Desmopressin is a safe and effective secretagogue to replace corticotropin-releasing hormone in petrosal sinus sampling.

Annales d'endocrinologie Pub Date : 2024-12-19 DOI:10.1016/j.ando.2024.101678

Cecilia Piazzola, Thomas Graillon, Nadine Girard, Henry Dufour, Thierry Brue, Frederic Castinetti

{"title":"Desmopressin is a safe and effective secretagogue to replace corticotropin-releasing hormone in petrosal sinus sampling.","authors":"Cecilia Piazzola, Thomas Graillon, Nadine Girard, Henry Dufour, Thierry Brue, Frederic Castinetti","doi":"10.1016/j.ando.2024.101678","DOIUrl":null,"url":null,"abstract":"Purpose: Bilateral inferior petrosal sinus sampling (BIPSS) with corticotropin-releasing hormone (CRH) was the gold standard for distinguishing Cushing disease (CD) from ectopic ACTH secretion (EAS). CRH, however, is no longer available.Objective: To assess the reliability of BIPSS with desmopressin to differentiate CD from EAS.Methods: A retrospective study included patients who underwent BIPSS with desmopressin for ACTH-dependent hypercortisolism, with the whole diagnostic procedure in a single center.Results: Fifty-eight patients with confirmed etiological diagnosis were included: 51 CD, 7 EAS. Forty-three CD patients (84.3%) had post-stimulation ratio ≥2 before stimulation and 6 of the other 8 (75%) had a ratio ≥3. All EAS patients were correctly diagnosed before and after stimulation. Sensitivity was 84.3% before stimulation and 92.2% combining pre- and post-stimulation results; specificity reached 100%. A ROC curve established optimal thresholds at 1.4 before stimulation and 1.7 after.Conclusion: Desmopressin is a good substitute for CRH, correcting diagnosis compared to baseline BIPSS in 12% of cases.","PeriodicalId":93871,"journal":{"name":"Annales d'endocrinologie","volume":" ","pages":"101678"},"PeriodicalIF":0.0000,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annales d'endocrinologie","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.ando.2024.101678","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose: Bilateral inferior petrosal sinus sampling (BIPSS) with corticotropin-releasing hormone (CRH) was the gold standard for distinguishing Cushing disease (CD) from ectopic ACTH secretion (EAS). CRH, however, is no longer available.

Objective: To assess the reliability of BIPSS with desmopressin to differentiate CD from EAS.

Methods: A retrospective study included patients who underwent BIPSS with desmopressin for ACTH-dependent hypercortisolism, with the whole diagnostic procedure in a single center.

Results: Fifty-eight patients with confirmed etiological diagnosis were included: 51 CD, 7 EAS. Forty-three CD patients (84.3%) had post-stimulation ratio ≥2 before stimulation and 6 of the other 8 (75%) had a ratio ≥3. All EAS patients were correctly diagnosed before and after stimulation. Sensitivity was 84.3% before stimulation and 92.2% combining pre- and post-stimulation results; specificity reached 100%. A ROC curve established optimal thresholds at 1.4 before stimulation and 1.7 after.

Conclusion: Desmopressin is a good substitute for CRH, correcting diagnosis compared to baseline BIPSS in 12% of cases.

查看原文