O'Keeffe Derek T, Maraka Spyridoula, Kotwal Anupam, Cloft Harry, Kallmes David F, Bancos Irina, Chang Alice Y, Erickson Dana, Young William F
Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland.
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Pituitary. 2025 Oct 22;28(6):118. doi: 10.1007/s11102-025-01595-0.
Distinguishing between pituitary corticotropin (ACTH)-dependent Cushing disease (CD) and ectopic ACTH-dependent Cushing syndrome (EADCS) is diagnostically challenging. This study compared the diagnostic performance of bilateral inferior petrosal sinus sampling (BIPSS) and bilateral internal jugular vein sampling (BIJVS).
We retrospectively reviewed 109 patients at Mayo Clinic (1998-2018) who underwent simultaneous BIPSS and BIJVS. Eighty-four patients proceeded to pituitary surgery based on BIPSS results, and 81 ultimately received confirmed diagnoses: 74 with CD and 7 with EADCS. Sensitivity and specificity were calculated using pre- and post-corticotropin-releasing hormone (CRH) stimulation criteria.
BIJVS was positive in 35/74 CD patients at baseline and 59/74 post-CRH, compared with 68/74 and 72/74, respectively, for BIPSS. Combined pre- and post-CRH criteria yielded 82% sensitivity and 86% specificity for BIJVS, compared with 100% sensitivity and specificity for BIPSS.
BIPSS is superior to BIJVS for establishing the source of ACTH hypersecretion in ACTH-dependent Cushing syndrome. BIJVS demonstrates limited diagnostic utility in clinical practice.
区分垂体促肾上腺皮质激素（ACTH）依赖性库欣病（CD）和异位ACTH依赖性库欣综合征（EADCS）在诊断上具有挑战性。本研究比较了双侧岩下窦采血（BIPSS）和双侧颈内静脉采血（BIJVS）的诊断性能。
我们回顾性分析了梅奥诊所1998年至2018年间109例行同步BIPSS和BIJVS的患者。84例患者根据BIPSS结果接受垂体手术，81例最终得到确诊：74例为CD，7例为EADCS。使用促肾上腺皮质激素释放激素（CRH）刺激前后的标准计算敏感性和特异性。
在基线时，35/74例CD患者的BIJVS呈阳性，CRH刺激后为59/74例，而BIPSS分别为68/74例和72/74例。CRH刺激前后的联合标准使BIJVS的敏感性为82%，特异性为86%，而BIPSS的敏感性和特异性均为100%。
在ACTH依赖性库欣综合征中，BIPSS在确定ACTH分泌过多的来源方面优于BIJVS。BIJVS在临床实践中的诊断效用有限。
