| Autor: |
Machado, Marcio Carlos, de Sa, Sandra Valeria, Domenice, Sorahia, Fragoso, Maria Candida B. Villares, Puglia, Paulo, Pereira, Maria Adelaide Albergaria, de Mendonça, Berenice Bilharinho, Salgado, Luiz Roberto |
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| Zdroj: |
Clinical Endocrinology; Jan2007, Vol. 66 Issue 1, p136-142, 7p, 3 Charts, 2 Graphs |
| Abstrakt: |
Objective Bilateral inferior petrosal sinus sampling (BIPSS) with corticotrophin-releasing hormone (CRH) stimulation is currently the gold standard test for the differential diagnosis of ACTH-dependent Cushing's syndrome. Reports on the use of desmopressin in this approach are limited. The aim of this study was to evaluate the use of desmopressin during BIPSS in a cohort of patients with ACTH-dependent Cushing's syndrome. Design A retrospective case-record study. Patients Fifty-six patients with confirmed ACTH-dependent Cushing's syndrome underwent BIPSS with desmopressin stimulation when presenting negative pituitary tumour imaging. Measurements Central to peripheral (CEN:PER) ACTH gradient, lateralization of the ACTH source and surgical tumour confirmation were evaluated. Results A CEN:PER ACTH gradient was found in 40 patients under basal conditions (CEN:PER ≥ 2) and in 47 patients after desmopressin stimulation (CEN:PER ≥ 3). Ectopic ACTH-producing tumours (three lung carcinoid tumour, one thymus carcinoid tumour and one thymus hyperplasia) were confirmed in five out of nine patients without the CEN:PER ACTH gradient, and four cases were false negative for Cushing's disease. Lateralization (IPS:IPS ≥ 1·4) was observed in 80·8% of patients under basal conditions (38/47) and in 97·8% after desmopressin (46/47), and it was surgically confirmed in 78·7%. There were no false-positive cases. Sensitivity and specificity were 92·1% and 100%, respectively. Conclusions Desmopressin improves the differential diagnosis of ACTH-dependent Cushing's syndrome by amplifying the CEN:PER and IPS:IPS ACTH gradients, and is therefore a useful ACTH secretagogue in BIPSS. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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