促肾上腺皮质激素依赖性库欣综合征患者岩下窦静脉采血的临床应用探讨

目的 研究并探讨岩下窦静脉采血(IPSS)在疑难库欣综合征(CS)诊断中的应用价值。方法 16例疑难CS患者行双侧岩下窦和外周静脉采血，测定岩下窦与外周静脉血促肾上腺皮质激素(ACTH)浓度比，评价IPSS对库欣病诊断的敏感度和特异度。结果 13例患者岩下窦与外周静脉血ACTH的比值＞2.0，其中12例经蝶窦垂体手术治疗，病理证实为垂体ACTH腺瘤；1例行鞍区γ-刀治疗，治疗后患者症状好转。3例岩下窦与外周静脉血ACTH的比值＜2.0，其中2例为右肺类癌，另1例为垂体ACTH腺瘤。IPSS诊断库欣病的敏感度和特异度分别为13/14和2/2。结论 IPSS诊断疑难库欣病的敏感度和特异度均较高，且操作安全，并发症少，可作为疑难CS的重要鉴别手段，值得临床上进一步推广应用。

Inferior petrosal sinus sampling in the diagnosis of adrenocorticotropin dependent Cushing syndrome with unknown orign

Objective To evaluate the value of inferior petrosal sinus sampling (IPSS) in the diagnosis of adreno-corticotropic hormone ( ACTH ) dependent Cushing syndrome ( CS ) with unknown origin. Methods IPSS was carried out for the diagnosis of 16 cases with ACTH dependent CS who had not been identified after a series of dexamethasone suppression tests and radiological examinations. The ratio of inferior petrosal sinus/peripheral ACTH was assayed. The sensitivity and specificity of diagnosis of the Cushing disease were estimated. Results The inferior petrosal sinus/peripheral ACTH ratio was over 2. 0 in 13 cases. Twelve cases underwent surgery with pathological diagnosis of pituitary ACTH adenoma, 1 patient relieved after γ knife treatment. The ratio was ＜ 2.0 in 3 cases including 2 pulmonary carcinoid and one pituitary ACTH adenoma. The sensitivity and specify of IPSS for the diagnosis of Cushing disease were 13/14and 2/2 respectively. Conclusion IPSS was a safe technique with high sensitivity, specify and infrequent complications in the diagnosis of ACTH dependent Cushing disease. It had great clinical value in the differential diagnosis of ACTH dependent Cushing disease with unknown origin.