Pituitary最新文献

{"title":"Relationship between plasma urea and copeptin in response to arginine stimulation in healthy adults, patients with vasopressin deficiency and primary polydipsia.","authors":"Cihan Atila, Sven Lustenberger, Irina Chifu, Emanuele Ferrante, Zoran Erlic, Juliana B Drummond, Rita Indirli, Roosmarijn Drexhage, Andrew S Powlson, Mark Gurnell, Beatriz Santana Soares, Johannes Hofland, Felix Beuschlein, Martin Fassnacht, Bettina Winzeler, Julie Refardt, Mirjam Christ-Crain","doi":"10.1007/s11102-024-01489-7","DOIUrl":"10.1007/s11102-024-01489-7","url":null,"abstract":"<p><strong>Background: </strong>Arginine infusion stimulates copeptin secretion, a surrogate marker of arginine vasopressin (AVP), thereby serving as a diagnostic test in the differential diagnosis of suspected AVP deficiency (AVP-D). Yet, the precise mechanism underlying the stimulatory effect of arginine on the vasopressinergic system remains elusive. Arginine plays a significant role in the urea cycle and increases the production of urea. An increase in plasma urea concentration raises blood osmolality, thereby possibly stimulating AVP release. We therefore hypothesized that the stimulatory effect of arginine on AVP may involve an increase in plasma urea levels.</p><p><strong>Methods: </strong>This analysis combined data from two prospective diagnostic studies. In total, 30 healthy adults (HA), 69 patients with AVP-D, and 89 patients with primary polydipsia (PP) underwent the arginine stimulation test. Infusion of arginine (L--arginine--hydrochloride 21%) at a dose of 0.5 g/kg body weight diluted in 500 mL of 0.9% normal saline was administered over 30 min. Blood was collected at baseline and 60, 90, and 120 min to analyze plasma copeptin and urea. The main objective was to investigate urea dynamics in response to arginine administration and its effect on copeptin release.</p><p><strong>Results: </strong>Plasma urea levels at baseline were comparable and increased 60 min after arginine infusion with a median (IQR) change of + 1.1 mmol/L (+ 0.8, + 1.5) in HA, + 1.4 mmol/L (+ 1.1, + 1.7) in patients with AVP-D and + 1.3 mmol/L (+ 0.9, + 1.5) in patients with PP. Concurrently, plasma copeptin levels substantially increased 60 min from baseline in HA (median change + 5.3 pmol/L (+ 3.2, + 8.8)) and in patients with PP (median change + 2.4 pmol/L (+ 1.2, + 3.8)), but remained stable in patients with AVP-D (median change + 0.3 pmol/L (+ 0.1, + 0.6)). Plasma urea and copeptin levels correlated the most in HA, with a Spearman's rho of 0.41 at baseline. Patients with AVP-D and PP showed only weak correlations of plasma urea and copeptin, with a correlation coefficient between 0.01 and 0.28.</p><p><strong>Conclusion: </strong>We demonstrate a slight increase in plasma urea levels in response to arginine, but plasma urea and copeptin levels were weakly correlated. Based on these findings, the stimulatory effect of arginine on AVP cannot be explained primarily by increasing urea levels.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 1","pages":"18"},"PeriodicalIF":3.3,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143041077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlates of prolonged length of stay after endoscopic transsphenoidal surgery for pituitary adenomas: varying definitions and non-clinical factors.","authors":"Khushi H Shah, Nikola Susic, Nicholas V DiStefano, Maxon V Knott, Adham M Khalafallah, Victor M Lu, Carolina G Benjamin, Ashish H Shah, Zoukaa B Sargi, Ricardo J Komotar, Michael E Ivan","doi":"10.1007/s11102-024-01483-z","DOIUrl":"10.1007/s11102-024-01483-z","url":null,"abstract":"<p><strong>Purpose: </strong>Prolonged length of stay (PLOS) can lead to resource misallocation and higher complication risks. However, there is no consensus on defining PLOS for endoscopic transsphenoidal pituitary surgery (ETPS). Therefore, we investigated the impact of varying PLOS definitions on factors associated with PLOS in patients undergoing ETPS.</p><p><strong>Methods: </strong>We conducted a retrospective review of patients with pituitary adenomas who underwent ETPS at our institution from 2012 to 2023. Patients were divided into non-PLOS and PLOS groups based on varying definitions of PLOS: > median, > 4 days, > 75th percentile, and > 90th percentile. Bivariate statistical analyses were conducted using Fisher's exact test, chi-square test, and t-tests. Univariate and multivariate logistic regression identified significant predictors for each PLOS definition.</p><p><strong>Results: </strong>Our cohort (n = 808) had a mean age of 54.37 ± 16.06 years, 50.43% male, and a median LOS of 3 days. The 75th and 90th percentiles of LOS were 4 and 6 days, respectively. The way PLOS was defined influenced associated factors identified. Preoperative KPS score, non-private insurance, and non-home discharge disposition were associated with PLOS across all definitions used (p < 0.05). Increased preoperative tumor volumes and postoperative hyponatremia were associated with PLOS only when defined by the 75th and 90th percentiles (p < 0.05). Non-White race and low income were significantly associated with PLOS > median while intraoperative CSF leak was a significant predictor for PLOS > 90th percentile (p < 0.05).</p><p><strong>Conclusion: </strong>Our study highlights the variability in predictors of PLOS based on its definition and emphasizes the role of non-clinical factors on LOS.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 1","pages":"21"},"PeriodicalIF":3.3,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143041075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osilodrostat improves blood pressure and glycemic control in patients with Cushing's disease: a pooled analysis of LINC 3 and LINC 4 studies.","authors":"Maria Fleseriu, Rosario Pivonello, John Newell-Price, Mônica R Gadelha, Beverly M K Biller, Richard J Auchus, Richard A Feelders, Akira Shimatsu, Przemysław Witek, Marie Bex, Andrea Piacentini, Alberto M Pedroncelli, André Lacroix","doi":"10.1007/s11102-024-01471-3","DOIUrl":"10.1007/s11102-024-01471-3","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effect of osilodrostat and hypercortisolism control on blood pressure (BP) and glycemic control in patients with Cushing's disease.</p><p><strong>Methods: </strong>Pooled analysis of two Phase III osilodrostat studies (LINC 3 and LINC 4), both comprising a 48-week core phase and an optional open-label extension. Changes from baseline in systolic and diastolic BP (SBP and DBP), fasting plasma glucose (FPG), and glycated hemoglobin (HbA_1c) were evaluated during osilodrostat treatment in patients with/without hypertension or diabetes at baseline.</p><p><strong>Results: </strong>Of 210 patients, 82.9% met criteria for hypertension and 40.0% for diabetes at baseline. In patients with hypertension, reductions in mean SBP/DBP were observed from week (W)12 to W72, and 49.1%/58.5% of patients with high SBP/DBP (> 130/>90 mmHg) at baseline had normotensive levels at W72. Antihypertensive medication dose was reduced/stopped in 26.8% of patients, and the proportion taking antihypertensive medication decreased from 54.3% at baseline to 47.3% at W72. In patients with diabetes, mean FPG and HbA_1c decreased from W12 to W72, and 33.3%/61.5% with high FPG/HbA_1c (≥ 100 mg/dL/≥6.5%) at baseline had normal levels at W72. Antihyperglycemic medication dose was reduced/stopped in 35.7% of patients, and the proportion taking antihyperglycemic medication decreased from 21.9% at baseline to 17.1% at W72; improvements in SBP/DBP and FPG/HbA_1c were correlated with improvement in mean urinary free cortisol but not weight change. BP/glycemic parameters generally remained normal in patients without hypertension/diabetes at baseline.</p><p><strong>Conclusions: </strong>Patients with Cushing's disease and comorbid hypertension/diabetes receiving osilodrostat had rapid and sustained improvements in SBP/DBP and glycemic control, respectively.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 1","pages":"22"},"PeriodicalIF":3.3,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of non-clinical factors in pituitary surgery.","authors":"Joao Paulo Almeida","doi":"10.1007/s11102-024-01491-z","DOIUrl":"https://doi.org/10.1007/s11102-024-01491-z","url":null,"abstract":"","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 1","pages":"17"},"PeriodicalIF":3.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Giant prolactinomas, a detailed analysis of 196 adult cases.","authors":"Lisa Billion, Arno Verleye, Christophe De Block, Paul Van de Heyning, Carlien De Herdt","doi":"10.1007/s11102-024-01492-y","DOIUrl":"https://doi.org/10.1007/s11102-024-01492-y","url":null,"abstract":"","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 1","pages":"16"},"PeriodicalIF":3.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of acromegaly-induced diabetes: an updated proposal.","authors":"Betina Biagetti, Marta Araujo-Castro, Mónica Marazuela, Manel Puig-Domingo","doi":"10.1007/s11102-024-01477-x","DOIUrl":"10.1007/s11102-024-01477-x","url":null,"abstract":"<p><p>Acromegaly-induced diabetes presents unique features due to the direct effects of excess growth hormone (GH) and insulin-like growth factor 1 (IGF-) on glucose metabolism, especially insulin resistance in association to low body fat content and water retention. Increased cardiovascular risk is much higher when acromegaly is complicated with diabetes, thus requiring a holistic management that addresses also these specific characteristics which differ from those of classical type 2 diabetes.The optimal management of diabetes in acromegaly requires not only an effective control of carbohydrate disturbances per se, but also the concurrent control of GH hypersecretion as it will directly impact on glucose control. If surgical treatment is not effective to normalize GH and IGF-1 levels, pharmacologic therapy for acromegaly must consider the metabolic effects that the different drugs may induce, as some of them may worsen carbohydrate metabolism. When treating acromegaly-induced diabetes, a comprehensive approach is essential, incorporating medications that may also protect against acromegaly associated comorbidities. Metformin remains the first-line therapy due to its ability to reduce hepatic glucose production enhance insulin sensitivity and its cost effectiveness. The newer drug classes, such as glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors, offer benefits similar to those seen in type 2 diabetes, but the unique metabolic profile of acromegaly-including an enhanced ketogenic state and the effects of incretins on GH secretion-have to be considered as it may influence outcomes. Understanding the distinct pathophysiology of acromegaly-induced diabetes and the benefits of these newer drug classes for the patient with acromegaly is crucial for optimizing treatment outcomes and improving the quality of life.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 1","pages":"15"},"PeriodicalIF":3.3,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empty sella syndrome: an update.","authors":"Francesco Padovano Sorrentino, Sabrina Chiloiro, Antonella Giampietro, Antonio Bianchi, Alfredo Pontecorvi, Laura De Marinis","doi":"10.1007/s11102-024-01475-z","DOIUrl":"https://doi.org/10.1007/s11102-024-01475-z","url":null,"abstract":"<p><strong>Introduction: </strong>Empty sella is characterized by a flattened profile of the pituitary gland that represents in most cases only a radiological incidental finding. When endocrine, ophthalmic, and neurological symptoms occur, this condition is described as empty sella syndrome.</p><p><strong>Materials and methods: </strong>We searched MEDLINE (PubMed database) with the data filter 2024-2009 using the keywords listed above. The articles met the following inclusion criteria: 1) written in English; 2) published between 1 January 2009, and 31 December 2023; 3) original studies and case series on the epidemiology, characteristics, and treatment of empty sella and empty sella syndrome. Exclusion criteria included: articles written in languages other than English and single case report.</p><p><strong>Results: </strong>The incidence of empty sella is about 12%, when it comes to neuroimaging, while in clinical practice it can reach 35%. Endocrine pituitary disorders, defined as at least one hormone deficit, were reported in 19% to 40% of patients. Magnetic nuclear imaging (MRI) is confirmed to be the gold standard for radiological diagnosis of empty sella. If no alterations are detected it is suggested a careful revaluation at 24-36 months, in relation to the low risk of progression to PES syndrome.</p><p><strong>Conclusions: </strong>Empty sella is, in most cases, a radiological finding without clinical manifestations. In people carrying empty sella hormonal pituitary evaluation should be assessed at the moment of the diagnosis, along with a careful imaging using MRI.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 1","pages":"13"},"PeriodicalIF":3.3,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of insurance on outcomes of patients undergoing endoscopic transsphenoidal surgery for non-functional pituitary adenomas: a single institution study.","authors":"Khushi H Shah, Nikola Susic, Adham M Khalafallah, Victor M Lu, Michael E Ivan, Ricardo J Komotar, Zoukaa B Sargi, Ashish H Shah","doi":"10.1007/s11102-024-01478-w","DOIUrl":"10.1007/s11102-024-01478-w","url":null,"abstract":"<p><strong>Purpose: </strong>Uninsured and underinsured patients face notable healthcare disparities in neurosurgery, but limited literature exists on the impact of insurance on non-functioning pituitary adenomas (NFPAs). We investigated how insurance affects outcomes of endoscopic transsphenoidal pituitary surgery (ETPS) for NFPAs.</p><p><strong>Methods: </strong>We retrospectively reviewed NFPA patients who underwent ETPS at our institution from 2012 to 2023. Patients were grouped by insurance status, and insured patients were further subcategorized by insurance providers. Bivariate analyses used Fisher's exact, chi-square, and t-tests. ANOVA or Kruskal-Wallis tests were applied for ≥ 2 groups. Logistic regression identified relationships between binomial variables and insurance.</p><p><strong>Results: </strong>Our cohort (n = 651, 56.93 ± 15.53 years, 52.53% male) included 611 insured and 40 uninsured patients. Uninsured patients had lower preoperative KPS, higher rates of visual disturbances (VD), preoperative tumor volumes (TV), chiasm compression, and Knosp 4 grade, along with lower resection and longer hospital stays (LOS) (p < 0.05). Multivariate analysis showed lack of insurance was associated with increased VD (aOR 3.38), TV (aOR 2.63), Knosp 4 (aOR 3.44), subtotal resection (aOR 2.72), and prolonged LOS (aOR 7.03) (p < 0.05). When insured patients were grouped into Private (n = 361), Medicare (n = 223), and Medicaid (n = 23), Medicaid patients had larger preoperative TV, chiasm compression, Knosp 3 grade, and longer LOS (p < 0.05), with higher odds for Knosp 3 (aOR 3.00), subtotal resection (aOR 3.86), and prolonged LOS (aOR 8.38) (p < 0.05).</p><p><strong>Conclusion: </strong>Our study highlights significant disparities in uninsured patients and those with Medicaid, underscoring the need for targeted interventions for these populations.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 1","pages":"14"},"PeriodicalIF":3.3,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11685240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sellar and perisellar meningiomas: effects on pituitary function in a Spanish cohort observational study.","authors":"Fernando Guerrero-Pérez, Betina Biagetti, Miguel Paja-Fano, Edelmiro Luis Menéndez-Torre, Gonzalo Rivero, Elena Dios, Felicia Alexandra Hanzu, Patricia Martín Rojas-Marcos, Ana Irigaray, María Dolores Moure Rodríguez, Rogelio García-Centeno, Laura González Fernández, Joaquim Enseñat, Mireia Mora, Rocío Villar-Taibo, Isabel M Ortiz García, Marta Araujo-Castro, Carmen Gándara, M Dolores Ollero García, Carmen Tenorio-Jiménez, Cristina Novo-Rodríguez, Soralla Civantos, Andreu Simó-Servat, Anna Aulinas, Queralt Asla, Fernando Cordido, Iría Novoa-Testa, Gemma Xifra, María Ayala-Conte, Álvaro Zamarrón, M Isabel García Berrocal, Pedro Iglesias","doi":"10.1007/s11102-024-01484-y","DOIUrl":"10.1007/s11102-024-01484-y","url":null,"abstract":"<p><strong>Purpose: </strong>Studies focused on the effects of sellar and/or perisellar (S/PS) meningiomas on pituitary function are scarce. The primary objective of the present study was to determinate the effects that S/PS meningiomas and their treatments have on pituitary function. Also, we described the clinical characteristics and therapeutic outcomes of the cohort of adult Spanish patients.</p><p><strong>Methods: </strong>A multicenter and retrospective study of patients with S/PS meningiomas attended in 20 tertiary Spanish centers.</p><p><strong>Results: </strong>165 patients, 123 (74.5%) females, with median age of 61.4 [51-71] years were analyzed. At presentation, 115 (69.7%) had visual disturbance, 62 (37.6%) headache, 46 (27.9%) cranial nerve palsy and 34 (26.2%) hypopituitarism. Median tumor diameter was 29.1 [22-35.5] mm and cavernous sinus infiltration was detected in 95 (59%). As initial treatment, 128 (77.6%) underwent surgery, 25 (15.2%) received radiotherapy and 12 (7.3%) were clinically and radiologically monitored. Among operated patients, gross total resection (GTR) was achieved in 44 (34.4%), whereas in 84 (65.6%) the tumor was incompletely removed. Overall median follow-up was 5.7 [2.9-9.2] years. After treatments, hypopituitarism was present in 86 (53.4%) patients at the last evaluation, and it was associated with surgery extension (subtotal or GTR) but not with tumor subtype, type of radiotherapy or radiation dose received.</p><p><strong>Conclusions: </strong>S/PS meningiomas affect the pituitary function in 25% of the cases. However, after the implementation of treatments, hypopituitarism prevails in more than 50% of the cases. They are relatively large tumors and GTR is achieved in one third of the cases in whom hypopituitarism is more prevalent.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 1","pages":"12"},"PeriodicalIF":3.3,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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":"Majid Valizadeh, Amirhossein Ramezani Ahmadi, Dana Ramadhan Hussein, Farnaz Emdadi, Farhad Hosseinpanah, Ashley Grossman, Behnaz Abiri","doi":"10.1007/s11102-024-01474-0","DOIUrl":"10.1007/s11102-024-01474-0","url":null,"abstract":"<p><strong>Background: </strong>Adrenocorticotropin (ACTH)-dependent Cushing's syndrome can arise from a pituitary tumour (Cushing's disease) or an ectopic ACTH-secreting tumour, making precise differentiation essential for effective treatment. Bilateral inferior petrosal sinus sampling (BIPSS) is the gold standard for this differentiation, but false-negative results can limit its accuracy. Adding prolactin (PRL) measurement to BIPSS has been proposed to improve diagnostic precision. This meta-analysis evaluates how correction for prolactin levels ('prolactin adjustment') affects the diagnostic value of BIPSS in distinguishing Cushing's disease from ectopic ACTH syndrome.</p><p><strong>Methods: </strong>A systematic literature search was conducted in PubMed, Scopus, EMBASE, Web of Science, and Google Scholar up to July 2024. Studies were included if they provided data on BIPSS with and without PRL adjustment for ACTH-dependent Cushing's syndrome. Data extraction and quality assessment were performed, and diagnostic accuracy metrics were analysed using bivariate generalised linear mixed modelling.</p><p><strong>Results: </strong>A total of 10 studies with 310 participants were included. The pooled sensitivity and specificity of BIPSS with PRL adjustment were 0.96 (95% CI: 0.93-0.98) and 0.68 (95% CI: 0.52-0.81), respectively. The diagnostic odds ratio (DOR) was 48.0 (95% CI: 19.0-123.0), with a positive likelihood ratio (LR) of 3.00 (95% CI: 1.9-4.7) and a negative LR of 0.06 (95% CI: 0.03-0.12). The area under the summary receiver operating characteristic (SROC) curve was 0.95 (95% CI: 0.93-0.97). For BIPSS without PRL adjustment, the pooled sensitivity was 0.90 (95% CI: 0.86-0.93) and specificity was 0.74 (95% CI: 0.59-0.85), with a DOR of 27.0 (95% CI: 13.0-59.0). The SROC curve area was 0.92 (95% CI: 0.89-0.94). Prolactin adjustment improved sensitivity (P < 0.01) without a significant change in specificity (P = 0.13).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 1","pages":"11"},"PeriodicalIF":3.3,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}