Inferior petrosal sinus sampling and stimulation with CRH: 15 years of experience in a tertiary hospital
| Autor: | Alejandra Maricel Rivas Montenegro, Rogelio Garcia Centeno, Juan Carlos Percovich Hualpa, Diego Muñoz Moreno, José Atencia Goñi, Laura González Fernández, Roberto José Añez Ramos, Yoko Lucía Olmedilla Ishishi, Aurelio López Guerra, Olga González Albarrán, María Miguélez González, Bettina Weber, Noemí Brox Torrecilla |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male endocrine system medicine.medical_specialty Hydrocortisone Corticotropin-Releasing Hormone Urology Stimulation Adrenocorticotropic hormone Petrosal Sinus Sampling Tertiary Care Centers Adrenocorticotropic Hormone Epidemiology medicine Humans In patient Pituitary ACTH Hypersecretion Cushing Syndrome Retrospective Studies business.industry Retrospective cohort study Middle Aged Inferior petrosal sinus sampling Peripheral Female business hormones hormone substitutes and hormone antagonists Hormone |
| Zdroj: | Endocrinologia, diabetes y nutricion. 68(6) |
| ISSN: | 2530-0180 |
| Popis: | Background Inferior petrosal sinus sampling (IPSS) is indicated in the diagnosis of adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (CS), especially when the results of the initial diagnostic tests are discordant. Objective To describe the patients who underwent this invasive functional test in a tertiary hospital. Methods This was an observational study of a retrospective cohort of patients with ACTH-dependent CS and IPSS between 2004 and 2019. We determined their epidemiological, hormonal, radiological and functional characteristics, and evaluated their diagnostic capacity and optimal cut-off points to differentiate between Cushing's disease (CD) and ectopic Cushing's syndrome (ECS). Results 23 patients were evaluated, of which 65.2% were women with the average age of 42 (36–62) years. ACTH secretion of pituitary origin was evident in 82.6% of the patients and of ectopic origin in 17.4%. Plasma cortisol, urinary free cortisol, and ACTH levels were higher in patients with ECS. Regarding IPSS, the baseline central/peripheral ACTH gradient detected 89.5% of patients with CD and after stimulation with CRH, 100%. The optimal cut-off points in the diagnosis of CD were 2.06 at baseline and 2.49 after CRH stimulation. Conclusion IPSS with CRH stimulation is a test with a high diagnostic accuracy for correctly classifying patients with CD and ECS. The cut-off points of the gradients may be different from the classic ones. Therefore, we recommend that each center perform its own evaluation. |
| Databáze: | OpenAIRE |
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