El cateterismo bilateral y simult neo de los senos petrosos inferiores en el diagnóstico diferencial del síndrome de Cushing / Bilateral inferior petrosal sinus sampling in the differential diagnosis of ACTH-dependent Cushing's syndrome
Rev. méd. Chile
;
135(9): 1095-1102, sept. 2007. ilus, tab
Article
Dans Espagnol
| LILACS
| ID: lil-468196
ABSTRACT
Background:
The features of pituitary ACTH-dependent Cushing syndrome are often indistinguishable from those of occult ectopic ACTH-dependent Cushing syndrome (CS).Aim:
To assess the diagnostic accuracy of bilateral inferior petrosal sinus sampling (BIPSS) in the differential diagnosis of ACTH-dependent Cushing's syndrome as compared with ACTH levels and the overnight high dose dexamethasone suppression test (HDDST). Material andmethods:
Retrospective review of medical records of 23 patients (aged 19 to 63 years, 16 women) with surgically proven CS, 20 pituitarymicroadenomas (CD) and 3 with occult ectopic ACTH secretion (EAS).Results:
No tumor was identifiable by imaging techniques. Mean plasma ACTH values were higher in patients with EAS than in CD (103± 110.2 and 73.1±41.98 pg/mL respectively, p=NS). Three patients with EAS and 3 patients with CD did not suppress cortisol with the HDDST. The sensitivity of the test was 86 percent and the specificity 100 percent. To improve the diagnostic outcome of BIPSS, an stimulation with Desmopressin (9 fig i.v) was performed in 9 patients. The threshold for a pituitary source, was defined as an inferior petrosal sinus to peripheral ACTH basal and post Desmopression ratio >2. BIPSS was successfully carried out in 22 patients and no complications occurred. In 6 patients BIPSS failed to meet the threshold criteria. In 3 patients, bronchial carcinoid tumors which proved to synthesize ACTH, were removed. The diagnostic sensitivity of BIPSS greatly improved from 86 percent to 100 percent after Desmopressin stimulation. BIPSS accurately predicted the ¡ateralization of the microadenoma in 8 of 12 patients (66 percent).Conclusions:
The combination of Desmopressin stimulation with BIPSS was useful for the differential diagnosis of ACTH-dependent Cushing's Syndrome. However, the preoperative location of pituitary microadenomas was poorly predicted by BIPSS.
Texte intégral:
Disponible
Indice:
LILAS (Amériques)
Sujet Principal:
Tumeurs de l'hypophyse
/
Syndrome de sécrétion ectopique d'ACTH
/
Adénomes
/
Cathétérisme des sinus pétreux
/
Hormone corticotrope
/
Syndrome de Cushing
Type d'étude:
Etude diagnostique
/
Étude observationnelle
/
Étude pronostique
/
Facteurs de risque
Limites du sujet:
Adulte
/
Femelle
/
Humains
/
Mâle
langue:
Espagnol
Texte intégral:
Rev. méd. Chile
Thème du journal:
Médicament
Année:
2007
Type:
Article
Pays d'affiliation:
Argentine
Institution/Pays d'affiliation:
Clínica La Sagrada Familia/AR
/
Hospital General de Agudos Dr. Carlos Durand/AR
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