Cavernous sinus sampling in patients with adrenocorticotrophic hormone—dependent Cushing's syndrome with emphasis on inter- and intracavernous adrenocorticotrophic hormone gradients

Teramoto, Akira; Yoshida, Yoichi; Sanno, Naoko; Nemoto, Shigeru

doi:10.3171/jns.1998.89.5.0762

Cited by 54 publications

(36 citation statements)

References 31 publications

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“…On the other hand, Teramoto et al described the usefulness of CSS compared to IPSS and suggested that the tentative cutoff ratio is 5 for the diagnosis of pituitary lesions [19]. In our case, we obtained a ratio of greater than 5 in left cavernous sinus and fortunately the origin of excessive ACTH was in the pituitary gland.…”

Section: Discussionsupporting

confidence: 51%

“…The accuracy of determining lateralization by means of bilateral inferior petrosal sinus sampling is reported to be approximately 75% [28], and that by means of bilateral CSS ranges widely from 40% to 94% [19,29,30]. In this case, the basal left-to-right gradient showed 1.24, but the normalized ACTH/PRL left-to-right gradient showed 1.34, which was near 1.4.…”

Section: Discussionmentioning

confidence: 83%

“…In our case, we obtained a ratio of greater than 5 in left cavernous sinus and fortunately the origin of excessive ACTH was in the pituitary gland. However, Teramoto et al also reported that basal C/P ratios in the cavernous sinus exceeded 10 in most cases of Cushing's disease [19]. Taking these facts into consideration, for a more reliable diagnosis we should perform CSS after CRH administration or measure the level of PRL from peripheral vein and cavernous sinus, and calculate a normalized ACTH/PRL petrosal sinus to peripheral ratio.…”

Section: Discussionmentioning

confidence: 99%

“…A number of studies have evaluated the role of venous sampling by microcatheter in the diagnosis of ACTH-dependent Cushing's syndrome [18][19][20][21][22]. Oldfield et al reported that a central-to-peripheral ACTH ratio of greater than 2.0 has a sensitivity of 95% and specificity of 100% and after CRH administration the ratio of greater than 3.0 has a sensitivity and a specificity of 100% in inferior petrosal sinus sampling (IPSS) [18].…”

Section: Discussionmentioning

confidence: 99%

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Reduction of a Pancreatic Tumor after Total Removal of an ACTH Secreting Pituitary Tumor: Differential Diagnosis of Cushing's Syndrome

et al. 2006

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Abstract. Endocrinologic tests sometimes fail to distinguish adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma from ectopic ACTH-secreting tumor. The authors experienced a case of Cushing's disease associated with a pancreatic tumor. Venous sampling contributed to the final diagnosis of Cushing's disease in this complex case, while endocrinologic tests showed paradoxical results. A 54-year-old woman presented with Cushing's syndrome and pancreatic tumor. Magnetic resonance imaging (MRI) failed to reveal a pituitary tumor, but a gadolinium-enhanced tumor with cystic components was seen in the pancreatic tail. Results of conventional endocrinologic tests suggested ectopic ACTH syndrome, but venous sampling including cavernous sinus sampling indicated an ACTH-secreting pituitary adenoma. Transsphenoidal surgery revealed a pituitary microadenoma, and total removal of the tumor was achieved. Postoperative abdominal MRI revealed that the pancreatic tumor diminished gradually without treatment. Selective cavernous sinus sampling was useful for distinguishing ACTH-secreting pituitary adenoma from ectopic ACTH syndrome in this complex case. This was a rare case in which the pancreatic tumor diminished after total removal of the ACTHsecreting pituitary adenoma.

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Reduction of a Pancreatic Tumor after Total Removal of an ACTH Secreting Pituitary Tumor: Differential Diagnosis of Cushing's Syndrome

et al. 2006

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“…Correct lateralization has been reported to be 57%-80% 15,16 and can also distinguish between central and ectopic sources of ACTH oversecretion.…”

Section: Discussionmentioning

confidence: 99%

Cavernous sinus sampling in patients with Cushing's disease

Burkhardt¹,

Flitsch²,

Leyen³

et al. 2015

FOC

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OBJECT Correct diagnosis and precise localization of adenomas in patients with Cushing's disease are essential for avoiding unsuccessful transsphenoidal pituitary exploration. In addition to the well-established inferior petrosal sinus sampling, preoperative cavernous sinus sampling (CSS) was introduced as a potentially improved way to predict adenoma lateralization. The authors present their results with CSS in a consecutive series of patients with Cushing's disease. METHODS During 1999–2014, transsphenoidal surgeries were consecutively performed in 510 patients with Cushing's disease. For most patients, suppression of cortisol in high-dose dexamethasone tests and stimulation of adrenocorticotropic hormone and cortisol after administration of corticotropin-releasing hormone were sufficient to prove the diagnosis of adrenocorticotropic hormone–dependent hypercortisolism. Of the 510 patients, 67 (13%) were referred to the department of neuroradiology for CSS according to the technique of Teramoto. The indications for CSS were unclear endocrine test results or negative MRI results. Data for all patients were retrospectively analyzed. RESULTS A central/peripheral gradient was found in 59 patients; lateralization to the left or right side was found in 51. For 8 patients with a central/peripheral gradient, no left/right gradient could be determined. For another 8 patients with equivocal test results, no central/peripheral gradient was found. No severe CSS-associated complications were encountered. Of the 51 patients who underwent transsphenoidal surgery, the predicted lateralization was proven correct for 42 (82%). CONCLUSIONS As MRI techniques have improved, the number of potential candidates for this invasive method has decreased in the past decade. However, because detecting minute adenomas remains problematic, CSS remains a useful diagnostic tool for patients with Cushing's disease.

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Evaluation of Cushing’s Syndrome

Newell‐Price

Besser

2002

Cushing’s Syndrome

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Cavernous sinus sampling in patients with adrenocorticotrophic hormone—dependent Cushing's syndrome with emphasis on inter- and intracavernous adrenocorticotrophic hormone gradients

Cited by 54 publications

References 31 publications

Reduction of a Pancreatic Tumor after Total Removal of an ACTH Secreting Pituitary Tumor: Differential Diagnosis of Cushing's Syndrome

Reduction of a Pancreatic Tumor after Total Removal of an ACTH Secreting Pituitary Tumor: Differential Diagnosis of Cushing's Syndrome

Cavernous sinus sampling in patients with Cushing's disease

Evaluation of Cushing’s Syndrome

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