The usefulness of the combined high-dose dexamethasone suppression test and desmopressin stimulation test in establishing the source of ACTH secretion in ACTH-dependent Cushing’s syndrome

Endocrine journal

article

Jingtao Qiao¹  Bowen Cai²  Yerong Yu¹  Jiaqi Li¹  Weiwei Zhang¹  Chun Wang¹  Jianwei Li¹  Shu Jiang²  Huiwen Tan¹  Yaxi Chen¹  Hui Liu¹ 

[1] Department of Endocrinology and Metabolism, West China Hospital, Sichuan University;Department of Neurosurgery, West China Hospital, Sichuan University

关键词: Cushing’s disease (CD);    Ectopic ACTH syndrome (EAS);    High-dose dexamethasone suppression test (HDDST);    Desmopressin stimulation test (DDAVP test);    Bilateral inferior petrosal sinus sampling (BIPSS);   

DOI  :  10.1507/endocrj.EJ20-0837

学科分类：内分泌与代谢学

来源: Japan Endocrine Society

【 摘 要 】

Bilateral inferior petrosal sinus sampling (BIPSS) is the current gold standard test for differentially diagnosing ACTH-dependent Cushing’s syndrome (CS). However, BIPSS is an invasive procedure, and its availability is limited. We retrospectively analysed the 24-hour urinary free cortisol (UFC) level during the high-dose dexamethasone suppression test (HDDST) and plasma ACTH/cortisol levels after the desmopressin stimulation test (DDAVP test) in subjects with confirmed Cushing’s disease (CD) ( n = 92) and ectopic ACTH-dependent CS (EAS) ( n = 16), and evaluated the positive predictive value (PPV) of the two combined-tests in the aetiological diagnosis of ACTH-dependent CS. The percent changes in UFC levels after the HDDST and in ACTH/cortisol levels after DDAVP administration relative to the corresponding basal levels and the area under the receiver operating characteristic (ROC) curve (AUC) were analysed. UFC suppression below 62.7% suggested a pituitary origin with a sensitivity (SE) of 80% (95% CI: 70–88) and a specificity (SP) of 80% (95% CI: 52–96). A threshold increase in the ACTH level after DDAVP stimulation of 44.6% identified CD with an SE of 91% (95% CI: 83–97) and an SP of 75% (95% CI: 48–93). The combination of both tests yielded an SE of 95.5% and PPV of 98.4% for CD, and significantly improved the efficiency of the differential diagnosis between CD and EAS. These dual non-invasive endocrine tests may substantially reduce the need for BIPSS in the etiological investigation of ACTH-dependent CS.

【 授权许可】

Unknown