Bilateral inferior petrosal sinus sampling with human CRH stimulation in ACTH-dependent Cushing's syndrome: results from a retrospective multicenter study
Authors' conclusion
Our study confirms the high accuracy of BIPSS in the differential diagnosis of ACTH-dependent Cushing's syndrome and suggests that the simultaneous measurement of prolactin might further improve the diagnostic performance of this test.
Study context
- Population
- Patients with overt ACTH-dependent Cushing's syndrome undergoing bilateral inferior petrosal sinus sampling (BIPSS) with human CRH stimulation; analysed subgroup with histopathologically confirmed tumors or biochemical remission and/or adrenal insufficiency after surgery (106 Cushing´s disease (CD), 14 ectopic Cushing's syndrome (ECS); 92 females)120 analysed
- Participants
- 156 patients
- Comparison
- ACTH inferior petrosal sinus (IPS):P ratio at baseline and 5 min post-CRH, and normalized ACTH:prolactin IPS:P ratio, for CD vs ECS
- Outcome
- Diagnostic performance of BIPSS (sensitivity, specificity, AUC) to differentiate CD from ECS, with and without prolactin (reference: CD)
Methodological detailsretrospective, multicenter, 5 European reference centers
- Retrospective
- Multicenter
- 5 European reference centers
Performance
As reported in the abstract
Diagnostic performance for CD vs ECS
| Test or model | AUC | Sensitivity | Specificity |
|---|---|---|---|
| ACTH IPS:P ratio baseline | 0.86 | 82.1% (95%CI 73.2-88.6)Sensitivity on a scale from 0 to 100 percent | 85.7% (95%CI 56.2-97.5)Specificity on a scale from 0 to 100 percent |
| ACTH IPS:P ratio 5 min post-CRH | 0.96 | 91.3% (95%CI 83.6-95.7)Sensitivity on a scale from 0 to 100 percent | 92.9% (95%CI 64.1-99.6)Specificity on a scale from 0 to 100 percent |
| Normalized ACTH:prolactin IPS:P ratio | 0.99 | 96.0% (95%CI 77.7-99.9)Sensitivity on a scale from 0 to 100 percent | 100% (95%CI 56.1-100)Specificity on a scale from 0 to 100 percent |
AUC
ACTH IPS:P ratio baseline0.86
ACTH IPS:P ratio 5 min post-CRH0.96
Normalized ACTH:prolactin IPS:P ratio0.99
Sensitivity
ACTH IPS:P ratio baseline82.1% (95%CI 73.2-88.6)
ACTH IPS:P ratio 5 min post-CRH91.3% (95%CI 83.6-95.7)
Normalized ACTH:prolactin IPS:P ratio96.0% (95%CI 77.7-99.9)
Sensitivity on a scale from 0 to 100 percentSpecificity
ACTH IPS:P ratio baseline85.7% (95%CI 56.2-97.5)
ACTH IPS:P ratio 5 min post-CRH92.9% (95%CI 64.1-99.6)
Normalized ACTH:prolactin IPS:P ratio100% (95%CI 56.1-100)
Specificity on a scale from 0 to 100 percentOriginal publication
Bilateral inferior petrosal sinus sampling with human CRH stimulation in ACTH-dependent Cushing's syndrome: results from a retrospective multicenter study. Eur J Endocrinol. Published 18 May 2023. doi:10.
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