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

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM 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

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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.

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去氨加压素是一种安全有效的促肾上腺皮质激素释放激素替代物。

目的：双侧下岩窦取样（BIPSS）与促肾上腺皮质激素释放激素（CRH）是鉴别库欣病（CD）与异位ACTH分泌（EAS）的金标准。然而，CRH已不再可用。目的：评价去氨加压素联合BIPSS鉴别CD与EAS的可靠性。方法：回顾性研究纳入acth依赖性高皮质醇症患者行BIPSS合并去氨加压素治疗，整个诊断过程在单一中心进行。结果：本组确诊病例58例，其中CD 51例，EAS 7例。43例（84.3%）患者刺激后比值≥2，其余8例（75%）患者刺激前比值≥3。所有EAS患者在刺激前后均得到正确诊断。刺激前敏感性为84.3%，刺激前后综合敏感性为92.2%；特异性达到100%。ROC曲线确定刺激前和刺激后的最佳阈值分别为1.4和1.7。结论：去氨加压素是CRH的良好替代品，与基线BIPSS相比，12%的病例可以纠正诊断。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annales d'endocrinologie 医学-内分泌学与代谢

CiteScore

4.40

自引率

6.50%

发文量

311

审稿时长

50 days

期刊介绍： The Annales d''Endocrinologie, mouthpiece of the French Society of Endocrinology (SFE), publishes reviews, articles and case reports coming from clinical, therapeutic and fundamental research in endocrinology and metabolic diseases. Every year, it carries a position paper by a work-group of French-language endocrinologists, on an endocrine pathology chosen by the Society''s Scientific Committee. The journal is also the organ of the Society''s annual Congress, publishing a summary of the symposia, presentations and posters. "Les Must de l''Endocrinologie" is a special booklet brought out for the Congress, with summary articles that are always very well received. And finally, we publish the high-level instructional courses delivered during the Henri-Pierre Klotz International Endocrinology Days. The Annales is a window on the world, keeping alert clinicians up to date on what is going on in diagnosis and treatment in all the areas of our specialty.