Document Detail


Desmopressin test during petrosal sinus sampling: a valuable tool to discriminate pituitary or ectopic ACTH-dependent Cushing's syndrome.
MedLine Citation:
PMID:  17766708     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 > 2 after desmopressin was found in 35 of the 36 cases of CD (sensitivity: 95%). A ratio < or = 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 (sensitivity = 50%). 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.
Authors:
F Castinetti; I Morange; H Dufour; P Jaquet; B Conte-Devolx; N Girard; T Brue
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of endocrinology / European Federation of Endocrine Societies     Volume:  157     ISSN:  0804-4643     ISO Abbreviation:  Eur. J. Endocrinol.     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-09-03     Completed Date:  2007-11-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423848     Medline TA:  Eur J Endocrinol     Country:  England    
Other Details:
Languages:  eng     Pagination:  271-7     Citation Subset:  IM    
Affiliation:
Federation of Endocrinology, Diabetes, Metabolic Diseases and Nutrition, Hôpital de la Timone, Centre Hospitalier Universitaire de Marseille, Marseille, France.
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MeSH Terms
Descriptor/Qualifier:
ACTH Syndrome, Ectopic / diagnosis*
ACTH-Secreting Pituitary Adenoma / complications,  diagnosis*
Adolescent
Adult
Antidiuretic Agents / diagnostic use*
Child
Cushing Syndrome / diagnosis*,  etiology
Deamino Arginine Vasopressin / diagnostic use*
Diagnosis, Differential
Female
Humans
Male
Middle Aged
Petrosal Sinus Sampling / methods*,  standards
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity
Chemical
Reg. No./Substance:
0/Antidiuretic Agents; 16679-58-6/Deamino Arginine Vasopressin

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