Pituitary tumour localization in patients with Cushing's disease by magnetic resonance imaging. Is there a place for petrosal sinus sampling?

Ww, de Herder; Uitterlinden, P.; Pieterman, H.; Hl, Tanghe; Dj, Kwekkeboom; Ha, Pols; Singh, Rohit; Jh, van de Berge; Sw, Lamberts

doi:10.1111/j.1365-2265.1994.tb02448.x

Cited by 88 publications

(55 citation statements)

References 26 publications

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“…Reversal of the inter-sinus ratio between pre-and post-CRH values has been reported (7,10,33): in our series basal vs post-CRH inter-sinus ratio concordance was found in 87% of cases. Among the 5 cases with reversed inter-sinus ratio, the correct side was indicated by the basal ratio in 3 cases.…”

Section: Discussionsupporting

confidence: 71%

Inferior petrosal sinus sampling in the differential diagnosis of Cushing's syndrome: results of an Italian multicenter study

Colao

Faggiano

Pivonello

et al. 2001

European Journal of Endocrinology

136

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Objective: To evaluate the diagnostic accuracy of inferior petrosal sinus sampling (IPSS) in the differential diagnosis of ACTH-dependent Cushing's syndrome as compared with pituitary imaging techniques. Design and Methods: We retrospectively studied the diagnostic accuracy of basal and post corticotropin-releasing hormone (CRH) IPSS, magnetic resonance imaging and computed tomography in distinguishing pituitary from ectopic ACTH secretion in 97 Cushing's syndrome patients: 74 with Cushing's disease (CD) and 10 with ectopic ACTH secretion (EAS). Thirteen patients were excluded because of unconfirmed diagnosis. The difference between IPSS and pituitary imaging techniques in the correctly localized pituitary adenoma in the patients with CD was also investigated. Results: The basal ACTH inferior petrosal sinus:periphery (IPS:P) ratio was $ 2 in 63/74 patients with CD (85%), and in 1/10 EAS patients (10%); after stimulation with CRH, the ratio was $ 3 in 60/ 68 patients with CD (88%) and , 3 in all patients with EAS.The basal and post-CRH ACTH IPS:P ratios had a diagnostic accuracy of 86% and 90% respectively. The diagnostic accuracy of IPSS with both ratios was significantly higher than magnetic resonance imaging (50%) and computed tomography (40%). The IPS:P ratio suggested by receiver-operator characteristic (ROC) analysis that better distinguished CD from EAS was 2.10 for the basal and 2.15 for the post-CRH ratios. Using these cut-offs, the specificity of basal ratio and the sensitivity of the post-CRH test rose to 100% and 93% respectively. Diagnostic accuracy remained substantially unchanged for the basal ratio (87% vs 86%), while it rose from 90% to 94% for the post-CRH ratio. The sensitivity of IPSS was significantly higher than that of magnetic resonance and computerized tomography.IPSS was less reliable in identifying the adenoma site found at surgery than magnetic resonance imaging or computed tomography (65% vs 75% and 79% respectively). Conclusion: In conclusion, IPSS improved the diagnostic performance of imaging techniques. It can help in excluding transsphenoidal surgery in EAS patients. More striking results were obtained when a $ 2X1 : 1 basal ratio or a $ 2X15 : 1 post-CRH ratio were considered as criteria to distinguish between patients with CD and EAS. To establish correctly the location of the pituitary adenoma, IPSS is less reliable than imaging techniques.

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Section: Discussionsupporting

confidence: 71%

Inferior petrosal sinus sampling in the differential diagnosis of Cushing's syndrome: results of an Italian multicenter study

Colao

Faggiano

Pivonello

et al. 2001

European Journal of Endocrinology

136

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“…A diagnosis of Cushing's disease was confirmed based on an ACTH central-to-peripheral gradient of >2 (>3 after Desmopressin (DDAVP) administration) and the laterality was predicted based on inter-sinus gradient > 1.4. [25][26][27] Remission was defined as normal postoperative (24-h UFC), suppression of morning serum cortisol to <50 nmol/L after a 1-mg low dose dexamethasone suppression test or being dependent on corticosteroid replacement. 22 These tests were done three and six months from surgery, and every year after that to rule out any evidence of recurrence.…”

Section: Endocrine Criteria For Diagnosis and Remissionmentioning

confidence: 99%

Impact of Technique on Cushing Disease Outcome Using Strict Remission Criteria

Alahmadi

Cusimano

Woo

et al. 2013

Can. J. Neurol. Sci.

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334Cushing's Disease (CD) is the commonest cause of endogenous hypercortisolemia 1 and is associated with significant morbidity and mortality. [2][3][4] Transsphenoidal pituitary surgery remains the first line treatment for this condition with reported remission rates of 52% to 89%. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Many attempts have been made to identify factors that would predict sustained remission after surgical intervention. Suggested factors include smaller adenomas and the confirmation of adenoma intraoperatively. 18,20 The question of whether the newer endoscopic surgical technique (endo TSS) 21 has improved results compared to the older microscopic technique (micro TSS) remains to be answered. The aim of this report is to study the outcomes of ABSTRACT: Background: Cushing disease (CD) constitutes a challenging condition for the pituitary surgeon. Given the variety of factors affecting outcomes in CD, it is uncertain whether the newer endoscopic technique improves the results of surgery. Methods: A review was conducted of CD cases at our institution between 2000 and 2010. Analysis was done to: determine if surgical technique had an effect on outcome, identify the predictors of outcome and provide details of failed cases. Remission was defined as normal postoperative 24-hour urinary free cortisol (24-h UFC), suppression of morning serum cortisol to <50 nmol/L after 1mg of dexamethasone or being dependent on steroid replacement. Results: Forty-two patients met our inclusion criteria. Average follow-up period was 33 months. There were 15 macroadenomas and 27 microadenomas. Seventeen patients had an endoscopic transsphenoidal surgery and twenty-five patients had a microscopic transsphenoidal procedure. Long-term overall remission was achieved in 26 (62%) patients. There was no significant difference in remission rates between the two techniques (p value 0.757). Patient's subjective symptomatic improvement and drop of morning serum cortisol in the postoperative period to less than 100 nmol/L correlated with longterm remission (p value 0.0031and 0.0101, respectively) while repeat surgery was the only predictor of the lack of postoperative remission (p value 0.0008). Conclusions: Revision surgery predicted poor remission rate for CD. Within the power of our study size, there was no difference in outcome between the endoscopic and microscopic approaches. Surgical outcomes should be reviewed in association with remission criteria used in a study. RÉSUMÉ: Évaluation de l'impact de la technique utilisée, au moyen de critères de rémission rigoureux, sur le résultat de la chirurgie dans le traitement de la maladie de Cushing. Contexte : La maladie de Cushing (MC) présente des défis pour le chirurgien qui la traite. Compte tenu de la variété des facteurs qui influencent le résultat du traitement dans la MC, nous ne savons pas si la nouvelle technique endoscopique améliore le résultat de la chirurgie. Méthode : Nous avons revu les dossiers des patients atteints de la MC traités dans notre instit...

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“…Only a few case reports exist in which ACTH-secreting bronchial NETs could be localised using pulmonary arterial sampling (94,95). However, generally CT, MRI and the different scintigraphy and PET techniques, as mentioned above, are more successful in the localisation of (occult) ACTH-producing extra-pituitary tumours (89,90,91,92,93). …”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

“…Reviewafter the administration of corticotrophin-releasing hormone (CRH) has become an established and widely used diagnostic procedure in patients with ACTH-dependent Cushing's syndrome, especially in those cases with a negative or equivocal pituitary MRI finding (89,90,91,92,93) (Fig. 5).…”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

GEP-NETs update: Functional localisation and scintigraphy in neuroendocrine tumours of the gastrointestinal tract and pancreas (GEP-NETs)

Herder¹

2014

European Journal of Endocrinology

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For patients with neuroendocrine tumours (NETs) of the gastrointestinal tract and pancreas (GEP) (GEP-NETs), excellent care should ideally be provided by a multidisciplinary team of skilled health care professionals. In these patients, a combination of nuclear medicine imaging and conventional radiological imaging techniques is usually mandatory for primary tumour visualisation, tumour staging and evaluation of treatment. In specific cases, as in patients with occult insulinomas, sampling procedures can provide a clue as to where to localise the insulin-hypersecreting pancreatic NETs. Recent developments in these fields have led to an increase in the detection rate of primary GEP-NETs and their metastatic deposits. Radiopharmaceuticals targeted at specific tumour cell properties and processes can be used to provide sensitive and specific whole-body imaging. Functional imaging also allows for patient selection for receptor-based therapies and prediction of the efficacy of such therapies. Positron emission tomography/computed tomography (CT) and single-photon emission CT/CT are used to map functional images with anatomical localisations. As a result, tumour imaging and tumour follow-up strategies can be optimised for every individual GEP-NET patient. In some cases, functional imaging might give indications with regard to future tumour behaviour and prognosis.

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Pituitary tumour localization in patients with Cushing's disease by magnetic resonance imaging. Is there a place for petrosal sinus sampling?

Cited by 88 publications

References 26 publications

Inferior petrosal sinus sampling in the differential diagnosis of Cushing's syndrome: results of an Italian multicenter study

Inferior petrosal sinus sampling in the differential diagnosis of Cushing's syndrome: results of an Italian multicenter study

Impact of Technique on Cushing Disease Outcome Using Strict Remission Criteria

GEP-NETs update: Functional localisation and scintigraphy in neuroendocrine tumours of the gastrointestinal tract and pancreas (GEP-NETs)

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