The application of a combined stimulation with CRH and desmopressin during bilateral inferior petrosal sinus sampling in patients with Cushing's syndrome

Tsagarakis, Stelios; Kaskarelis, Ioannis; Kokkoris, Panagiotis; Malagari, C.; Thalassinos, Nikolaos

doi:10.1046/j.1365-2265.2000.00943.x

Cited by 42 publications

(28 citation statements)

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“…Previous studies have shown the potential interest of the vasopressin (AVP) analog desmopressin in the diagnosis of Cushing's disease due to an overexpression of the V1b/V3 subtype of the arginine vasopressin receptor in adenomatous vs normal corticotroph cells (24,33). Indeed, taking together the results from several studies in a total of 192 subjects with Cushing's disease, a positive cortisol response to desmopressin was reported on average in 92% of patients, and an ACTH response in 85% (17,25,26,30,31,34). Definitions for positive response may, however, differ slightly between authors who also used different assays with distinct characteristics.…”

Section: Discussionmentioning

confidence: 99%

The desmopressin test as a predictive factor of outcome after pituitary surgery for Cushing's disease

Valéro

Vallette-Kasic²,

Conte-Devolx³

et al. 2004

European Journal of Endocrinology

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Objective: Taking advantage of the over-expression of V3 receptors in adenomatous corticotroph cells, we evaluated the response to the vasopressin agonist desmopressin in 22 patients operated on for Cushing's disease, with a mean follow-up of 4.5 years. Subjects and methods: Twenty-two patients (17 women) operated on for Cushing's disease with a follow-up . 2 years (median, 48; range, 24 -141 months) underwent one desmopressin test (10 mg i.v. bolus) 3-6 months postoperatively. Twelve were in remission (R group), five had immediate failure (IF) after surgery and five had late recurrence (LR). Results: Both ACTH and cortisol peaks after desmopressin were significantly lower in the R group than in the LR group (P ¼ 0.003 and P ¼ 0.013 respectively). The receiver operator characteristic curve method defined an ACTH peak threshold $22 pg/ml or ACTH rise $ 35%; cortisol peak $350 nmol/l or cortisol rise $14%. None of twelve patients in remission had ACTH or cortisol peaks above these thresholds vs three of five patients from the LR group and five of five in the IF group. Discussion: On the basis of ACTH or cortisol peaks respectively, the desmopressin test was predictive of a later recurrence with a positive predictive value of 100% or 80% respectively, and a negative predictive value of 92%. Sensitivity and specificity were 80% and 100% respectively based on ACTH peak, and 80% and 92% respectively based on cortisol peak. Conclusion: In this first long-term study, a marked response of ACTH or cortisol to desmopressin was predictive of a later recurrence with good specificity and sensitivity.European Journal of Endocrinology 151 727-733

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Section: Discussionmentioning

confidence: 99%

The desmopressin test as a predictive factor of outcome after pituitary surgery for Cushing's disease

Valéro

Vallette-Kasic²,

Conte-Devolx³

et al. 2004

European Journal of Endocrinology

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“…Therefore, the CRH test, introduced in the IPSS procedure to create an ACTH pulse and thus minimize the IPS:P ratio distortion due to interpulse intervals (6,27), seems to achieve the maximal sensitivity, negative predictivity and diagnostic accuracy when the cumulative response to both basal and stimulated test was used. The diagnostic accuracy of IPSS seems to be further improved by using a combined stimulus with CRH and desmopressin (28).…”

Section: Discussionmentioning

confidence: 99%

Inferior petrosal sinus sampling in the differential diagnosis of Cushing's syndrome: results of an Italian multicenter study

Colao

Faggiano

Pivonello

et al. 2001

European Journal of Endocrinology

136

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Objective: To evaluate the diagnostic accuracy of inferior petrosal sinus sampling (IPSS) in the differential diagnosis of ACTH-dependent Cushing's syndrome as compared with pituitary imaging techniques. Design and Methods: We retrospectively studied the diagnostic accuracy of basal and post corticotropin-releasing hormone (CRH) IPSS, magnetic resonance imaging and computed tomography in distinguishing pituitary from ectopic ACTH secretion in 97 Cushing's syndrome patients: 74 with Cushing's disease (CD) and 10 with ectopic ACTH secretion (EAS). Thirteen patients were excluded because of unconfirmed diagnosis. The difference between IPSS and pituitary imaging techniques in the correctly localized pituitary adenoma in the patients with CD was also investigated. Results: The basal ACTH inferior petrosal sinus:periphery (IPS:P) ratio was $ 2 in 63/74 patients with CD (85%), and in 1/10 EAS patients (10%); after stimulation with CRH, the ratio was $ 3 in 60/ 68 patients with CD (88%) and , 3 in all patients with EAS.The basal and post-CRH ACTH IPS:P ratios had a diagnostic accuracy of 86% and 90% respectively. The diagnostic accuracy of IPSS with both ratios was significantly higher than magnetic resonance imaging (50%) and computed tomography (40%). The IPS:P ratio suggested by receiver-operator characteristic (ROC) analysis that better distinguished CD from EAS was 2.10 for the basal and 2.15 for the post-CRH ratios. Using these cut-offs, the specificity of basal ratio and the sensitivity of the post-CRH test rose to 100% and 93% respectively. Diagnostic accuracy remained substantially unchanged for the basal ratio (87% vs 86%), while it rose from 90% to 94% for the post-CRH ratio. The sensitivity of IPSS was significantly higher than that of magnetic resonance and computerized tomography.IPSS was less reliable in identifying the adenoma site found at surgery than magnetic resonance imaging or computed tomography (65% vs 75% and 79% respectively). Conclusion: In conclusion, IPSS improved the diagnostic performance of imaging techniques. It can help in excluding transsphenoidal surgery in EAS patients. More striking results were obtained when a $ 2X1 : 1 basal ratio or a $ 2X15 : 1 post-CRH ratio were considered as criteria to distinguish between patients with CD and EAS. To establish correctly the location of the pituitary adenoma, IPSS is less reliable than imaging techniques.

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“…The first (nZ26 patients with CD and 4 with EAS) tried to compare the use of CRH with desmopressin during bilateral petrosal sinus samplingthe procedure showed an accuracy of about 90% of cases in differentiating CD and ectopic ACTH secretion (25). The second (nZ56 patients, 5 EAS) found a sensitivity of 92% and a specificity of 100% (26).…”

Section: Figurementioning

confidence: 99%

Desmopressin test during petrosal sinus sampling: a valuable tool to discriminate pituitary or ectopic ACTH-dependent Cushing’s syndrome

Castinetti¹,

Morange²,

Dufour³

et al. 2007

eur j endocrinol

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Corticotropin-releasing hormone (CRH)-stimulated petrosal sinus sampling is currently the gold standard method for the differential diagnosis between pituitary and ectopic ACTH-dependent Cushing's syndrome. Our objective was to determine sensitivity and specificity of desmopressin test during petrosal sinus sampling. Patients and methods: Forty-three patients had petrosal sinus sampling because of the lack of visible adenoma on magnetic resonance imaging (MRI) and/or because of discordant cortisol response to high-dose dexamethasone suppression test. ACTH sampling was performed in an antecubital vein, right and left petrosal sinuses, then at each location 5 and 10 min after injection of desmopressin. Diagnosis was based on the ACTH ratio between petrosal sinus and humeral vein ACTH after desmopressin test. Diagnosis was confirmed after surgery. A receiver operating characteristics curve was used to determine optimal sensitivity and specificity. Results: Thirty-six patients had Cushing's disease (CD) and seven had ectopic ACTH secretion. A ratio O2 after desmopressin was found in 35 of the 36 cases of CD (sensitivity: 95%). A ratio %2 was found in the seven patients with ectopic ACTH secretion (specificity: 100%). Sinus sampling was ineffective in determining the left or right localization of the adenoma (sensitivityZ50%). No major adverse effects were observed during or after the procedure. Conclusion: Desmopressin test during petrosal sinus sampling is a safe and effective diagnostic procedure in ACTH-dependent Cushing's syndrome. It thus represents a valuable alternative to CRH.

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The application of a combined stimulation with CRH and desmopressin during bilateral inferior petrosal sinus sampling in patients with Cushing's syndrome

Abstract: A combined stimulus using CRH and desmopressin appears to induce a higher ACTH output from pituitary corticotroph adenomas during BIPSS, which may improve the diagnostic sensitivity of this procedure.

Cited by 42 publications

References 0 publications

The desmopressin test as a predictive factor of outcome after pituitary surgery for Cushing's disease

The desmopressin test as a predictive factor of outcome after pituitary surgery for Cushing's disease

Inferior petrosal sinus sampling in the differential diagnosis of Cushing's syndrome: results of an Italian multicenter study

Desmopressin test during petrosal sinus sampling: a valuable tool to discriminate pituitary or ectopic ACTH-dependent Cushing’s syndrome

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