岩下窦静脉取血在疑难ACTH依赖性库欣综合征诊断中的应用

目的 探讨岩下窦静脉取血(IPSS)在疑难库欣综合征诊断中的价值.方法 对20例疑难库欣综合征行岩下窦和外周静脉取血,测定血ACTH浓度比,评价其对库欣病诊断的敏感性和特异性.结果 18例患者的岩下窦与外周静脉血ACTH的比值＞2,其中13例行经蝶窦垂体术后病理为垂体ACTH腺瘤;1例行鞍区γ-刀治疗、4例行生长抑素治疗后病情缓解.2例岩下窦与外周静脉血ACTH的比值＜2,其中1例为右肺类癌,另1例为垂体ACTH腺瘤.本组IPSS诊断库欣病的敏感性和特异性分别为93%和100%.结论 IPSS操作安全,并发症少,可作为疑难库欣综合征的重要鉴别方法.

Bilateral inferior petrosal sinus sampling in the differential diagnosis of adrenocorticotropin-dependent Cushing's syndrome with unknown origin

Objective To evaluate the value of inferior petrosal sinus sampling in ACTH-dependent Cushing's syndrome with unknown origin.Method IPSS was carried out for the diagnosis of 20 cases of ACTH dependent Cushing's syndrome who had not been identified of diagnosis after a series of dexamethasone suppression tests and radiological examinations from Jan,2008 to Jan 2009.The ratio of plasma ACTH concentration between inferior petrosal sinus and peripheral veins was assayed.The sensitivity and specificity of diagnosis of the Cushing's disease were estimated.Results The basal ratio of ACTH concentration between inferior petrosal sinus and peripheral veins was ＞2 in 18 cases.13 cases underwent transphenoidal surgery with pathological diagnosis of pituitary ACTH adenoma;1 patient chose γ knife treatment and 4 patients chose somatostatin therapy with relieve of the disease.The basal ratio of ACTH concentration between inferior petrosal sinus and peripheral veins was ＜2 in 2 cases. One pulmonary node was removed by surgery with pathological diagnosis of carcinoid in 1 patient.One transphenoidal surgery was still undergone according to the clinical features in the other patient with pathological diagnosis of pituitary ACTH adenoma. The sensitivity and specify of inferior petrosal sinus sampling for the diagnosis of Cushing's disease in this study were 93% and 100% respectively.Conclusion Inferior petrosal sinus sampling is a safe technique with infrequent complications. It has great value in the differential diagnosis of ACTH-dependent Cushing's disease with unknown origin.