■库欣病(CD)和异位ACTH综合征(EAS)之间的鉴别诊断很复杂,双侧岩下窦采样(BIPSS)被认为是金标准测试。然而,具有促肾上腺皮质激素释放激素(CRH)刺激的BIPSS很少可用。
■这项回顾性队列研究旨在评估去氨加压素刺激前后岩下窦对外周ACTH梯度(IPS:P)的准确性,以鉴别诊断ACTH依赖性库欣综合征(CS)。应用不同的截止值。
■共有50名接受BIPSS的患者(48名CD患者和2名EAS患者)纳入本研究。评价去氨加压素刺激前后BIPSS中IPS:P的敏感性和特异性。检查IPS:P的各种截断值以确定其诊断准确性。
■使用传统的IPS:P截止,刺激前的敏感度为85.1%,刺激后89.6%,综合灵敏度为91.7%。应用IPS的截止值:刺激前P>1.4,刺激后P>2.8,灵敏度分别为87.2%和89.6%,分别,综合灵敏度为91.7%。受试者工作特征(ROC)曲线分析确定了刺激前1.2和刺激后1.57的最佳截止值,灵敏度分别为93.6%和93.8%,分别,综合灵敏度为97.9%。在所有分析中特异性保持在100%。在43名对刺激反应积极的患者中,42(97.7%)在前三分钟内做到了这一点,所有43人(100%)在前五分钟内都这样做了。评估的临床变量均未预测BIPSS中ACTH对刺激的反应具有统计学意义。
■在BIPSS期间使用去氨加压素进行ACTH刺激可提高IPS:P的准确性,使其成为研究ACTH依赖性库欣综合征的有价值的工具。考虑到并发症的低风险,我们建议在BIPSS期间使用去氨加压素刺激来鉴别ACTH依赖性CS.
The differential diagnosis between Cushing\'s disease (CD) and ectopic ACTH syndrome (EAS) is complex, and bilateral inferior petrosal sinus sampling (BIPSS) is considered the gold-standard test. However, BIPSS with corticotropin-releasing hormone (CRH) stimulation is rarely available.
This retrospective cohort study aimed to assess the accuracy of the inferior petrosal sinus to peripheral ACTH gradient (IPS:P) before and after desmopressin stimulation for the differential diagnosis of ACTH-dependent Cushing\'s syndrome (CS), applying different cutoff values.
A total of 50 patients (48 with CD and 2 with EAS) who underwent BIPSS were included in this study. The sensitivity and specificity of IPS:P in BIPSS before and after desmopressin stimulation were evaluated. Various cutoff values for IPS:P were examined to determine their diagnostic accuracy.
Using the traditional IPS:P cutoff, the sensitivity was 85.1% before stimulation, 89.6% after stimulation, and a combined sensitivity of 91.7%. Applying cutoff values of IPS:P >1.4 before and >2.8 after stimulation, the sensitivity was 87.2% and 89.6%, respectively, with a combined sensitivity of 91.7%. Receiver operating characteristic (ROC) curve analysis determined optimal cutoff values of 1.2 before stimulation and 1.57 after stimulation, resulting in a sensitivity of 93.6% and 93.8%, respectively, with a combined sensitivity of 97.9%. Specificity remained at 100% throughout all analyses. Among the 43 patients who responded positively to stimulation, 42 (97.7%) did so within the first three minutes, and all 43 (100%) did so within the first five minutes. None of the assessed clinical variables predicted the ACTH response to stimulation in BIPSS with statistical significance.
ACTH stimulation with desmopressin during BIPSS improves the accuracy of IPS:P, making it a valuable tool for investigating ACTH-dependent Cushing\'s syndrome. Considering the low risk of complications, we recommend the use of desmopressin stimulation during BIPSS for the differential diagnosis of ACTH-dependent CS.