Interventional Radiology
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
Jiang Xiaodong, Zhang Xiaobo, Lu Lin, Jin Zhengyu, Wang Zhiwei, Gu Feng, Lu Zhaolin, Zeng Zhengpei, Li Xiaoguang, Liu Wei, Pan Jie, Shi Haifeng, Yang Ning, Wang Renzhi
Published 2016-10-10
Cite as Chin J Radiol, 2016,50(10): 794-797. DOI: 10.3760/cma.j.issn.1005-1201.2016.10.013
Abstract
ObjectiveTo 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.
MethodsRetrospective 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.
ResultsThe 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% .
ConclusionDesmopressin stimulated IPSS is an effective diagnostic procedure in diagnosing ACTH dependent Cushing disease recurrence or ineffectiveness after surgery or radiotherapy.
Key words:
Cushing syndrome; ACTH Syndrome, ectopic; Diagnosis; Petrosal sinus sampling
Contributor Information
Jiang Xiaodong
Department of Radiology, Peking Union Medical College Hospital, Beijing 100730, China. (Present address: Department of Neurosurgery, Affiliated Hospital of Chifeng University, Chifeng 024000, China)
Zhang Xiaobo
Lu Lin
Jin Zhengyu
Wang Zhiwei
Gu Feng
Lu Zhaolin
Zeng Zhengpei
Li Xiaoguang
Liu Wei
Pan Jie
Shi Haifeng
Yang Ning
Wang Renzhi
