1. Inferior petrosal sinus sampling and stimulation with CRH: 15 years of experience in a tertiary hospital.
- Author
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González Fernández L, Añez Ramos RJ, Rivas Montenegro AM, Brox Torrecilla N, Miguélez González M, Muñoz Moreno D, Atencia Goñi J, Weber B, López Guerra A, Olmedilla Ishishi YL, Percovich Hualpa JC, González Albarrán O, and García Centeno R
- Subjects
- Adrenocorticotropic Hormone, Adult, Female, Humans, Hydrocortisone, Male, Middle Aged, Pituitary ACTH Hypersecretion diagnosis, Retrospective Studies, Tertiary Care Centers, Corticotropin-Releasing Hormone therapeutic use, Cushing Syndrome diagnosis, Petrosal Sinus Sampling
- Abstract
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., (Copyright © 2021 SEEN and SED. Published by Elsevier España, S.L.U. All rights reserved.)
- Published
- 2021
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