Available online 14 January 2023

Previous studies have shown inconsistent results about the usefulness of prolactin adjustment in bilateral inferior petrosal sinus sampling (BIPSS) in the differential diagnosis of adrenocorticotropic hormone (ACTH) -dependent Cushing syndrome (CS). This meta-analysis compared the diagnostic accuracy of prolactin adjustment vs. no adjustment in BIPSS.

This study searched PubMed, Embase, Web of Science, Cochrane library, and Wanfang database for published data on the use of prolactin adjustment in BIPSS to differentially diagnose ACTH-dependent CS as of March 2022. A Bayesian joint bivariate model was used in the head-to-head comparison of the diagnostic accuracy.

This meta-analysis included a total of 10 studies with 300 patients. The combined sensitivity and specificity for BIPSS without prolactin adjustment were 94.47% (95% credible interval, CI 88.67% to 98.44%), 91.14% (95% CI 57.17% to 99.80%), respectively. The combined sensitivity and specificity after prolactin adjustment were 99.97% (95% CI 99.03% to 100.00%), 80.69% (95% CI 50.27% to 97.82%), respectively. After the prolactin adjustment, the sensitivity of BIPSS to diagnose Cushing’s disease (CD) was improved with a statistically significant difference (difference in sensitivity 5.39%, 95% CI 1.37% to 11.26%), while the decrease in specificity was without statistically significant difference (difference in specificity -9.20%, 95% CI -42.02% to 26.61%).

This meta-analysis indicated that prolactin adjustment in BIPSS might help to recognize CD among ACTH-dependent CS patients. However, prolactin adjustment may not help identify ectopic ACTH syndrome (EAS) in BIPSS.

Bilateral inferior petrosal sinus sampling

ACTH-dependent Cushing syndrome

prolactin adjustment

Differential diagnosis

Diagnostic meta-analysis

Bilateral inferior petrosal sinus sampling

Adrenocorticotropic hormone

Corticotrophin- releasing hormone

© 2023 Published by Elsevier Inc. on behalf of the AACE.