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來源資料
相關文獻
- Assessment of Bilateral Inferior Petrosal Sinus Sampling (BIPSS) in the Diagnosis of Cushing’s Disease
- 庫欣氏病(Cushing's disease)
- 垂腺瘤導致之庫欣氏病有皮醇延遲相迴饋抑制缺陷並於腺瘤切除術後恢復正常
- A Young Adult Woman with Severe Osteoporosis due to Cushing's Disease: A Case Report and Literatures Review
- 庫欣氏病之診治:臺灣專家共識
- 庫欣氏病合併蝶竇氣化不全:病例報告
- 皮促素細胞腺巨瘤致亞臨床性庫欣氏病
- 庫欣氏病病因研究的最新進展
- 異位性ACTH症或庫欣氏病?
- 找不到腫瘤的異位性ACTH症如何處理?
頁籤選單縮合
題名 | Assessment of Bilateral Inferior Petrosal Sinus Sampling (BIPSS) in the Diagnosis of Cushing’s Disease=利用兩側下岩竇採血診斷庫欣氏病之評估 |
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作者姓名(中文) | 林亮羽; 鄧木火; 黃俊一; 馬文雅; 王康齡; 林宏達; 翁錦興; | 書刊名 | 中華醫學會雜誌 |
卷期 | 70:1 2007.01[民96.01] |
頁次 | 頁4-10+CA1 |
分類號 | 415.934 |
關鍵詞 | 釋皮質促素; 庫欣氏病; 下岩竇採血; Corticotropin-releasing hormone; Cushing's disease; Inferior petrosal sinus sampling; |
語文 | 英文(English) |
中文摘要 | 背景:對內分泌醫師而言,促腎上腺皮質素依賴型庫欣氏症的鑑別診斷仍深具挑戰性。就這方面,兩側下岩竇採血檢查是目前所有的方法中最敏感也是最具特異性的檢查。在此,我們將報告本院15年度藉由兩側下岩竇採血檢查來正確認斷庫欣氏病及定位腫瘤的經驗。 方法:自1992年至2006年,18位庫欣氏病患者(14歲至56歲的16位女性2位男性)曾經於本院接受兩側下岩竇採血合併注射釋皮質促素檢查。兩側下岩竇採血檢查是經股靜脈將導管置放到左右兩側的下岩竇採血檢驗促腎上腺皮質素。其中4位病患曾經接受過經蝶竇手術且證實疾病復發。當下岩竇與周邊血中的促腎上腺皮質素比值基礎值大於等於2或者或經釋皮質促素刺激後大於等於3皆顯示來自腦垂體的腫瘤,此外,以兩側下岩竇促腎上腺皮質素比較之基硬值或者是經釋皮質促素刺激後大於等於1.4作為腫瘤定位的依據。 結果:檢查結果顯示16位病患的促腎上腺皮質素基礎比值及17位經釋皮質促素刺激後比值呈陽性反應。本研究中除1位因蝶竇骨氣化不全外,17位病患後來皆接受手術證實庫欣氏病。然而,有一位曾經接受過經蝶竇手術患者的檢查結果呈現為陰性。因此,兩側下岩竇採血檢查對於診斷庫欣氏病的敏感性為89%,且經由釋皮質促素刺激後更可達94%。此外,藉由兩側上岩竇的促腎上腺皮質素之比值大於等於1.4為標準,17位病患中可分別於基礎值及經由釋皮質促素刺激後正確定位9位和10位病患的腦垂體腫瘤,包括兩位病患腦垂體腫瘤位於中央且兩側下岩竇的促腎上腺皮質素之比值小於1.4。因此,兩側下岩竇採血檢查定位腫瘤的敏感度分別為53%及59%。但是4位曾接受過經蝶竇手術的患者則無法藉此檢查正確定位。假使排除此4位病患,兩側下岩竇採血檢查對於定位未曾手術田病患的腦垂體腫瘤每怹度將分別提高至70%(9/13)及77%(10/13)。 結論:兩側下岩竇採血檢查合併釋皮質促素攪激是一種安全且可靠的檢查,特別是用於鑑別診斷庫欣氏病及未曾開刀的患者腦垂體腫瘤的正確定位。然而,本研究中發現此檢查對於曾經接受過腦垂体手術的患者判讀時要更誡慎,避免誤判。 |
英文摘要 | Background: The differential diagnosis of adrenocorticotropin (ACTH)-dependent Cushing’s syndrome (CS) remains a challenging issue for clinical endocrinologists. In this respect, bilateral inferior petrosal sinus sampling (BIPSS) appears to be the most sensitive and specific test. Here, we report our 15-year experience of analyzing the performance of BIPSS, both in the correct diagnosis and in the precise lateralization of tumors in patients with Cushing’s disease (CD). Methods: Between 1992 and 2006, 18 patients with CD (16 females, 2 males; age range, 14–56 years) were admitted to Taipei Veterans General Hospital and subjected to BIPSS plus ovine corticotropin-releasing hormone (oCRH) stimulation. Four of them had previously undergone transsphenoidal hypophysectomy (TSH) and had a recurrence thereafter. BIPSS was performed by inserting a catheter in the right and left inferior petrosal sinus for ACTH assay via a femoral vein puncture. An inferior petrosal sinus/peripheral ACTH ratio (C/P ratio) ≥2 at baseline or ≥3 after oCRH injection indicated a pituitary origin of ACTH secretion, and an interpetrosal ACTH gradient (IPS ratio) ≥1.4 at baseline or after oCRH indicated evidence of lateralization. Results: Positive BIPSS results were found in 16 patients at baseline and in 17 patients after oCRH injection. In 17 out of 18 patients, TSH was subsequently carried out and a pituitary source was confirmed on histopathologic examination. The only 1 false-negative test result was noted in a patient who had undergone previous TSH. Thus, the sensitivities of BIPSS for the diagnosis of CD before and after oCRH stimulation were 89% and 94%, respectively. Moreover, using an IPS ratio ≥1.4 as a criterion, BIPSS correctly lateralized the tumor in 9 of 17 and 10 of 17 patients at baseline and after oCRH stimulation, respectively, including in 2 patients who had a centrally located tumor and who had an IPS ratio <1.4. Thus, the sensitivities of lateralization of BIPSS were 53% and 59%, respectively. None of the 4 patients who had previous TSH were precisely localized by BIPSS. If these 4 patients were excluded, the sensitivities of BIPSS for localizing in the patients who had not undergone previous operation increased to 70% (9/13) at baseline and 77% (10/13) after oCRH stimulation, respectively. Conclusion: BIPSS combined with oCRH stimulation is a safe and reliable examination both in the differential diagnosis of CD and in the correct lateralization of pituitary microadenoma in patients without previous pituitary surgery. Nevertheless, this procedure may provide misleading results in patients who have received previous pituitary surgery. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。