Selective use of bilateral inferior petrosal sinus sampling in patients with adrenocorticotropin-dependent Cushing's syndrome prior to transsphenoidal surgery.

Abstract

CONTEXT:

Few data are available on the selective use of bilateral inferior petrosal sinus sampling (BIPSS) in the presurgical evaluation of patients with ACTH-dependent Cushing's syndrome, so we investigated whether its use only in patients without a clear adenoma on magnetic resonance imaging and/or inconsistent biochemical testing affected remission and long-term outcome after surgery in patients with Cushing's disease (CD).

SETTING:

This was a retrospective review of patients treated for CD by one pituitary neurosurgeon at tertiary medical centers in New York City.

PATIENTS:

A total of 193 consecutive adult patients who underwent initial transsphenoidal surgery (TS) for presumed CD between 1987 and 2005 were included.

MAIN OUTCOME MEASURES:

We examined preoperative pituitary imaging and biochemical data, results of BIPSS and surgical pathology, and outcome based on biochemical tests after initial TS and long term after subsequent therapies.

RESULTS:

Remission rate after the first TS was 80.8% overall, 79.1% in the BIPSS group (n = 105), and 83.0% in the No-BIPSS group (n = 88). Recurrences occurred in 13.5% after the first TS at a mean of 4.8 +/- 3.5 yr (range, 0.7-12.4 yr) with no difference between BIPSS and No-BIPSS groups. Long-term remission was achieved after surgeries and radiotherapy in 85% (86.7% of BIPSS group, 83.0% of No-BIPSS group). CD was ultimately confirmed in all but one patient in each group.

CONCLUSIONS:

Selective use of BIPSS in the preoperative evaluation of patients with presumed CD did not lead to misdiagnosis in the No-BIPSS group or adversely affect remission rates or long-term outcome.

• Authors: Sigrid Jehle, Jane E Walsh, Pamela U Freda, Kalmon D Post
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 93 Issue 12 Pg. 4624-32 (Dec 2008) ISSN: 0021-972X [Print] United States
• PMID: 18796519 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Adrenocorticotropic Hormone
• Corticotropin-Releasing Hormone

Topics

• Adolescent
• Adrenocorticotropic Hormone (blood, physiology)
• Algorithms
• Child
• Child, Preschool
• Corticotropin-Releasing Hormone (metabolism)
• Data Collection
• Female
• Humans
• Infant
• Infant, Newborn
• Magnetic Resonance Imaging
• Male
• Neurosurgical Procedures
• Petrosal Sinus Sampling
• Pituitary ACTH Hypersecretion (diagnosis, diagnostic imaging, surgery)
• Radiosurgery
• Recurrence
• Retrospective Studies
• Sphenoid Sinus (surgery)
• Tomography, X-Ray Computed
• Treatment Outcome