Endocrine Journal ( IF 2 ) Pub Date : 2021-07-28 , DOI: 10.1507/endocrj.ej20-0837 Jingtao Qiao 1 , Jiaqi Li 1 , Weiwei Zhang 1 , Chun Wang 1 , Jianwei Li 1 , Shu Jiang 2 , Huiwen Tan 1 , Yaxi Chen 1 , Hui Liu 1 , Bowen Cai 2 , Yerong Yu 1
Bilateral inferior petrosal sinus sampling (BIPSS) is the current gold standard test for differentially diagnosing ACTH-dependent Cushing’s syndrome (CS). However, BIPSS is an invasive procedure, and its availability is limited. We retrospectively analysed the 24-hour urinary free cortisol (UFC) level during the high-dose dexamethasone suppression test (HDDST) and plasma ACTH/cortisol levels after the desmopressin stimulation test (DDAVP test) in subjects with confirmed Cushing’s disease (CD) (n = 92) and ectopic ACTH-dependent CS (EAS) (n = 16), and evaluated the positive predictive value (PPV) of the two combined-tests in the aetiological diagnosis of ACTH-dependent CS. The percent changes in UFC levels after the HDDST and in ACTH/cortisol levels after DDAVP administration relative to the corresponding basal levels and the area under the receiver operating characteristic (ROC) curve (AUC) were analysed. UFC suppression below 62.7% suggested a pituitary origin with a sensitivity (SE) of 80% (95% CI: 70–88) and a specificity (SP) of 80% (95% CI: 52–96). A threshold increase in the ACTH level after DDAVP stimulation of 44.6% identified CD with an SE of 91% (95% CI: 83–97) and an SP of 75% (95% CI: 48–93). The combination of both tests yielded an SE of 95.5% and PPV of 98.4% for CD, and significantly improved the efficiency of the differential diagnosis between CD and EAS. These dual non-invasive endocrine tests may substantially reduce the need for BIPSS in the etiological investigation of ACTH-dependent CS.
中文翻译:
联合大剂量地塞米松抑制试验和去氨加压素刺激试验在确定ACTH依赖性库欣综合征中ACTH分泌来源的作用
双侧岩下窦取样 (BIPSS) 是目前用于鉴别诊断 ACTH 依赖性库欣综合征 (CS) 的金标准测试。然而,BIPSS 是一种侵入性手术,其可用性有限。我们回顾性分析了确诊库欣病 (CD) 受试者大剂量地塞米松抑制试验 (HDDST) 期间的 24 小时尿游离皮质醇 (UFC) 水平和去氨加压素刺激试验 (DDAVP 试验) 后血浆 ACTH/皮质醇水平。n = 92) 和异位 ACTH 依赖性 CS (EAS) ( n= 16),并评估了两种联合测试在ACTH依赖性CS的病因诊断中的阳性预测值(PPV)。分析了 HDDST 后 UFC 水平和 DDAVP 给药后 ACTH/皮质醇水平相对于相应基础水平和接受者操作特征 (ROC) 曲线 (AUC) 下面积的百分比变化。UFC 抑制低于 62.7% 表明垂体起源,敏感性 (SE) 为 80% (95% CI: 70-88),特异性 (SP) 为 80% (95% CI: 52-96)。DDAVP 刺激 44.6% 后 ACTH 水平的阈值增加确定 CD 的 SE 为 91%(95% CI:83-97)和 SP 为 75%(95% CI:48-93)。两种检测相结合,CD 的 SE 为 95.5%,PPV 为 98.4%,显着提高了 CD 和 EAS 的鉴别诊断效率。