Shivnani Puneet, Kasliwal Rajeev, Goyal Gourav, Sharma Jyoti, Balani Utkarsh, Gupta Pankaj, Sharma Bhawani S, Yadav Dinesh, Mishra Vineet, Sharma Surendra K
Department of Endocrinology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India.
Department of Neurology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India.
Indian J Endocrinol Metab. 2024 Nov-Dec;28(6):589-595. doi: 10.4103/ijem.ijem_60_24. Epub 2024 Dec 30.
Corticotropin releasing hormone (CRH)-stimulated bilateral inferior petrosal sinus sampling (BIPSS) is the most accurate procedure in the differential diagnosis of adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (CS) with a sensitivity of 88-100% and a specificity of 67-100%. However, CRH is not available globally currently. We undertook this study of BIPSS using lysine vasopressin (LVP) as an agent to stimulate the release of ACTH from corticotrophs. Our objective was to assess the accuracy of LVP-stimulated BIPSS in differentiating Cushing's disease (CD) from ectopic ACTH syndrome (EAS) with negative or equivocal 3T contrast-enhanced MRI (CEMRI).
Seventeen patients with clinically and biochemically confirmed ACTH-dependent CS with equivocal or negative CEMRI pituitary underwent BIPSS using LVP as a stimulating agent.
Of seventeen patients who underwent BIPSS, nine patients had a raised central-to-peripheral ACTH ratio and were classified as having CD that was confirmed on histopathology following transsphenoidal sinus surgery. Remaining eight patients, who did not show a raised central-to-peripheral ACTH ratio, were classified to have EAS. All patients with EAS underwent contrast-enhanced computerised tomography of the neck, chest, and abdomen and/or Gallium 68 DOTANOC positron emission tomography/computerised tomography. Seven out of eight patients demonstrated solitary pulmonary nodule in the lung (bronchial carcinoid), and one patient had a mass in the thymus (thymic carcinoid).
BIPSS using LVP confirmed the source of ACTH excess correctly in all the patients with ACTH-dependent CS without the loss of specificity.
促肾上腺皮质激素释放激素（CRH）刺激下的双侧岩下窦采血（BIPSS）是诊断促肾上腺皮质激素（ACTH）依赖性库欣综合征（CS）最准确的方法，其敏感性为88%-100%，特异性为67%-100%。然而，目前CRH并非在全球范围内都可获得。我们开展了这项使用赖氨酸加压素（LVP）作为刺激剂来刺激促肾上腺皮质激素细胞释放ACTH的BIPSS研究。我们的目的是评估LVP刺激下的BIPSS在鉴别库欣病（CD）与3T对比增强磁共振成像（CEMRI）为阴性或不明确的异位ACTH综合征（EAS）方面的准确性。
17例临床和生化检查确诊为ACTH依赖性CS且垂体CEMRI不明确或为阴性的患者接受了以LVP作为刺激剂的BIPSS。
在接受BIPSS的17例患者中，9例患者的中央与外周ACTH比值升高，被归类为患有CD，经蝶窦手术后的组织病理学检查得以证实。其余8例未显示中央与外周ACTH比值升高的患者被归类为患有EAS。所有EAS患者均接受了颈部、胸部和腹部的对比增强计算机断层扫描和/或镓68 DOTANOC正电子发射断层扫描/计算机断层扫描。8例患者中有7例在肺部显示孤立性肺结节（支气管类癌），1例患者在胸腺有肿块（胸腺类癌）。
使用LVP的BIPSS在所有ACTH依赖性CS患者中均正确确认了ACTH分泌过多的来源，且未丧失特异性。
