{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:46:32Z","timestamp":1787021192195,"version":"build-2736575974"},"reference-count":44,"publisher":"The Endocrine Society","issue":"4","license":[{"start":{"date-parts":[[2019,11,23]],"date-time":"2019-11-23T00:00:00Z","timestamp":1574467200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100005089","name":"Beijing Municipal Natural Science Foundation","doi-asserted-by":"publisher","award":["7192153"],"award-info":[{"award-number":["7192153"]}],"id":[{"id":"10.13039\/501100005089","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Health Science Promotion Project of Beijing","award":["2018-TG-35"],"award-info":[{"award-number":["2018-TG-35"]}]},{"name":"Health Science Promotion Project of Beijing","award":["CAMS-2016-I2M-1\u2013002"],"award-info":[{"award-number":["CAMS-2016-I2M-1\u2013002"]}]},{"name":"Health Science Promotion Project of Beijing","award":["2016-I2M-1\u2013008"],"award-info":[{"award-number":["2016-I2M-1\u2013008"]}]},{"name":"Health Science Promotion Project of Beijing","award":["2017-I2M-1\u2013011"],"award-info":[{"award-number":["2017-I2M-1\u2013011"]}]},{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2016YFC091500"],"award-info":[{"award-number":["2016YFC091500"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Contexts<\/jats:title>\n                    <jats:p>Bilateral inferior petrosal sinus sampling (BIPSS) can differentiate Cushing\u2019s disease (CD) and ectopic adrenocorticotropin (ACTH) syndrome (EAS). The traditional cutoff of inferior petrosal sinus to peripheral (IPS:P) ACTH gradient was 2 before stimulation and 3 after stimulation, which yielded unsatisfactory sensitivity in some studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine the optimal cutoff in BIPSS before or after desmopressin stimulation and to evaluate the necessity of stimulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and Setting<\/jats:title>\n                    <jats:p>Single-center retrospective study (2011\u20132018) along with meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients<\/jats:title>\n                    <jats:p>226 CD and 24 EAS patients with confirmed diagnosis who underwent BIPSS with desmopressin stimulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the meta-analysis of 25 studies with 1249 CD and 152 EAS patients, the traditional cutoff yielded sensitivity of 86% and 97% and specificity of 98% and 100% before and after stimulation, respectively. We then analyzed the data from our center. With the traditional cutoff, the sensitivity was 87.2% (197\/226) and 96.5% (218\/226) before and after stimulation, and specificity was both 100% (25\/25), which were close to the results of meta-analysis. Receiver operating characteristic analysis revealed that the optimal cutoff was 1.4 before stimulation and 2.8 after stimulation. With the new cutoff, the sensitivity was 94.7% (214\/226) and 97.8% (221\/226) while the specificity remained 100% (25\/25) before and after stimulation. Among the 7 CD patients (7\/226; 3.1%) for whom stimulation was necessary to get correct diagnosis, none has a pituitary lesion &amp;gt;6 mm by magnetic resonance imaging, and their sampling lateralization rate (P = .007) and peak ACTH level at dominant inferior petrosal sinus (P = .011) were lower than those among CD patients with IPS:P &amp;gt;1.4 before stimulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The optimal cutoff for IPS:P in BIPSS is different from the commonly-used one. The optimal cutoff value can yield satisfactory accuracy even without stimulation, and stimulation may be unnecessary for those with pituitary adenoma &amp;gt;6 mm.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgz194","type":"journal-article","created":{"date-parts":[[2019,11,23]],"date-time":"2019-11-23T01:00:28Z","timestamp":1574470828000},"page":"e1673-e1685","source":"Crossref","is-referenced-by-count":44,"title":["The Optimal Cut-off of BIPSS in Differential Diagnosis of ACTH-dependent Cushing\u2019s Syndrome: Is Stimulation Necessary?"],"prefix":"10.1210","volume":"105","author":[{"given":"Shi","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0745-7946","authenticated-orcid":false,"given":"Kang","family":"Chen","sequence":"additional","affiliation":[{"name":"Eight-Year Program of Clinical Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirui","family":"Wang","sequence":"additional","affiliation":[{"name":"Eight-Year Program of Clinical Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huijuan","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaobo","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anli","family":"Tong","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renzhi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaolin","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2019,11,23]]},"reference":[{"issue":"9996","key":"2021122210025575800_CIT0001","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1016\/S0140-6736(14)61375-1","article-title":"Cushing\u2019s syndrome","volume":"386","author":"Lacroix","year":"2015","journal-title":"Lancet."},{"issue":"2","key":"2021122210025575800_CIT0002","first-page":"440","article-title":"Diagnosis and management of Cushing\u2019s syndrome: results of an Italian multicentre study. 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