{Reference Type}: Journal Article
{Title}: Inferior petrosal sinus sampling and stimulation with CRH: 15 years of experience in a tertiary hospital.
{Author}: González Fernández L;Añez Ramos RJ;Rivas Montenegro AM;Brox Torrecilla N;Miguélez González M;Muñoz Moreno D;Atencia Goñi J;Weber B;López Guerra A;Olmedilla Ishishi YL;Percovich Hualpa JC;González Albarrán O;García Centeno R;
{Journal}: Endocrinol Diabetes Nutr (Engl Ed)
{Volume}: 68
{Issue}: 6
{Year}: Jun-Jul 2021
{Factor}: 1.833
{DOI}: 10.1016/j.endien.2021.10.006
{Abstract}: <B>BACKGROUND: </B>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.<BR><B>OBJECTIVE: </B>To describe the patients who underwent this invasive functional test in a tertiary hospital.<BR><B>METHODS: </B>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).<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.