在促肾上腺皮质激素释放激素（ovine CRH）短缺时代，蝶鞍区岩下窦取样术在库欣综合征中的诊断产量。
The diagnostic yield of inferior petrosal sinus sampling in Cushing syndrome in the era of ovine CRH shortage.
机构信息
Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
Faculty of Medicine, University of Bern, Bern, Switzerland.
出版信息
Acta Neurochir (Wien). 2024 Apr 3;166(1):167. doi: 10.1007/s00701-024-06058-2.
PURPOSE
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
目的
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。
方法
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。
结果
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%）。
结论
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。
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