Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
Faculty of Medicine, University of Bern, Bern, Switzerland.
Acta Neurochir (Wien). 2024 Apr 3;166(1):167. doi: 10.1007/s00701-024-06058-2.
The ovine corticotropin-releasing hormone (oCRH) stimulation test has been routinely used in the diagnostic work-up of ACTH-dependent Cushing syndrome (CS). With oCRH currently being out-of-stock in Europe, we aimed at evaluating the diagnostic performance of inferior petrosal sinus sampling (IPSS) without oCRH stimulation.
We compared the values of 40 patients with ACTH-dependent CS and negative MRI findings in whom ACTH was measured before and after oCRH stimulation.
The ratio of central-to-peripheral ACTH measurement (IPS:P) before the combined 3, 5, and 10 min of oCRH stimulation yielded diminished sensitivity (85% vs. 97%), alongside markedly decreased specificity (57% vs. 71%), as well as reduced positive and negative predictive values (90% vs. 94% and 44% vs. 83%), respectively.
With the current drug shortages in Europe, ACTH measurements without oCRH stimulation in IPSS cannot be recommended. Thus, we call for desmopressin or the commercially available human CRH as a potential alternative in the confirmation of ACTH excess by IPSS in equivocal MRI findings.
绵羊促肾上腺皮质激素释放激素（oCRH）刺激试验已常规用于 ACTH 依赖性库欣综合征（CS）的诊断。由于 oCRH 在欧洲目前缺货，我们旨在评估无 oCRH 刺激的岩下窦取样（IPSS）的诊断性能。
我们比较了 40 例 ACTH 依赖性 CS 患者和 MRI 阴性的患者，这些患者在 oCRH 刺激前后测量了 ACTH。
oCRH 刺激后 3、5 和 10 分钟的中央-外周 ACTH 比值（IPS：P）降低了敏感性（85%比 97%），特异性明显降低（57%比 71%），阳性和阴性预测值也降低（90%比 94%和 44%比 83%）。
在欧洲目前药物短缺的情况下，不推荐在 IPSS 中进行无 oCRH 刺激的 ACTH 测量。因此，我们呼吁使用去氨加压素或市售的人 CRH 作为 IPSS 在 MRI 结果不确定时确认 ACTH 过多的潜在替代方法。
