A reappraisal of the ovine corticotropin-releasing hormone stimulation test in the differential diagnosis of Cushing's syndrome: a comparison with the standard high-dose dexamethasone suppression test.

Ting-I Lee, Shih-Yi Lin, Justin Ging-Shing Won, Kam-Tsun Tang, Tjin-Shing Jap, Ching-Fai Kwok, Hong-Da Lin
{"title":"A reappraisal of the ovine corticotropin-releasing hormone stimulation test in the differential diagnosis of Cushing's syndrome: a comparison with the standard high-dose dexamethasone suppression test.","authors":"Ting-I Lee,&nbsp;Shih-Yi Lin,&nbsp;Justin Ging-Shing Won,&nbsp;Kam-Tsun Tang,&nbsp;Tjin-Shing Jap,&nbsp;Ching-Fai Kwok,&nbsp;Hong-Da Lin","doi":"","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>We evaluated the diagnostic efficacy of the ovine corticotropin-releasing hormone (oCRH) stimulation test in the differential diagnosis of Cushing's syndrome and compared it with the standard high-dose dexamethasone suppression test.</p><p><strong>Methods: </strong>Twelve healthy volunteers and 30 with Cushing's syndrome (12 Cushing's disease and 18 adrenal Cushing's syndrome) were enrolled. Plasma ACTH and cortisol levels were measured before and after an intravenous bolus of 100 microg oCRH. Plasma and urinary free cortisol were determined after standard 2-day high-dose dexamethasone suppression.</p><p><strong>Results: </strong>Basal cortisol in 12 patients with Cushing's disease and 18 with adrenal Cushing's syndrome were higher than the control group (21.4 +/- 0.1 microg/dl vs. 22.3 +/- 0.5 microg/dl vs. 9.1 +/- 1.5 microg/dl; p < 0.01). In Cushing's disease, basal plasma ACTH value was significantly higher than those with adrenal disease (61.1 +/- 1.4 pg/ml vs. 6.2 +/- 4.5 pg/ml; p < 0.01). After oCRH, plasma ACTH and cortisol significantly increased, with a mean of 2.0 +/- 0.2-fold (range 1.0-2.4) and 1.6 +/- 0.1-fold (range 1.1-2.1), respectively over the basal values in patients with Cushing's disease, and 11 (90%) attained a significant ACTH (1.5-fold) or cortisol (1.2-fold) response. All except 2 (89%) with adrenal Cushing's showed no apparent change in response to oCRH. Dexamethsone suppressed urinary free cortisol by 90% in 8 (67%) with Cushing's disease, but all (100%) with adrenal Cushing's syndrome were resistant. No patient with Cushing's disease was refractory to oCRH and dexamethasone, while none with adrenal Cushing's syndrome was responsive to both. Combination of both tests could achieved a specificity of 100% for Cushing's disease and adrenal Cushing's, when these 2 tests gave concomitant positive or negative results, respectively.</p><p><strong>Conclusions: </strong>The oCRH test is a reliable examination in the differential diagnosis of Cushing's syndrome and is comparable to the high-dose dexamethasone test. A highest discrimination could be achieved when both are used.</p>","PeriodicalId":24073,"journal":{"name":"Zhonghua yi xue za zhi = Chinese medical journal; Free China ed","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2002-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Zhonghua yi xue za zhi = Chinese medical journal; Free China ed","FirstCategoryId":"1085","ListUrlMain":"","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Background: We evaluated the diagnostic efficacy of the ovine corticotropin-releasing hormone (oCRH) stimulation test in the differential diagnosis of Cushing's syndrome and compared it with the standard high-dose dexamethasone suppression test.

Methods: Twelve healthy volunteers and 30 with Cushing's syndrome (12 Cushing's disease and 18 adrenal Cushing's syndrome) were enrolled. Plasma ACTH and cortisol levels were measured before and after an intravenous bolus of 100 microg oCRH. Plasma and urinary free cortisol were determined after standard 2-day high-dose dexamethasone suppression.

Results: Basal cortisol in 12 patients with Cushing's disease and 18 with adrenal Cushing's syndrome were higher than the control group (21.4 +/- 0.1 microg/dl vs. 22.3 +/- 0.5 microg/dl vs. 9.1 +/- 1.5 microg/dl; p < 0.01). In Cushing's disease, basal plasma ACTH value was significantly higher than those with adrenal disease (61.1 +/- 1.4 pg/ml vs. 6.2 +/- 4.5 pg/ml; p < 0.01). After oCRH, plasma ACTH and cortisol significantly increased, with a mean of 2.0 +/- 0.2-fold (range 1.0-2.4) and 1.6 +/- 0.1-fold (range 1.1-2.1), respectively over the basal values in patients with Cushing's disease, and 11 (90%) attained a significant ACTH (1.5-fold) or cortisol (1.2-fold) response. All except 2 (89%) with adrenal Cushing's showed no apparent change in response to oCRH. Dexamethsone suppressed urinary free cortisol by 90% in 8 (67%) with Cushing's disease, but all (100%) with adrenal Cushing's syndrome were resistant. No patient with Cushing's disease was refractory to oCRH and dexamethasone, while none with adrenal Cushing's syndrome was responsive to both. Combination of both tests could achieved a specificity of 100% for Cushing's disease and adrenal Cushing's, when these 2 tests gave concomitant positive or negative results, respectively.

Conclusions: The oCRH test is a reliable examination in the differential diagnosis of Cushing's syndrome and is comparable to the high-dose dexamethasone test. A highest discrimination could be achieved when both are used.

羊促肾上腺皮质激素释放激素刺激试验在库欣综合征鉴别诊断中的价值:与标准大剂量地塞米松抑制试验的比较
背景:评价羊促肾上腺皮质激素释放激素(oCRH)刺激试验在库欣综合征鉴别诊断中的诊断效果,并与标准高剂量地塞米松抑制试验进行比较。方法:健康志愿者12人,库欣综合征患者30人(库欣病12人,肾上腺库欣综合征18人)。在静脉注射100微克促肾上腺皮质激素前后分别测量血浆ACTH和皮质醇水平。在标准2天高剂量地塞米松抑制后测定血浆和尿中游离皮质醇。结果:12例库欣病患者和18例肾上腺库欣综合征患者的基础皮质醇高于对照组(21.4 +/- 0.1 μ g/dl vs. 22.3 +/- 0.5 μ g/dl vs. 9.1 +/- 1.5 μ g/dl;P < 0.01)。库欣病患者的基础血浆ACTH值显著高于肾上腺疾病患者(61.1 +/- 1.4 pg/ml vs. 6.2 +/- 4.5 pg/ml;P < 0.01)。oCRH后,血浆ACTH和皮质醇显著升高,平均分别比库欣病患者的基础值高2.0 +/- 0.2倍(范围1.0-2.4)和1.6 +/- 0.1倍(范围1.1-2.1),11例(90%)患者达到显著的ACTH(1.5倍)或皮质醇(1.2倍)反应。除2例(89%)肾上腺库欣综合征患者外,其余患者对oCRH的反应均无明显变化。地塞米松对8例库欣病患者(67%)尿中游离皮质醇的抑制作用为90%,但对肾上腺库欣综合征患者(100%)均有耐药性。库欣病患者对oCRH和地塞米松均无难治性,而肾上腺库欣综合征患者对两者均无反应。当两种检测同时出现阳性或阴性结果时,两种检测联合使用对库欣病和肾上腺库欣病的特异性可达100%。结论:oCRH试验与大剂量地塞米松试验相比,是鉴别库欣综合征可靠的检查方法。当两者同时使用时,可以达到最高的歧视。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信