Gasińiska Teresa, Dec Renata, Wichary Hanna, Pietrasik Lidia, Kulawik Grazyna
Katedra i Klinika Chorób Wewngtrznych i Chemioterapii Onkologicznej, Slaska Akademia Medyczna, Katowice.
Pol Arch Med Wewn. 2007 Jan-Feb;117(1-2):20-6.
Early and precise diagnosis is necessary in successful treatment of the patients with Cushing's disease. Transsphenoidal surgery is the first line treatment option in Cushing's disease. In patients in whom magnetic resonance imaging does not visualise pituitary adenoma patient selection for surgical treatment should be based on convincing results of functional tests.
The diagnostic accuracy of the desmopressin test was compared with that of the CRH test and the overnight high-dose dexamethasone suppression test in the diagnosis of Cushing's disease.
We studied 15 patients with pituitary-dependent Cushing's disease (10 with detected microadenoma and 5 with undetected microadenoma using magnetic resonance imaging). The diagnosis was confirmed during pituitary surgery. The control group included 15 subjects without Cushing's syndrome. Patients underwent tests with desmopressin, CRH and 8 mg overnight dexamethasone.
A false negative response to CRH was present in 1 of 15 patients, a false negative response t dexamethasone was present in 1 of 15 patients and a false negative response to desmopressin in 2 of 15 patients. In other patients positive responses to CRH, desmopressin and dexamethasone were found. A positive response to desmopressin was present in 4 of 5 patients with undetected pituitary adenoma. In the control group a positive response to CRH and dexamethazone and a negative response to desmopressin was found in all patients.
对于库欣病患者的成功治疗，早期和精确诊断是必要的。经蝶窦手术是库欣病的一线治疗选择。对于磁共振成像未显示垂体腺瘤的患者，手术治疗的患者选择应基于功能测试的可靠结果。
比较去氨加压素试验与促肾上腺皮质激素释放激素（CRH）试验及过夜大剂量地塞米松抑制试验在库欣病诊断中的诊断准确性。
我们研究了15例垂体依赖性库欣病患者（10例通过磁共振成像检测到微腺瘤，5例未检测到微腺瘤）。诊断在垂体手术期间得到证实。对照组包括15名无库欣综合征的受试者。患者接受了去氨加压素、CRH和8毫克过夜地塞米松试验。
15例患者中有1例对CRH出现假阴性反应，15例患者中有1例对地塞米松出现假阴性反应，15例患者中有2例对去氨加压素出现假阴性反应。在其他患者中发现对CRH、去氨加压素和地塞米松有阳性反应。5例未检测到垂体腺瘤的患者中有4例对去氨加压素有阳性反应。在对照组中，所有患者对CRH和地塞米松出现阳性反应，对去氨加压素出现阴性反应。
