Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2026
Lower Cutoffs Improve the Diagnostic Performance of Desmopressin-Stimulated Bilateral Inferior Petrosal Sinus Sampling for Cushing Disease: A Prospective Cohort Study.
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Zhang Dingyue, Wang Yingjing, Zhang Yuelun, Zhang Xiaobo, Pan Hui, Lyu Xiaohong, Chen Shi, Lu Lin
Аннотация
OBJECTIVE: To prospectively evaluate the diagnostic performance of traditional versus optimized adrenocorticotropic hormone (ACTH) ratio cutoffs for desmopressin (DDAVP)-stimulated bilateral inferior petrosal sinus sampling (BIPSS) in differentiating Cushing disease (CD) from ectopic ACTH syndrome (EAS) in ACTH-dependent Cushing syndrome.
METHODS: We conducted a prospective single-center observational cohort study of 181 consecutive patients undergoing DDAVP-stimulated BIPSS in a high-volume tertiary pituitary center (Peking Union Medical College Hospital) in China between October 2023 and December 2024. Final diagnosis was confirmed by histopathology and/or biochemical remission. Diagnostic accuracy of traditional cutoffs (basal IPS:P >2.0 or stimulated >3.0) versus optimized cutoffs (determined by receiver operating characteristic curve analysis) was compared.
RESULTS: Among 167 patients with definitive diagnosis (153 CD, 14 EAS), BIPSS showed excellent overall discrimination (area under the curve, 0.994). Traditional cutoffs yielded a sensitivity of 91.5% and specificity of 100.0%. Lower cutoffs (basal IPS:P >1.49 or peak stimulated IPS:P >2.26) improved sensitivity to 97.4% while maintaining 100.0% specificity. Most peak IPS: P values occurred at 3 to 5 min post-DDAVP. False-negative results were associated with absent intersinus lateralization and low IPS ACTH levels, suggesting technical or anatomic sampling limitations rather than impaired DDAVP responsiveness.
CONCLUSION: DDAVP-stimulated BIPSS showed excellent diagnostic performance for differentiating CD from EAS and provides a practical alternative stimulation strategy when corticotropin-releasing hormone is unavailable. Lower DDAVP-specific ACTH ratio cutoffs improved sensitivity without compromising specificity and may reduce false-negative diagnoses of CD in patients with ACTH-dependent Cushing syndrome.
METHODS: We conducted a prospective single-center observational cohort study of 181 consecutive patients undergoing DDAVP-stimulated BIPSS in a high-volume tertiary pituitary center (Peking Union Medical College Hospital) in China between October 2023 and December 2024. Final diagnosis was confirmed by histopathology and/or biochemical remission. Diagnostic accuracy of traditional cutoffs (basal IPS:P >2.0 or stimulated >3.0) versus optimized cutoffs (determined by receiver operating characteristic curve analysis) was compared.
RESULTS: Among 167 patients with definitive diagnosis (153 CD, 14 EAS), BIPSS showed excellent overall discrimination (area under the curve, 0.994). Traditional cutoffs yielded a sensitivity of 91.5% and specificity of 100.0%. Lower cutoffs (basal IPS:P >1.49 or peak stimulated IPS:P >2.26) improved sensitivity to 97.4% while maintaining 100.0% specificity. Most peak IPS: P values occurred at 3 to 5 min post-DDAVP. False-negative results were associated with absent intersinus lateralization and low IPS ACTH levels, suggesting technical or anatomic sampling limitations rather than impaired DDAVP responsiveness.
CONCLUSION: DDAVP-stimulated BIPSS showed excellent diagnostic performance for differentiating CD from EAS and provides a practical alternative stimulation strategy when corticotropin-releasing hormone is unavailable. Lower DDAVP-specific ACTH ratio cutoffs improved sensitivity without compromising specificity and may reduce false-negative diagnoses of CD in patients with ACTH-dependent Cushing syndrome.