High accuracy of bilateral and simultaneous petrosal sinus sampling with desmopressin for the differential diagnosis of pediatric ACTH-dependent Cushing’s syndrome

Cavalcante, Lara Bessa Campelo Pinheiro; Freitas, Thaís Castanheira de; Musolino, Nina Rosa Castro; Cescato, Valter Ângelo Sperling; Silva, Gilberto Ochman; Fragoso, Maria Candida Barisson Villares; Puglia, Paulo; Bronstein, Marcello D.; Machado, Márcio Carlos

doi:10.1007/s11102-020-01051-1

Cited by 12 publications

(19 citation statements)

References 22 publications

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“…Since then, other articles have been reported that accounted for over 500 patients, with the great majority having CD. The literature data presented in Table 3 show that baseline ACTH IPS/P ratio ≥2 ranged from 64.7 to 100%, and after CRH/desmopressin stimulation ≥ 3 from 50 to 100%, but it has almost always been 100% in larger series ( 8 , 19 – 23 , 25 , 26 , 29 , 31 ).…”

Section: Discussionmentioning

confidence: 99%

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The Effects of Sampling Lateralization on Bilateral Inferior Petrosal Sinus Sampling for Pediatric Cushing’s Disease—A Single Endocrinology Centre Experience and Review of the Literature

et al. 2021

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BackgroundThis study aims to analyze the diagnostic accuracy of bilateral inferior petrosal sinus sampling (BIPSS), the gold standard test for the differential diagnosis of ACTH-dependent Cushing’s syndrome (CS) in a group of pediatric patients with Cushing’s disease (CD).MethodsThis is a retrospective analysis which include 12 patients with hypercortisolemia and inconclusive pituitary MRI, who underwent bilateral inferior petrosal sinus sampling (BIPSS) and transsphenoidal surgery (TSS) from 2004 to 2020 in the Children’s Memorial Health Institute (CMHI) Warsaw, Poland. Pituitary origin of ACTH secretion was considered if baseline central to peripheral (C/P) ACTH level ratio was ≥ 2 or C/P ratio was ≥ 3 after human corticotropin-releasing hormone (hCRH) stimulation. The diagnosis was histologically confirmed in almost all cases after TSS.ResultsThe diagnostic accuracy of BIPSS reached 75% at baseline and 83.3% after CRH stimulation. The compatibility of localization of a microadenoma by BIPSS with the surgical location was 66.7%.ConclusionsOwing to its high diagnostic effectiveness, BIPSS remains the best test to differentiate CD from EAS. The indications for the procedure should be carefully considered, because EAS in the pediatric population, unlike in adults, is extremely rare. Moreover BIPSS has only limited value for indicating tumor localization.

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Section: Discussionmentioning

confidence: 99%

“…Literature data show that BIPSS lateralization complies with the result during surgery by 54-100%. For stimulation during BIPSS ovine CRH (oCRH) is used, rather than human CRH (hCRH), only a few authors mention performing the procedure with desmopressin ( 25 , 26 ).…”

Section: Discussionmentioning

confidence: 99%

The Effects of Sampling Lateralization on Bilateral Inferior Petrosal Sinus Sampling for Pediatric Cushing’s Disease—A Single Endocrinology Centre Experience and Review of the Literature

et al. 2021

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“…We selected four studies published from 2007 to 2020 ( 7 , 8 , 9 , 10 ). Two of them were performed in Brazil ( 7 , 9 ) and the rest were conducted in China ( 8 ) and Argentina ( 10 ). All studies were case series of children with ACTH-dependent CS ( 7 , 8 , 9 , 10 ).…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Power of Bilateral Inferior Petrosal Sinus Sampling with Desmopressin in Paediatric Cushing’s Disease

Virú-Loza¹,

Quispe²

2022

Jcrpe

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Objective: The aim of this study was to evaluate the diagnostic accuracy of bilateral inferior petrosal sinus sampling (BIPSS) with desmopressin for pediatric Cushing’s disease (CD). Methods: We reviewed studies performed in children that evaluated the accuracy of BIPSS with desmopressin. Results: All included studies were case series of children with adrenocorticotropin hormone (ACTH)-dependent Cushing’s syndrome. The overall accuracy of BIPSS before stimulation was 84.1% (37/44), and after stimulation it was 92.3% (36/39). The overall lateralizing accuracy of BIPSS was 50.0%. Conclusion: Considering that available evidence is limited, it appears that BIPSS with desmopressin stimulation is accurate for the diagnosis of pediatric CD, but its lateralizing accuracy is probably not suitable for pediatric clinical practice.

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“…Different studies have reported the results of children and adolescents with CD undergoing BIPPS from different countries, and the role of BIPSS in diagnosis and lateralization has been evaluated and a significant difference between MRI and BIPSS in terms of success in detecting CD was found ( 3 , 14 , 16 , 17 , 30 , 31 ). Herein, we present the first report of a series of children and adolescent with CD who underwent BIPSS from Turkey.…”

Section: Discussionmentioning

confidence: 99%

“…Since EAS is very rare in children, the main use of BIPSS in the pediatric age group is for accurate location of the pituitary microadenoma. However, few studies have investigated the usefulness of BIPSS in predicting the location of pituitary adenoma in the pediatric population ( 14 , 15 , 17 , 31 ). As reported previously in children and adolescents, rates of identifying the laterality of the tumor by BIPSS ranged from 73.7 to 100%, and the consistency of these predictions with the actual tumor lateralization was 58.7-100% ( 3 , 13 , 18 , 26 , 30 , 37 ).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Bilateral Petrosal Sinus Sampling in Children with Cushing Disease: A Multi-center Study

Turan¹,

Çatlı²,

Kardelen³

et al. 2022

Jcrpe

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Objective: Although the sensitivity and specificity of bilateral inferior petrosal sinus sampling (BIPSS) were shown to be quite high in adult patients, pediatric studies are limited in number and have conflicting results, since BIPSS is much less commonly performed in children. The aim of this study was to assess the role of BIPSS in the detection and accuracy of lateralization of pituitary adenomas in pediatric patients with Cushing disease (CD) and its possible advantage over other diagnostic methods. Methods: This was a multicenter, nationwide, web-based study. The diagnostic value of BIPSS in 16 patients, aged between four and 16.5 years with a confirmed diagnosis of CD, was evaluated retrospectively. The sensitivity and specificity of BIPSS and magnetic resonance imaging (MRI) were calculated, and compared statistically. Results: Standard tests, except for morning cortisol level, were effective in proving the presence of Cushing syndrome. While MRI findings were consistent with microadenoma in eight cases (50%), CD presence and lateralization was successfully predicted in 14 of 16 patients using BIPSS. BIPSS compared with MRI examination was significantly more accurate, both in pre-stimulation and post-stimulation results (p=0.047 and p=0.041, respectively). BIPSS showed a significantly higher sensitivity (92.8%) than MRI in detecting the pituitary source of adrenocorticotropic hormone secretion. Conclusion: These results suggest that BIPSS is superior to MRI for diagnostic work-up to confirm the diagnosis of CD. Moreover, in line with previous studies, BIPSS was shown to provide better information about adenoma location, which is vital for possible surgical intervention.

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High accuracy of bilateral and simultaneous petrosal sinus sampling with desmopressin for the differential diagnosis of pediatric ACTH-dependent Cushing’s syndrome

Cited by 12 publications

References 22 publications

The Effects of Sampling Lateralization on Bilateral Inferior Petrosal Sinus Sampling for Pediatric Cushing’s Disease—A Single Endocrinology Centre Experience and Review of the Literature

The Effects of Sampling Lateralization on Bilateral Inferior Petrosal Sinus Sampling for Pediatric Cushing’s Disease—A Single Endocrinology Centre Experience and Review of the Literature

Diagnostic Power of Bilateral Inferior Petrosal Sinus Sampling with Desmopressin in Paediatric Cushing’s Disease

Diagnostic Value of Bilateral Petrosal Sinus Sampling in Children with Cushing Disease: A Multi-center Study

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