Hermus A R, Pieters G F, Pesman G J, Smals A G, Benraad T J, Kloppenborg P W
Lancet. 1986 Sep 6;2(8506):540-4. doi: 10.1016/s0140-6736(86)90113-3.
The diagnostic accuracy of the corticotropin-releasing-hormone (CRH) test was compared with that of the oral high-dose dexamethasone suppression test in the differential diagnosis of Cushing's syndrome. A false-negative response to CRH was present in 9% (2 of 22) of patients with pituitary-dependent Cushing's disease and to high-dose dexamethasone in 11% (2 of 18). All 3 patients with Cushing's syndrome due to an adrenal adenoma were unresponsive to both CRH and dexamethasone. The only patient with ectopic corticotropin secretion had a false-positive response of corticotropin to dexamethasone and no response of corticotropin to CRH. Simultaneous failure of both tests to indicate the cause of Cushing's syndrome did not occur in this series, except in 1 patient with Cushing's disease and overt macronodular hyperplasia. It is concluded that the diagnostic accuracy of the CRH test in patients with Cushing's syndrome is comparable to that of the high-dose dexamethasone test and that the highest discriminatory score in the differential diagnosis of Cushing's syndrome is achieved by using both a CRH test and a high-dose dexamethasone test.
在库欣综合征的鉴别诊断中，比较了促肾上腺皮质激素释放激素（CRH）试验与口服高剂量地塞米松抑制试验的诊断准确性。垂体依赖性库欣病患者中，9%（22例中的2例）对CRH呈假阴性反应，11%（18例中的2例）对高剂量地塞米松呈假阴性反应。所有3例因肾上腺腺瘤导致的库欣综合征患者对CRH和地塞米松均无反应。唯一1例异位促肾上腺皮质激素分泌患者对地塞米松呈促肾上腺皮质激素假阳性反应，对CRH无促肾上腺皮质激素反应。除1例患有库欣病且有明显大结节性增生的患者外，本系列中未出现两种试验均无法明确库欣综合征病因的情况。结论是，CRH试验在库欣综合征患者中的诊断准确性与高剂量地塞米松试验相当，并且通过同时使用CRH试验和高剂量地塞米松试验，在库欣综合征的鉴别诊断中可获得最高的鉴别分数。
