双侧岩下窦采血的偏侧化结果：去氨加压素与促肾上腺皮质激素释放激素对比
Lateralization outcomes of bilateral inferior petrosal sinus sampling: desmopressin vs CRH.
作者信息
Erkan Buruc, Cil Mehmet Said, Cingoz Mehmet, Burhan Sebnem, Aksoy Seyma, Yuzkan Sabahattin, Akpinar Ebubekir, Demir Suat, Tanriverdi Osman, Kocak Burak, Cakir Ilkay, Ciftci Sema, Ozturk Feyza Yener, Gunaldi Omur, Altuntas Yuksel, Niyazioglu Mutlu, Hatipoglu Esra Suheda
机构信息
Department of Neurosurgery, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey.
Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey.
出版信息
Hormones (Athens). 2024 Dec 16. doi: 10.1007/s42000-024-00620-4.
PURPOSE
Bilateral inferior petrosal sinus sampling (BIPSS) is the gold standard for localizing ACTH-dependent Cushing's syndrome (CS). While corticotropin-releasing hormone (CRH) was initially used for stimulation, desmopressin has become a common alternative. This research evaluates desmopressin's effectiveness in lateralizing Cushing's disease (CD) during BIPSS compared to CRH stimulation.
METHODS
The study included 33 individuals with ACTH-dependent CS who underwent BIPSS and had diagnoses confirmed by endoscopic endonasal transsphenoidal pituitary surgery (EETPS). Fourteen participants underwent BIPSS with CRH and 19 with desmopressin. A comparative analysis was conducted.
RESULTS
BIPSS accurately lateralized 76% of cases, specifically, 71% with CRH and 79% with desmopressin (p = 0.2). For tumors < 6 mm on MRI, overall accuracy was 82%, namely, 75% with CRH and 90% with desmopressin (p = 0.4). IPSS achieved 100% accuracy in the four cases with no lesion on preoperative MRI.
CONCLUSION
This study demonstrates no significant difference in lateralization accuracy between desmopressin and CRH for IPSS. In challenging cases, especially those with microadenomas or non-lesional CD, desmopressin with IPSS aids in preoperative lateralization.
目的
双侧岩下窦采血（BIPSS）是定位促肾上腺皮质激素（ACTH）依赖性库欣综合征（CS）的金标准。虽然最初使用促肾上腺皮质激素释放激素（CRH）进行刺激，但去氨加压素已成为一种常见的替代方法。本研究评估了在BIPSS期间，与CRH刺激相比，去氨加压素在定位库欣病（CD）方面的有效性。
方法
该研究纳入了33例ACTH依赖性CS患者，这些患者接受了BIPSS检查，并经鼻内镜经蝶窦垂体手术（EETPS）确诊。14名参与者接受了CRH刺激下的BIPSS检查，19名接受了去氨加压素刺激下的BIPSS检查。进行了对比分析。
结果
BIPSS准确地定位了76%的病例，具体而言，CRH刺激下为71%，去氨加压素刺激下为79%（p = 0.2）。对于MRI上<6 mm的肿瘤，总体准确率为82%，即CRH刺激下为75%，去氨加压素刺激下为90%（p = 0.4）。在术前MRI未发现病变的4例病例中，岩下窦采血（IPSS）的准确率达到了100%。
结论
本研究表明，在IPSS中，去氨加压素和CRH在定位准确性方面没有显著差异。在具有挑战性的病例中，尤其是那些患有微腺瘤或无病变CD的病例，去氨加压素联合IPSS有助于术前定位。
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