Improved diagnostic accuracy of inferior petrosal sinus sampling over imaging for localizing pituitary pathology in patients with Cushing's disease

The Journal of Clinical Endocrinology and Metabolism
G L BoothShereen Ezzat

Abstract

The majority of patients with Cushing's disease can be cured by transsphenoidal microsurgery; however, precise localization of the pituitary source of ACTH is not always possible by standard imaging techniques. Bilateral venous sampling from the inferior petrosal sinuses (IPSS) is also useful for diagnosing Cushing's disease, but the interpretation of discordant findings between IPSS and imaging remains problematic. We tested the ability of imaging and IPSS to localize an ACTH-secreting pituitary lesion in comparison to definitive histopathological examination of the pituitary in patients with Cushing's disease (n = 37). Bilateral IPS catheterization was technically feasible in 32 patients and provided evidence of lateralization in 31 patients. Histological examination confirmed a corticotropic adenoma in 28 patients and corticotropic hyperplasia in 2 patients; Crooke's hyaline change was found in 7 patients, among whom 1 subsequently was found to have an ectopic sphenoid corticotropic adenoma, and the remainder had suspected microadenomas that were not identified microscopically. Accurate localization of the pituitary lesion was more frequent when based on IPSS results than on imaging studies (70% vs. 49%, P < 0.06). The 2 tes...Continue Reading

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Citations

Jul 6, 2000·Journal of Endocrinological Investigation·F Pecori GiraldiF Cavagnini
Jul 27, 2007·Endocrine Pathology·Nabeel Y Y Al BrahimSylvia L Asa
Jun 1, 1999·Endocrine Pathology·G L BoothS Ezzat
Aug 7, 2012·Best Practice & Research. Clinical Endocrinology & Metabolism·Odelia Cooper, Shlomo Melmed
Mar 28, 2007·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Gulsah Bademci
Jul 21, 2016·Endocrine·Giovanni VitaleUNKNOWN A.B.C. Group

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