Department of Neurosurgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China.
Department of Radiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China.
Clin Endocrinol (Oxf). 2018 Feb;88(2):251-257. doi: 10.1111/cen.13505. Epub 2017 Nov 27.
Bilateral inferior petrosal sinus sampling (IPSS) with corticotropin-releasing hormone (CRH) is currently the gold standard in the diagnosis of Cushing's disease (CD) and has also been used in tumour lateralization. Our objective was to determine the diagnostic value and lateralization accuracy of IPSS with desmopressin.
We retrospectively analysed 91 patients with Cushing's syndrome who had either negative findings on pituitary dynamic enhanced magnetic resonance imaging (MRI) or nonsuppressed high-dose dexamethasone suppression tests (HDDST). Thin-slice thoracoabdominal computed tomography (CT) and octreotide receptor imaging of whole body were also negative to rule out ectopic adrenocorticotropin hormone (ACTH) syndrome. All patients went through IPSS with desmopressin. Afterwards, transsphenoidal pituitary surgery, light microscope pathology and immunohistological staining for ACTH were performed in all patients.
Diagnosis of CD. Among the 91 patients included, 90 were confirmed with CD, of whom 89 had positive IPSS findings, therefore the sensitivity was 98.9%. The one patient who was negative for CD also had negative IPSS findings, therefore the specificity was 100%. Tumour lateralization. Among the 51 patients who were ultimately diagnosed with CD and whose lateralization by IPSS and surgery was either left or right, 37 had IPSS lateralization in concordance with surgery, therefore the concordance rate was 72.5%. Patients in the concordant group had a higher frequency of right lateralization by surgery.
IPSS with desmopressin is a sensitive approach in the diagnosis of CD and has moderate accuracy in tumour lateralization, making it an alternative choice to IPSS with CRH.
双侧岩下窦采样（IPSS）联合促肾上腺皮质激素释放激素（CRH）目前是库欣病（CD）诊断的金标准，也已用于肿瘤侧别定位。我们的目的是确定去氨加压素辅助 IPSS 在诊断 CD 中的诊断价值和肿瘤侧别定位准确性。
我们回顾性分析了 91 例库欣综合征患者，这些患者要么垂体内分泌动态增强磁共振成像（MRI）无阳性发现，要么大剂量地塞米松抑制试验（HDDST）未被抑制。薄层高分辨胸腹部 CT 和全身奥曲肽受体显像也为阴性，以排除异位促肾上腺皮质激素（ACTH）综合征。所有患者均接受去氨加压素辅助 IPSS。随后，所有患者均接受经蝶窦垂体手术，光镜病理检查，以及 ACTH 的免疫组织化学染色。
CD 的诊断。91 例患者中，90 例确诊为 CD，其中 89 例 IPSS 阳性，因此敏感性为 98.9%。1 例 CD 阴性患者 IPSS 也为阴性，因此特异性为 100%。肿瘤侧别定位。最终诊断为 CD 且 IPSS 和手术定位为左侧或右侧的 51 例患者中，37 例 IPSS 与手术定位一致，因此符合率为 72.5%。在符合组中，手术右侧定位的患者比例更高。
去氨加压素辅助 IPSS 是诊断 CD 的一种敏感方法，在肿瘤侧别定位方面具有中等准确性，是 CRH 辅助 IPSS 的替代选择。
