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Objective To analyze the peripheral 1-de-amino-8-D-arginine vasopressin (hereinafter referred as DDAVP)irritant test as the best cut-off point for the differential diagnosis of Cushing's disease and ectopic adreno-cortico-tropic-hormone(ACTH) syndrome (hereinafter referred as EAS), so as to explore the value of peripheral DDAVP irritant test in differential diagnosis of ACTH-dependent Cushing's syndrome. Methods The clinical data of 102 cases with ACTH-dependent Cushing's syndrome, diagnosed in the Endocrinology Department of the First Medical Center of Chinese PLA General Hospital from January 2016 to December 2019, were retrospectively analyzed, including 93 cases with Cushing's disease (Cushing's disease group) and 9 cases with EAS (EAS group). Based on the ROC curve, the blood ACTH level after stimulation was used as the detection variable, and the diagnosis result of Cushing's disease was used as the status variable to search the best cut-off point for the diagnosis of Cushing's disease. The sensitivity and specificity were analyzed of the peripheral DDAVP irritant test in the differential diagnosis of EAS and Cushing's disease at different cut-off points. Results Compared with Cushing's disease group, the course of disease was shorter and the basic blood cortisol and ACTH values were higher in EAS group with statistical significance (P<0.05). On the ROC curve, taking the increase by 33.6% of ACTH after stimulation as the cut-off point, the sensitivity and specificity for Cushing's disease and EAS were 98.9% and 55.6%, respectively, which were the best cut-off point. With the increase of blood ACTH value after stimulation, the sensitivity for diagnosing Cushing's disease decreased. If the increase by 20.0% of blood cortisol value after stimulation as the cut-off point simultaneously, then, the sensitivity for diagnosing Cushing's disease decreased and the specificity not increased. Thus, the blood ACTH was more specific than the blood cortisol. If taking the increase by 33.6% of the blood ACTH after peripheral DDAVP stimulation test, as well as the greater than or equal to 50.0% of the blood cortisol suppression ratio (or urinary free cortisol suppression ratio) in classical high-dose dexamethasone suppression test (HDDST) were taken as cut-off points, the sensitivity and specificity for identifying ACTH dependent Cushing's syndrome were 73.3% and 87.5%, respectively. Conclusion When taking the increase by 33.6% of blood ACTH after peripheral DDAVP stimulation as the cut-off point, the sensitivity was the highest in diagnosing Cushing's disease, so this method can be used as a screening test for and improve the detection rate of Cushing's disease.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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