The value of X-ray guided desmopressin stimulated bilateral inferior petrosal sinus sampling in diagnosing the recurrence of ACTH dependent Cushing disease or ineffectiveness of surgery or radiotherapy
10.3760/cma.j.issn.1005-1201.2016.10.013
- VernacularTitle:X线引导下双侧岩下窦取血联合去氨加压素刺激试验对垂体术后或放疗后复发及无效的促肾上腺皮质激素依赖性库欣综合征的诊断意义
- Author:
Xiaodong JIANG
;
Xiaobo ZHANG
;
Lin LU
;
Zhengyu JIN
;
Zhiwei WANG
;
Feng GU
;
Zhaolin LU
;
Zhengpei ZENG
;
Xiaoguang LI
;
Wei LIU
;
Jie PAN
;
Haifeng SHI
;
Ning YANG
;
Renzhi WANG
- Publication Type:Journal Article
- Keywords:
Cushing syndrome;
ACTH Syndrome,ectopic;
Diagnosis;
Petrosal sinus sampling
- From:
Chinese Journal of Radiology
2016;50(10):794-797
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the value of X-ray guided desmopressin (DDAVP) stimulated bilateral inferior petrosal sinus sampling (IPSS) in diagnosing the recurrence of ACTH dependent Cushing disease or ineffectiveness after surgery or radiotherapy. Methods Retrospective analyses of patients with recurrent ACTH dependent Cushing disease (31 cases) or ineffective (3 cases) treatment after surgery or radiotherapy from January 2013 to October 2014 in our hospital was conducted. Bilateral inferior petrosal sinus angiography showed the same side of the cavernous sinus to prove successful intubation. The cases with discontinuous of the inferior petrosal sinus and cavernous sinus were excluded by this study. Finally, there were 34 cases of the patients in this study. Diagnosis was based on the ratio of ACTH level in IPS to peripheral vein after desmopressin test.The gradient≥2 at baseline or gradient≥3 after desmopressin test suggested the sources were in the pituitary. Diagnosis was confirmed by gold standard to investigate the value of X-ray guided desmopressin (DDAVP) stimulated bilateral IPSS. Results The IPS gradient≥2 at baseline or gradient≥3 after desmopressin test suggested the sources were in the pituitary in 30 patients. A total of 22 (22/30) patients underwent surgery with a final diagnosis of ACTH adenoma. The symptoms were obviously relieved in 8 (8/30) cases after sellar area gamma knife treatment and lesions were confirmed in the pituitary. IPS gradient<2 at baseline or gradient<3 after desmopressin test was found in 4 cases. One case (1/4) was found to have for ACTH adenoma after pituitary surgery. The other 3 cases (3/4) were confirmed to have lung carcinoid and clinical symptom alleviated after surgery. The sensitivity of desmopressin stimulated IPSS was 96.8%, the specificity was 100%, and the accuracy was 97.1%. Conclusion Desmopressin stimulated IPSS is an effective diagnostic procedure in diagnosing ACTH dependent Cushing disease recurrence or ineffectiveness after surgery or radiotherapy.
