Abstract

Purpose

The ovine corticotropin-releasing hormone (oCRH) stimulation test has been routinely used in the diagnostic work-up of ACTH-dependent Cushing syndrome (CS). With oCRH currently being out-of-stock in Europe, we aimed at evaluating the diagnostic performance of inferior petrosal sinus sampling (IPSS) without oCRH stimulation.

Methods

We compared the values of 40 patients with ACTH-dependent CS and negative MRI findings in whom ACTH was measured before and after oCRH stimulation.

Results

The ratio of central-to-peripheral ACTH measurement (IPS:P) before the combined 3, 5, and 10 min of oCRH stimulation yielded diminished sensitivity (85% vs. 97%), alongside markedly decreased specificity (57% vs. 71%), as well as reduced positive and negative predictive values (90% vs. 94% and 44% vs. 83%), respectively.

Conclusions

With the current drug shortages in Europe, ACTH measurements without oCRH stimulation in IPSS cannot be recommended. Thus, we call for desmopressin or the commercially available human CRH as a potential alternative in the confirmation of ACTH excess by IPSS in equivocal MRI findings.

中文翻译：

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绵羊CRH短缺时代岩下窦取样对库欣综合征的诊断率

摘要

目的

绵羊促肾上腺皮质激素释放激素 (oCRH) 刺激试验已常规用于 ACTH 依赖性库欣综合征 (CS) 的诊断检查。由于 oCRH 目前在欧洲缺货，我们旨在评估无 oCRH 刺激的岩下窦取样 (IPSS) 的诊断性能。

方法

我们比较了 40 名 ACTH 依赖性 CS 和 MRI 阴性患者的值，这些患者在 oCRH 刺激之前和之后测量了 ACTH。

结果

在联合 3、5 和 10 分钟的 oCRH 刺激之前，中枢与外周 ACTH 测量值 (IPS:P) 的比值降低了敏感性（85% 对 97%），同时特异性也显着降低（57% 对 71%）。 %），以及阳性和阴性预测值分别降低（90% vs. 94% 和 44% vs. 83%）。

结论

由于欧洲目前药物短缺，不建议在 IPSS 中进行没有 oCRH 刺激的 ACTH 测量。因此，我们呼吁使用去氨加压素或市售的人 CRH 作为潜在替代方案，通过 IPSS 在模棱两可的 MRI 结果中确认 ACTH 过量。