Comparative evaluation of conventional and dynamic magnetic resonance imaging of the pituitary gland for the diagnosis of Cushing's disease

Tabarin, Antoine; Laurent, François; Catargi, Bogdan; Olivier‐Puel, Fréderique; Lescene, Robin; Berge, Jérôme; Galli, F. San; Drouillard, J; Roger, Patrick; Guérin, J.

doi:10.1046/j.1365-2265.1998.00541.x

Cited by 138 publications

(89 citation statements)

References 29 publications

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“…In the use of these agents such as gadolinium, differences in the dynamic release of the contrast agent from the vasculature to the interstitial space was examined to differentiate normal pituitary gland from adenoma. [24][25][26][27] These studies found that factors such as surrounding microvasculature, arterial blood supply, size of adenoma, and tumor type (fibrous versus soft) affected the variability in clinical diagnoses. 26 Although we have yet to perform such rigorous investigation on this newly proposed imaging method, the fact that Mn 2ϩ enters into cells by a means that is directly related to the activity of a cell suggests the potential for improved clinical pituitary tumor assessment.…”

Section: Discussionmentioning

confidence: 99%

In Vivo Manganese MR Imaging of Calcium Influx in Spontaneous Rat Pituitary Adenoma

Cross¹,

Flexman²,

Anzai³

et al. 2007

American Journal of Neuroradiology

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BACKGROUND AND PURPOSE:Rapid uptake of the calcium analog manganese (Mn 2ϩ ) into spontaneous pituitary adenoma during MR imaging of aged rats generated the hypothesis that neuroendocrine tumors may have a corresponding increase in calcium influx required to trigger hormonal release. A goal of this study was to investigate the potential for clinical evaluation of pituitary adenoma by MR imaging combined with administration of Mn 2ϩ (Mn-MR imaging).

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Section: Discussionmentioning

confidence: 99%

In Vivo Manganese MR Imaging of Calcium Influx in Spontaneous Rat Pituitary Adenoma

Cross¹,

Flexman²,

Anzai³

et al. 2007

American Journal of Neuroradiology

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“…Based on our recent unpublished data, both the CRH test and 8 mg DST would achieve a higher specific measure for the diagnosis of Cushing's disease when combined with MRI [15,16], because the test results, along with the presence of a pituitary adenoma offer > 90% speficicity in Cushing's disease. In fact, MRI shows a high specificity to diagnose Cushing's disease [17]. The ability of MRI to detect pituitary ACTH-secreting adenomas in patients with Cushing's disease is, however, limited, because the calculated accuracy for detecting a pituitary source of ACTH is reported to be almost 60% for MRI [18].…”

Section: Bmentioning

confidence: 99%

Evaluation of Diagnostic Tests for ACTH-Dependent Cushing’s Syndrome

et al. 2009

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because of the Cushingoid appearance, with the characteristic features of central obesity, moon face, skin atrophy, purple striae and buffalo hump, and the clinical criteria are clear, a debate exists in the literature over the biochemical diagnosis of this disease [3]. Recently, the diagnostic criteria for Cushing's disease have been reported by the Ministry of Health, Labour, and Welfare of Japan [4]. In the guideline, the following endocrinological findings were considered as diagnostic criteria: 1) The presence of a Cushingoid appearance; 2) Evidence of autonomic or abnormal secretion of ACTH, such as (a) normal-high ACTH and cortisol levels, and (b) high levels of urinary excretion of free cortisol; 3) Screening tests show (a) incomplete suppression of cortisol (> 5 µg/dl) by a lowdose (0.5 mg) overnight dexamethasone suppression test (DST), (b) high cortisol levels (> 5 µg/dl) during night time sleeping, and (c) response of plasma ACTH levels to the desmopressin (DDAVP) test; 4) The dif- Abstract. We evaluated the usefulness and accuracy of diagnostic tests for adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome, based on our experience of 88 cases, including 73 cases with Cushing's disease, and 15 cases with ectopic ACTH syndrome (EAS). In our study, 0.5 mg of dexamethasone failed to suppress the morning cortisol secretion in 100% of cases with Cushing's disease and EAS. Plasma ACTH levels were significantly increased by desmopressin (DDAVP) in 86% of cases with Cushing's disease, especially in microadenomas (90%), while these levels were not affected in normal subjects. In EAS, 44% responded to DDAVP. Plasma ACTH levels were increased in response to the human corticotropin-releasing hormone (CRH) test in 100% of microadenomas and 73% of macroadenomas with Cushing's disease, but only in 27% of cases with EAS. A high dose (8 mg) of dexamethasone suppressed the morning cortisol secretion in 89% of microadenomas with Cushing's disease, and in 82% of all cases with Cushing's disease, while it did in only 20% of cases with EAS. Taken together, the 0.5 mg dexamethasone suppression test (DST) and DDAVP test are considerably useful for the screening of ACTH-dependent Cushing's syndrome. The CRH test and 8 mg DST would be effective for the diagnosis of Cushing's diseases, because our study shows a sensitivity of 81% in cases with Cushing's disease when these tests are considered together. These data were submitted to prepare the diagnostic criteria for Cushing's disease, suggested by the working group of the Ministry of Health, Labour, and Welfare of Japan.

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“…Corticotrophic microadenomas are not detectable on imaging studies in 40% to 50% of patients. 1 Bilateral inferior petrosal sinus sampling (IPSS) with corticotropin-releasing hormone (CRH) stimulation is a diagnostic technique that can aid with both the localization of the tumor to the pituitary gland as well as suggest lateralization within the gland. This procedure can also be used in cases of equivocal endocrine testing but established hypercortisolism or before reoperation.…”

mentioning

confidence: 99%

Neurologic Complications of Inferior Petrosal Sinus Sampling

Gandhi¹,

Meyer²,

Patel³

et al. 2008

AJNR Am J Neuroradiol

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Comparative evaluation of conventional and dynamic magnetic resonance imaging of the pituitary gland for the diagnosis of Cushing's disease

Abstract: In our hands, dynamic procedures did not improve the usefulness of MRI in Cushing's syndrome.

Cited by 138 publications

References 29 publications

In Vivo Manganese MR Imaging of Calcium Influx in Spontaneous Rat Pituitary Adenoma

In Vivo Manganese MR Imaging of Calcium Influx in Spontaneous Rat Pituitary Adenoma

Evaluation of Diagnostic Tests for ACTH-Dependent Cushing’s Syndrome

Neurologic Complications of Inferior Petrosal Sinus Sampling

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Comparative evaluation of conventional and dynamic magnetic resonance imaging of the pituitary gland for the diagnosis of Cushing's disease

Abstract: In our hands, dynamic procedures did not improve the usefulness of MRI in Cushing's syndrome.

Cited by 138 publications

References 29 publications

In Vivo Manganese MR Imaging of Calcium Influx in Spontaneous Rat Pituitary Adenoma

In Vivo Manganese MR Imaging of Calcium Influx in Spontaneous Rat Pituitary Adenoma

Evaluation of Diagnostic Tests for ACTH-Dependent Cushing&rsquo;s Syndrome

Neurologic Complications of Inferior Petrosal Sinus Sampling

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Product

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Evaluation of Diagnostic Tests for ACTH-Dependent Cushing’s Syndrome