Department of Medicine, Division of Diabetes, Endocrinology & Metabolism, Johns Hopkins University, Baltimore, MD, USA.
Department of Endocrinology, Endocrinology & Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA.
Endocrine. 2023 May;80(2):425-432. doi: 10.1007/s12020-023-03327-5. Epub 2023 Mar 14.
PURPOSE: The diagnostic value of adding a Corticotropin-Releasing Hormone (CRH) Stimulation Test to the 2-day Low Dose Dexamethasone Suppression Test (Dex-CRH Test) has been debated in the literature.
We identified 65 patients with Cushing disease (CD) and 42 patients in whom a diagnosis of Cushing disease could not be confirmed (NCD) after a minimum follow-up of 14 months who underwent the Dex-CRH test.
The female sex ratio, median (range) age, and BMI were similar between the two groups. The follow-up for patients with CD and NCD was 74 (4-233) and 52 (14-146) months, respectively. Among 65 patients with CD, 5 (7.7%) had a cortisol level ≤1.4 µg/dl after LDDST but were appropriately classified as CD with a cortisol level >1.4 µg/dL at 15-min post CRH stimulation. In contrast, 3/42 patients (7.1%) in NCD had an abnormal Dex-CRH test. In only one of three patients, the LDDST was marginally normal (cortisol was 1.4 µg/dL and increased to 3.1 µg/dL 15-min post CRH). A cortisol cutoff value of >1.4 µg/dL during the Dex-CRH test provided a sensitivity of 100%, specificity of 93%, and diagnostic accuracy of 97% to diagnose CD. When patients without a Dex level were excluded (n = 74), the sensitivity did not change, but the specificity and accuracy of the Dex-CRH test increased to 97 and 99%, respectively.
The Dex-CRH Test provided additional case detection in 5/65 (7.7%) patients with CD. It resulted in one false-positive case compared to LDDST. Measurement of dexamethasone improved diagnostic accuracy of the test.
目的：在文献中，关于在两天低剂量地塞米松抑制试验（Dex-CRH 试验）中添加促肾上腺皮质激素释放激素（CRH）刺激试验的诊断价值一直存在争议。
我们确定了 65 例库欣病（CD）患者和 42 例经至少 14 个月的随访后不能确诊库欣病（NCD）的患者，这些患者均接受了 Dex-CRH 试验。
两组间的女性性别比、中位（范围）年龄和 BMI 相似。CD 和 NCD 患者的随访时间分别为 74（4-233）和 52（14-146）个月。在 65 例 CD 患者中，5（7.7%）例患者在 LDDST 后皮质醇水平≤1.4μg/dl，但在 CRH 刺激后 15 分钟时皮质醇水平>1.4μg/dL，被恰当地归类为 CD。相比之下，NCD 中 3/42 例（7.1%）患者 Dex-CRH 试验异常。在 3 例患者中，只有 1 例 LDDST 轻度正常（皮质醇为 1.4μg/dL，在 CRH 刺激后 15 分钟增加到 3.1μg/dL）。Dex-CRH 试验中皮质醇>1.4μg/dL 的截断值对 CD 的诊断具有 100%的敏感性、93%的特异性和 97%的诊断准确性。当排除无 Dex 水平的患者（n=74）时，敏感性未改变，但 Dex-CRH 试验的特异性和准确性分别提高至 97%和 99%。
Dex-CRH 试验在 5/65（7.7%）例 CD 患者中增加了病例检出。与 LDDST 相比，它导致了 1 例假阳性病例。地塞米松的测量提高了试验的诊断准确性。
