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The value of prolactin in inferior petrosal sinus sampling with desmopressin stimulation in Cushing’s disease

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Abstract

Prolactin may reduce false-negative results in diagnosing Cushing’s disease (CD) during inferior petrosal sinus sampling (IPSS). Prolactin normalization could improve the accuracy of IPSS in predicting adenoma lateralization in CD. However, none of the previous studies had involved the use of desmopressin during IPSS. Our objective was to examine the utility of prolactin measurement during IPSS with desmopressin stimulation. We conducted a retrospective analysis of 40 patients (including 31 females) with ACTH-dependent Cushing’s syndrome who underwent IPSS between 2010 and 2013. Thirty-eight CD patients were partitioned into true positive (n = 35) and false negative (n = 3). The proportion of improper IPSS venous sampling defined by corresponding IPS:P (inferior petrosal sinus to peripheral) prolactin ratio <1.8 was significantly different between two groups (P = 0.004). Applying a prolactin-normalized ACTH IPS:P ratio >0.8 cutoff could increase the sensitivity of IPSS to 38/38 (100 %). Among the 31 patients with histopathologically proven adenoma localization, correct prediction of adenoma lateralization was obtained in 14/31 (45 %) patients by a peak intersinus ACTH gradient of ≥1.4 in baseline and was not improved by desmopressin stimulation. Left–right intersinus gradients of unilateral prolactin-adjusted ACTH IPS:P ratios could increase the correct prediction of adenoma lateralization to 20/31 (65 %) in baseline and 24/31 (77 %) (P = 0.006) after desmopressin stimulation, respectively. Prolactin is helpful to adjust negative results of IPSS with desmopressin stimulation. It may improve the accuracy in predicting adenoma lateralization in CD as well.

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Abbreviations

ACTH:

Adrenocorticotropin

CD:

Cushing’s disease

EAS:

Ectopic ACTH syndrome

IPSS:

Inferior petrosal sinus sampling

UFC:

Urinary free cortisol

IPS:

Inferior petrosal sinus

IPS:P:

Inferior petrosal sinus to peripheral

CRH:

Corticotropin-releasing hormone

CV:

Coefficient of variation

PRL:

Prolactin

IPS:IPS:

Inferior petrosal sinus to inferior petrosal sinus

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Acknowledgments

This study was supported by Key Project of Shanghai Science and Technology Commission (11411951902), National Natural Science Foundation of China (81000329) and Science and Technology Innovation Projects of Shanghai Science and Technology Commission (11411951900).

Conflict of interest

The authors declared that they have no conflict of interests.

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Authors and Affiliations

  1. Department of Endocrinology & Metabolism, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, China

    Xiaona Qiao, Hongying Ye, Weiwei Zhao, Shuo Zhang, Bin Lu, Xuanchun Wang, Zhaoyun Zhang, Xi Wu, Min He, Xiaolong Zhao, Linuo Zhou, Yehong Yang, Renming Hu & Yiming Li

  2. Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Xiaolong Zhang

  3. Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Shiqi Li

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  1. Xiaona Qiao
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Correspondence to Linuo Zhou or Yehong Yang.

Additional information

Yehong Yang and Linuo Zhou contributed equally to this work.

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Qiao, X., Ye, H., Zhang, X. et al. The value of prolactin in inferior petrosal sinus sampling with desmopressin stimulation in Cushing’s disease. Endocrine 48, 644–652 (2015). https://doi.org/10.1007/s12020-014-0338-3

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