Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, P.R. China.
Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, Hubei, P.R. China.
Endocrine. 2022 Feb;75(2):516-524. doi: 10.1007/s12020-021-02891-y. Epub 2021 Oct 4.
The differential diagnosis of adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome remains a challenge in clinical practice. The present study was aimed at assessing the diagnostic performance of pituitary dynamic contrast-enhanced magnetic resonance imaging (dMRI), high-dose dexamethasone suppression test (HDDST), and a combination of both tests for patients with ACTH-dependent Cushing's syndrome.
A total of 119 consecutive patients with ACTH-dependent Cushing's syndrome confirmed surgically were enrolled: 101 with proven Cushing's disease and 18 with proven ectopic ACTH syndrome. All patients underwent pituitary dMRI and HDDST. The sensitivity and specificity of pituitary dMRI, HDDST, and a combination of both tests were determined.
The sensitivity and specificity of pituitary dMRI for diagnosing Cushing's disease were 80.2 and 83.3%, respectively, with a positive predictive value of 96.4%. The sensitivity and specificity of HDDST were 70.3 and 77.8%, respectively, with positive predictive value of 94.7%. A combination of both tests showed that the combined criteria of more than 50% suppression of serum cortisol on HDDST and a positive pituitary dMRI finding yielded a high specificity of 94.4 and sensitivity of 59.4%. The combined criteria of more than 68% suppression on HDDST and/or a positive pituitary dMRI finding yielded a sensitivity of 86.1% and specificity of 83.3%.
Pituitary dMRI was superior to HDDST in the differential diagnosis of ACTH-dependent Cushing's syndrome. HDDST is recommended in combination with pituitary dMRI to establish a diagnosis process because of the significantly increased specificity with the combination.
促肾上腺皮质激素（ACTH）依赖性库欣综合征的鉴别诊断在临床实践中仍然具有挑战性。本研究旨在评估垂体动态对比增强磁共振成像（dMRI）、高剂量地塞米松抑制试验（HDDST）以及两者联合应用对 ACTH 依赖性库欣综合征患者的诊断性能。
共纳入 119 例经手术证实的 ACTH 依赖性库欣综合征患者：101 例为确诊的库欣病，18 例为确诊的异位 ACTH 综合征。所有患者均行垂体 dMRI 和 HDDST。确定垂体 dMRI、HDDST 及两者联合检测的敏感性和特异性。
垂体 dMRI 诊断库欣病的敏感性和特异性分别为 80.2%和 83.3%，阳性预测值为 96.4%。HDDST 的敏感性和特异性分别为 70.3%和 77.8%，阳性预测值为 94.7%。联合检测时，HDDST 上皮质醇抑制超过 50%且垂体 dMRI 阳性的联合标准具有 94.4%的高特异性和 59.4%的敏感性。HDDST 上抑制超过 68%且/或垂体 dMRI 阳性的联合标准具有 86.1%的敏感性和 83.3%的特异性。
垂体 dMRI 在 ACTH 依赖性库欣综合征的鉴别诊断中优于 HDDST。由于联合应用可显著提高特异性，因此建议将 HDDST 与垂体 dMRI 联合应用以建立诊断流程。
