The role of bilateral inferior petrosal sinus sampling in determining the preoperative localization of ACTH-secreting pituitary microadenomas in Cushing's disease: Experience of a tertiary center

Bestepe N., ÖZDEMİR D., Polat B., TOPALOĞLU O., Algin O., BAL E., ...Daha Fazla

CLINICAL NEUROLOGY AND NEUROSURGERY, cilt.207, 2021 (SCI-Expanded, Scopus) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 207
  • Basım Tarihi: 2021
  • Doi Numarası: 10.1016/j.clineuro.2021.106724
  • Dergi Adı: CLINICAL NEUROLOGY AND NEUROSURGERY
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, CAB Abstracts, EMBASE, MEDLINE
  • Anahtar Kelimeler: Cushing disease, Inferior petrosal sinus sampling, Pituitary adenoma, Pituitary tumor, Pituitary surgery, CORTICOTROPIN-RELEASING-HORMONE, CAVERNOUS SINUS, DIFFERENTIAL-DIAGNOSIS, PROLACTIN MEASUREMENT, ENDOCRINE MARKERS, DESMOPRESSIN TEST, LATERALIZATION, SURGERY, STIMULATION, ACCURACY
  • Ankara Üniversitesi Adresli: Hayır

Özet

Introduction: Bilateral inferior petrosal sinus sampling (BIPSS) is an important procedure in the diagnostic workup of Cushing's syndrome (CS). In this study, we investigated the diagnostic performance of BIPSS in detecting the source of adrenocorticotropic hormone (ACTH) secretion in Cushing's disease (CD) without radiological evidence. Methods: Thirty-five consecutive patients who underwent BIPSS due to ACTH-dependent CS between 2010 and 2019 in our clinic and subsequently underwent transsphenoidal surgery were included. The indication for BIPSS was biochemically proven ACTH-dependent CS but normal or <6 mm pituitary lesion in pituitary magnetic resonance imaging (MRI). Corticotropin releasing hormone (CRH) stimulation was applied to all patients during the BIPSS procedure. BIPSS data, MRI results, pathological findings, and follow-up results were analyzed. The diagnostic performance of BIPSS was calculated. Results: A total of 35 patients, 6 (17%) males and 29 (83%) females, were included in the study. Pituitary MRI was normal in 12 (34.3%) and revealed lesions < 6 mm in 23 (65.7%) patients. BIPSS lateralized the right side in 13 (37.1%) and left side in 18 (51.4%) patients, while no lateralization was observed in the remaining 4 (11.5%) patients. BIPSS showed lateralization in the same direction with pituitary adenoma in 21 (60%) patients before CRH injection and in 29 (83%) patients after CRH injection (p = 0.034). The sensitivity of the BIPSS procedure was 88%. Accurate localization of the pituitary lesion was more frequent when based on BIPSS results than on MRI (83% vs. 51%, P = 0.005). Conclusion: BIPSS appears to be a valuable and safe diagnostic tool in patients who are diagnosed with CD biochemically but do not have clear radiological evidence of ACTH-producing lesion.