Department of Endocrinology, Diabetes and Metabolism, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Endocrinology, Diabetes and Metabolism, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Endocr Pract. 2022 Aug;28(8):767-773. doi: 10.1016/j.eprac.2022.04.013. Epub 2022 May 4.
To limit the role of bilateral inferior petrosal sinus sampling (BIPSS) in distinguishing between Cushing disease (CD) and ectopic Cushing syndrome (ECS), recent reports have proposed a noninvasive approach based on a combination of biochemical testing and radiological imaging as an alternative to the conventional invasive strategy (CIS). However, this strategy requires further validation. The current study aimed to evaluate 2 limited invasive protocols (LIP-1 and LIP-2) in limiting the role of BIPSS while maintaining a diagnostic accuracy similar to that of CIS.
This was a single-center study conducted on individuals with corticotropin-dependent Cushing syndrome. The LIPs were based on performing high-dose dexamethasone suppression (>50% cut-off in first [LIP-1] and >80% in second [LIP-2]) and magnetic resonance imaging of the sella in all individuals and selective use of computed tomography of the chest and abdomen before BIPSS. These LIPs were evaluated for limiting the use of BIPSS, their accuracy, and cost in comparison to CIS.
Of the 206 individuals, 114 (97 of CD and 21 of ECS) were eligible for the current study. Using LIP-1, LIP-2, and CIS, BIPSS could have been avoided in 62.3%, 35.9%, and 25.4% of individuals, respectively. The positive predictive value for CD using LIP-1 and LIP-2 was 98.9% and 100%, respectively. The cost per patient evaluated using LIP-1, LIP-2, and CIS was $602.21, $966.81, and $1107.78, respectively.
LIPs represent an equally accurate, less invasive, and more cost-effective alternative to the CIS for distinguishing between CD and ECS.
为了限制双侧岩下窦采样（BIPSS）在鉴别库欣病（CD）和异位库欣综合征（ECS）中的作用，最近的报告提出了一种基于生化检测和影像学相结合的非侵入性方法，作为传统有创策略（CIS）的替代方法。然而，这种策略需要进一步验证。本研究旨在评估 2 种有限侵入性方案（LIP-1 和 LIP-2）在限制 BIPSS 作用的同时保持与 CIS 相似的诊断准确性。
这是一项在依赖促肾上腺皮质激素的库欣综合征患者中进行的单中心研究。LIPs 基于对所有患者进行大剂量地塞米松抑制试验（第一次 [LIP-1] 超过 50%截止值，第二次 [LIP-2] 超过 80%）和鞍区磁共振成像，以及选择性使用胸部和腹部计算机断层扫描，然后再进行 BIPSS。这些 LIPs 在限制 BIPSS 的使用、准确性和成本方面与 CIS 进行了评估。
在 206 名患者中，114 名（97 名 CD 和 21 名 ECS）符合当前研究标准。使用 LIP-1、LIP-2 和 CIS，BIPSS 可以分别在 62.3%、35.9%和 25.4%的患者中避免。LIP-1 和 LIP-2 对 CD 的阳性预测值分别为 98.9%和 100%。使用 LIP-1、LIP-2 和 CIS 评估每位患者的成本分别为 602.21 美元、966.81 美元和 1107.78 美元。
LIPs 是一种与 CIS 同样准确、侵入性更小、成本效益更高的鉴别 CD 和 ECS 的替代方法。
