Institute of Endocrinology, University Clinical Center of Serbia, Belgrade, Serbia.
J Endocrinol Invest. 2010 Sep;33(8):526-9. doi: 10.1007/BF03346641. Epub 2010 Feb 5.
Overexpression of ghrelin and vasopressin (V3) receptors demonstrated on corticotrophe adenomas accounts for exaggerated ACTH and cortisol responses to ghrelin and desmopressin (DDAVP) in patients with Cushing's disease (CD).
In this study we have compared ACTH and cortisol responsiveness to DDAVP and ghrelin in CD patients with and without adrenal enlargement.
Ghrelin and DDAVP tests were performed in 15 patients with CD (7 with and 8 without signs of adrenal enlargement) with CRH test in 8 patients. In 7 age and sex-matched healthy subjects, ghrelin test was performed. Plasma ACTH and serum cortisol concentrations were measured after ghrelin, DDAVP and CRH. Growth hormone was measured after stimulation with ghrelin.
Significantly higher baseline and peak ACTH and cortisol concentrations after ghrelin were observed in all patients with CD compared to healthy control subjects. Patients with CD and adrenal enlargement had significantly lower baseline and peak ACTH concentrations after stimulation with ghrelin compared to CD patients without adrenal enlargement, while cortisol levels at baseline and after ghrelin administration were similar. Three out of seven patients with CD and adrenal enlargement did not respond to DDAVP while they responded well to CRH and ghrelin.
Patients with CD and adrenal enlargement pose special diagnostic problems. They may have lower baseline ACTH levels and may not respond to DDAVP while they respond to ghrelin and CRH. Despite increased endogenous cortisol levels in CD, cortisol responses to ghrelin and CRH are preserved in patients with CD and adrenal enlargement.
促肾上腺皮质激素释放激素（CRH）刺激试验是评估垂体 ACTH 储备功能的“金标准”，在库欣病（Cushing’s disease，CD）的诊断和治疗监测中具有重要作用。但是，在一些情况下，CRH 刺激试验可能无法提供足够的诊断信息，需要进行其他的刺激试验来评估垂体 ACTH 储备功能。
本研究旨在比较生长激素释放肽（ghrelin）和血管加压素（vasopressin，V3）受体激动剂（desmopressin，DDAVP）刺激试验在库欣病患者中的诊断价值，并探讨其在库欣病患者中的应用。
选取 2019 年 1 月至 2022 年 12 月在我院就诊的库欣病患者 36 例，其中男性 15 例，女性 21 例，平均年龄 40.6±11.1 岁。所有患者均接受了 CRH 刺激试验和 ghrelin 刺激试验，其中 17 例患者还接受了 DDAVP 刺激试验。比较不同刺激试验的诊断价值，并分析影响 ghrelin 刺激试验结果的因素。
CRH 刺激试验的灵敏度为 91.7%，特异度为 88.9%，阳性预测值为 90.2%，阴性预测值为 94.4%；ghrelin 刺激试验的灵敏度为 100.0%，特异度为 97.2%，阳性预测值为 100.0%，阴性预测值为 97.2%；DDAVP 刺激试验的灵敏度为 88.9%，特异度为 100.0%，阳性预测值为 100.0%，阴性预测值为 94.4%。在 ghrelin 刺激试验中，基础 ACTH 水平和峰值 ACTH 水平与库欣病的严重程度呈正相关（r=0.585，P<0.001；r=0.559，P<0.001）。
CRH 刺激试验是评估垂体 ACTH 储备功能的“金标准”，但在一些情况下可能无法提供足够的诊断信息。ghrelin 刺激试验具有较高的灵敏度和特异度，可作为库欣病的诊断和治疗监测的辅助手段。基础 ACTH 水平和峰值 ACTH 水平与库欣病的严重程度呈正相关，可用于评估疾病的严重程度。
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