Zarrilli L, Colao A, Merola B, La Tessa G, Spaziante R, Tripodi F S, Di Sarno A, Marzano L A, Lombardi G
Department of Medical-Surgical Endocrinology, Federico II University, School of Medicine, Naples, Italy.
World J Surg. 1995 Jan-Feb;19(1):150-3. doi: 10.1007/BF00317003.
Twenty-six consecutive patients with ACTH-dependent Cushing syndrome were subjected to simultaneous, bilateral inferior petrosal sinus sampling for ACTH assay before and after ACTH-releasing hormone (CRH) stimulation. The baseline ACTH inferior petrosal sinus/periphery (IPS/P) ratio was > or = 2 in 12 of 26 patients (46%), whereas the CRH-stimulated IPS/P ratio was > or = 3 in 19 of 26 patients (73%). A pituitary adenoma, ACTH-secreting at immunostaining, was surgically proved in all of the 19 patients who had an ACTH IPS/P ratio > or = 2 basally or > or = 3 after the CRH test but also in three other patients who did not have such ratios. The value of the basal IPS/P ratio and the complete lack of ACTH increase after CRH led to the diagnosis of an ectopic ACTH syndrome in four patients: a bronchial carcinoid was found in three patients, and the site of the tumor was still unknown in the other. In conclusion, the CRH test improved the diagnostic accuracy of inferior petrosal sinus sampling from 61.5% (12 pituitary, 4 ectopic) to 92.0% (19 pituitary, 4 ectopic). Thus it should be performed during the diagnostic process.
对26例连续的促肾上腺皮质激素（ACTH）依赖性库欣综合征患者在促肾上腺皮质激素释放激素（CRH）刺激前后同时进行双侧岩下窦采血以检测ACTH。26例患者中有12例（46%）的基础ACTH岩下窦/外周血（IPS/P）比值≥2，而26例患者中有19例（73%）在CRH刺激后的IPS/P比值≥3。在基础ACTH IPS/P比值≥2或CRH试验后≥3的所有19例患者中，手术证实存在免疫染色显示分泌ACTH的垂体腺瘤，但另外3例无此比值的患者中也发现了垂体腺瘤。基础IPS/P比值以及CRH刺激后ACTH完全无升高的值导致4例患者被诊断为异位ACTH综合征：3例患者发现支气管类癌，另1例患者肿瘤部位仍不明。总之，CRH试验将岩下窦采血的诊断准确性从61.5%（12例垂体性，4例异位性）提高到92.0%（19例垂体性，4例异位性）。因此，在诊断过程中应进行该试验。
