The diagnostic value of prolactin adjustment in bilateral inferior petrosal sinus sampling for differentiating Cushing’s disease from the ectopic ACTH syndrome: a systematic review and meta-analysis
Authors' conclusion
Prolactin adjustment in BIPSS slightly improves sensitivity for diagnosing Cushing's disease but does not enhance specificity for ectopic ACTH syndrome. This highlights the value of PRL measurement in improving diagnostic accuracy and reducing false negatives, while BIPSS remains crucial for ruling out EAS in clinical practice.
Study context
- Population
- Patients with ACTH-dependent CS undergoing bilateral inferior petrosal sinus sampling (BIPSS) to differentiate CD from ectopic ACTH syndrome; studies in PubMed, Scopus, EMBASE, Web of Science and Google Scholar up to July 2024
- Participants
- 310 patients10 studies
- Comparison
- BIPSS with vs without prolactin (PRL) adjustment
- Outcome
- Diagnostic accuracy of BIPSS for distinguishing CD from ectopic ACTH syndrome
Methodological detailsbivariate generalised linear mixed modelling
- Bivariate generalised linear mixed modelling
Pooled result
As reported in the abstract
Diagnostic accuracy (pooled)
| Group | Sensitivity | Specificity | Diagnostic OR | Positive likelihood ratio (LR) | Negative LR | Summary receiver operating characteristic (SROC) AUC |
|---|---|---|---|---|---|---|
| BIPSS with PRL adjustment | 0.96 (95% CI: 0.93-0.98) | 0.68 (95% CI: 0.52-0.81) | 48.0 (95% CI: 19.0-123.0) | 3.00 (95% CI: 1.9-4.7) | 0.06 (95% CI: 0.03-0.12) | 0.95 (95% CI: 0.93-0.97) |
| BIPSS without PRL adjustment | 0.90 (95% CI: 0.86-0.93) | 0.74 (95% CI: 0.59-0.85) | 27.0 (95% CI: 13.0-59.0) | 0.92 (95% CI: 0.89-0.94) |
Sensitivity
BIPSS with PRL adjustment0.96 (95% CI: 0.93-0.98)
BIPSS without PRL adjustment0.90 (95% CI: 0.86-0.93)
Specificity
BIPSS with PRL adjustment0.68 (95% CI: 0.52-0.81)
BIPSS without PRL adjustment0.74 (95% CI: 0.59-0.85)
Diagnostic OR
BIPSS with PRL adjustment48.0 (95% CI: 19.0-123.0)
BIPSS without PRL adjustment27.0 (95% CI: 13.0-59.0)
Positive likelihood ratio (LR)
BIPSS with PRL adjustment3.00 (95% CI: 1.9-4.7)
BIPSS without PRL adjustment— not stated in the abstract
Negative LR
BIPSS with PRL adjustment0.06 (95% CI: 0.03-0.12)
BIPSS without PRL adjustment— not stated in the abstract
Summary receiver operating characteristic (SROC) AUC
BIPSS with PRL adjustment0.95 (95% CI: 0.93-0.97)
BIPSS without PRL adjustment0.92 (95% CI: 0.89-0.94)
- BIPSS with PRL adjustment vs BIPSS without PRL adjustment: P < 0.01 — PRL adjustment improved sensitivity
- BIPSS with PRL adjustment vs BIPSS without PRL adjustment: P = 0.13 — no significant change in specificity
Original publication
The diagnostic value of prolactin adjustment in bilateral inferior petrosal sinus sampling for differentiating Cushing’s disease from the ectopic ACTH syndrome: a systematic review and meta-analysis. Pituitary. Published 28 December 2024. doi:10.
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