol, urinary free cortisol, and ACTH levels were higher in patients with ECS. Regarding IPSS, the baseline central/peripheral ACTH gradient detected 89.5% of patients with CD and after stimulation with CRH, 100%. The optimal cut-off points in the diagnosis of CD were 2.06 at baseline and 2.49 after CRH stimulation.
CONCLUSIONS: IPSS with CRH stimulation is a test with a high diagnostic accuracy for correctly classifying patients with CD and ECS. The cut-off points of the gradients may be different from the classic ones. Therefore, we recommend that each center perform its own evaluation.