Всего найдено: 2

Simultaneous bilateral inferior petrosal sinus blood sampling after desmopressin stimulation in the differential diagnosis of acth-dependent cushing’s syndrome

DOI: https://doi.org/10.25512/DIR.2013.07.3.06

For quoting:
Sitkin I.I., Belaya Zh.E., Rozhinskaya L.Ja., Melnichenko G.A., Dzeranova L.K., Marova E.I., Arapova S.D., Molitvoslovova N.N., Pigarova E.A., Grigoriev A.Yu., Kolesnikova G.S., Voronzov A.V., Dedov I.I. "Simultaneous bilateral inferior petrosal sinus blood sampling after desmopressin stimulation in the differential diagnosis of acth-dependent cushing’s syndrome". Journal Diagnostic & interventional radiology. 2013; 7(3); 57-62.

authors:

Sitkin I.I.

Belaya Zh.E.

Rozhinskaya L.Ja.

Melnichenko G.A.

Dzeranova L.K.

Marova E.I.

Arapova S.D.

Molitvoslovova N.N.

Pigarova E.A.

Grigoriev A.Yu.

Kolesnikova G.S.

Voronzov A.V.

Dedov I.I.

keywords:

endogenous hypercoticism

bilateral inferior petrosal sinus blood sampling

adrenocorticotropin

desmopressin

Cushing’s disease

Abstract:

Aim: was to estimate the diagnostic performance of inferior petrosal sinus blood sampling with Desmopressin stimulation in patients with ACTH-dependent Cushing's syndrome.

Materials and Methods: all enrolled patients had clinically evident and biochemically proven ACTH-dependent Cushing's syndrome. The inclusion criteria was as follows: the absence of pituitary adenoma on MRI, pituitary adenoma less than 6 mm and/or negative high dose (8mg) dexamethasone suppression test or unsuccessful neurosurgery when the histological material was not informative. A petrosal sinus to peripheral ACTH gradient of at least 2,0 at baseline or at least 3 after Desmopressin administration suggested a pituitary source of ACTH. Plasma ACTH was measured by automated electrochemiluminescence immunoassay (F. Hoffmann-La Roche Ltd (Cobas e601).

Results: 117 patients were included in the present study (86 females (73,5%) and 31 (26,5%) males with a median age of 34 years (Q25-Q75 26-49 years). The youngest patient was 17 years old and the oldest 66 years old. The median of 24h urinary free cortisol was 2148 (1268-4129) nmol/24 hours; the morning plasma ACTH level -105,8 (67,7-150,8) ng/ml; late-night ACTH - 83,6 (51,8-126,2) ng/ml. A final histological diagnosis was available only in 110 patients (94 patients with Cushing's disease and 16 cases of ACTH-ectopic Cushing's syndrome). Only the data of patients with histological proven diagnosis was included in the final analysis. The sensitivity of bilateral inferior petrosal sinus blood sampling with Desmopressin stimulation was found to be 90,4% (95% DI 82,8-94,9), and the specificity- 93,7% (95% DI 71,7 - 98,9). The area under the curve (when the ratios before and after Desmopressin administration were analyzed) was 0,940 (95% DI 0, 893-0,988). The median duration of the procedure was 60 minutes and the median X-Ray dose was 4,7 mSv In general, the manipulation was well tolerated.

Conclusion: bilateral inferior petrosal sinus blood sampling with Desmopressin administration demonstrated the high values of sensitivity and specificity.

Comparative selective blood sampling from adrenal gland's veins - critical sight at a problem

DOI: https://doi.org/10.25512/DIR.2011.05.2.06

For quoting:
Sitkin I.I., Fadeev V.V., Beltsevich D.G., Rogal E.Yu., Molashenko N.V., Kolesnikova G.S. "Comparative selective blood sampling from adrenal gland's veins - critical sight at a problem". Journal Diagnostic & interventional radiology. 2011; 5(2); 45-53.

authors:

Sitkin I.I.

Fadeev V.V.

Beltsevich D.G.

Rogal E.Yu.

Molashenko N.V.

Kolesnikova G.S.

keywords:

aldosteroma

comparative selective blod sampling from adrenal gland's veins

Abstract:

Primary hyperaldosteronism (PHA) is one of the most-spread reasons of arterial hypertension.

Comparative selective blood sampling froms adrenal gland's veins - is the only method of differential diagnostics of different form of PHA This methodic, its technical complexities and problems of data's interpretation are presented in the article. And a case report: aldosteron producing adenoma.

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