Valizadeh Majid, Ahmadi Amirhossein Ramezani, Hussein Dana Ramadhan, Emdadi Farnaz, Hosseinpanah Farhad, Grossman Ashley, Abiri Behnaz
Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Pituitary. 2024 Dec 28;28(1):11. doi: 10.1007/s11102-024-01474-0.
Adrenocorticotropin (ACTH)-dependent Cushing's syndrome can arise from a pituitary tumour (Cushing's disease) or an ectopic ACTH-secreting tumour, making precise differentiation essential for effective treatment. Bilateral inferior petrosal sinus sampling (BIPSS) is the gold standard for this differentiation, but false-negative results can limit its accuracy. Adding prolactin (PRL) measurement to BIPSS has been proposed to improve diagnostic precision. This meta-analysis evaluates how correction for prolactin levels ('prolactin adjustment') affects the diagnostic value of BIPSS in distinguishing Cushing's disease from ectopic ACTH syndrome.
A systematic literature search was conducted in PubMed, Scopus, EMBASE, Web of Science, and Google Scholar up to July 2024. Studies were included if they provided data on BIPSS with and without PRL adjustment for ACTH-dependent Cushing's syndrome. Data extraction and quality assessment were performed, and diagnostic accuracy metrics were analysed using bivariate generalised linear mixed modelling.
A total of 10 studies with 310 participants were included. The pooled sensitivity and specificity of BIPSS with PRL adjustment were 0.96 (95% CI: 0.93-0.98) and 0.68 (95% CI: 0.52-0.81), respectively. The diagnostic odds ratio (DOR) was 48.0 (95% CI: 19.0-123.0), with a positive likelihood ratio (LR) of 3.00 (95% CI: 1.9-4.7) and a negative LR of 0.06 (95% CI: 0.03-0.12). The area under the summary receiver operating characteristic (SROC) curve was 0.95 (95% CI: 0.93-0.97). For BIPSS without PRL adjustment, the pooled sensitivity was 0.90 (95% CI: 0.86-0.93) and specificity was 0.74 (95% CI: 0.59-0.85), with a DOR of 27.0 (95% CI: 13.0-59.0). The SROC curve area was 0.92 (95% CI: 0.89-0.94). Prolactin adjustment improved sensitivity (P < 0.01) without a significant change in specificity (P = 0.13).
Prolactin adjustment in BIPSS slightly improves sensitivity for diagnosing Cushing's disease but does not enhance specificity for ectopic ACTH syndrome. This highlights the value of PRL measurement in improving diagnostic accuracy and reducing false negatives, while BIPSS remains crucial for ruling out EAS in clinical practice.
促肾上腺皮质激素（ACTH）依赖性库欣综合征可由垂体肿瘤（库欣病）或异位ACTH分泌肿瘤引起，因此精确鉴别对于有效治疗至关重要。双侧岩下窦采血（BIPSS）是这种鉴别的金标准，但假阴性结果可能会限制其准确性。有人提出在BIPSS中加入催乳素（PRL）测量以提高诊断精度。本荟萃分析评估了催乳素水平校正（“催乳素调整”）如何影响BIPSS在区分库欣病与异位ACTH综合征中的诊断价值。
截至2024年7月，在PubMed、Scopus、EMBASE、Web of Science和谷歌学术中进行了系统的文献检索。纳入的研究需提供有关ACTH依赖性库欣综合征在有和没有PRL调整情况下的BIPSS数据。进行了数据提取和质量评估，并使用双变量广义线性混合模型分析了诊断准确性指标。
共纳入10项研究，310名参与者。经PRL调整的BIPSS的合并敏感性和特异性分别为0.96（95%CI：0.93 - 0.98）和0.68（95%CI：0.52 - 0.81）。诊断比值比（DOR）为48.0（95%CI：19.0 - 123.0），阳性似然比（LR）为3.00（95%CI：1.9 - 4.7），阴性LR为0.06（95%CI：0.03 - 0.12）。汇总的受试者工作特征（SROC）曲线下面积为0.95（95%CI：0.93 - 0.97）。对于未进行PRL调整的BIPSS，合并敏感性为0.90（95%CI：0.86 - 0.93），特异性为0.74（95%CI：0.59 - 0.85），DOR为27.0（95%CI：13.0 - 59.0）。SROC曲线面积为0.92（95%CI：0.89 - 0.94）。催乳素调整提高了敏感性（P < 0.01），而特异性没有显著变化（P = 0.13）。
BIPSS中的催乳素调整略微提高了诊断库欣病的敏感性，但并未提高异位ACTH综合征的特异性。这突出了PRL测量在提高诊断准确性和减少假阴性方面的价值，而BIPSS在临床实践中对于排除异位ACTH综合征仍然至关重要。
