The Lateralization Accuracy of Inferior Petrosal Sinus Sampling in 501 Patients With Cushing's Disease

Wind, Joshua J.; Lonser, Russell R.; Nieman, Lynnette K.; DeVroom, Hetty L.; Chang, Richard; Oldfield, Edward H.

doi:10.1210/jc.2012-3943

Cited by 129 publications

(109 citation statements)

References 23 publications

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“…Special Section Review O Koulouri and others conventional (SE) MRI sequences, with several case series suggesting that 40% or more of patients with CD have 'negative scans' (6,10). Accordingly, more detailed sequences (e.g., dynamic and/or SPGR MRI) are often employed, leading to a reported improvement in sensitivity from 50-55% (SE) to 70-75% (dynamic) and 70-90% (SPGR), but with the important caveat of a high detection rate of incidental pituitary lesions (6,20,21,22).…”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

“…Accordingly, reliance on cross-sectional imaging alone (e.g., magnetic resonance imaging (MRI) or computed tomography (CT)) may fail to deliver a surgical target in up to 40% of CD patients (6), or erroneously implicate an incidentaloma as the source of adrenocorticotrophic hormone (ACTH) excess (7). Bilateral inferior petrosal sinus sampling (BIPSS) remains an important tool for discriminating central (pituitary) Cushing's from the ectopic ACTH syndrome (EAS), but its utility in lateralising a corticotroph adenoma is limited (findings at surgery correspond with BIPSS lateralisation in approximately two-thirds of cases, a rate only marginally better than chance alone) (8,9,10). Functional nuclear medicine imaging (e.g.…”

Section: Introductionmentioning

confidence: 99%

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A role for 11C-methionine PET imaging in ACTH-dependent Cushing's syndrome

Koulouri

Steuwe

Gillett

et al. 2015

European Journal of Endocrinology

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Objective: We report our experience of functional imaging with 11 C-methionine positron emission tomography-computed tomography (PET-CT) co-registered with 3D gradient echo (spoiled gradient recalled (SPGR)) magnetic resonance imaging (MRI) in the investigation of ACTH-dependent Cushing's syndrome. Design: Twenty patients with i) de novo Cushing's disease (CD, nZ10), ii) residual or recurrent hypercortisolism following first pituitary surgery (Gradiotherapy; nZ8) or iii) ectopic Cushing's syndrome (nZ2) were referred to our centre for functional imaging studies between 2010 and 2015. Six of the patients with de novo CD and five of those with persistent/relapsed disease had a suspected abnormality on conventional MRI. Methods: All patients underwent 11 C-methionine PET-CT. For pituitary imaging, co-registration of PET-CT images with contemporaneous SPGR MRI (1 mm slice thickness) was performed, followed by detailed mapping of 11 C-methionine uptake across the sella in three planes (coronal, sagittal and axial). This allowed us to determine whether suspected adenomas seen on structural imaging exhibited focal tracer uptake on functional imaging. Results: In seven of ten patients with de novo CD, asymmetric 11 C-methionine uptake was observed within the sella, which co-localized with the suspected site of a corticotroph microadenoma visualised on SPGR MRI (and which was subsequently confirmed histologically following successful transsphenoidal surgery (TSS)). Focal 11 C-methionine uptake that correlated with a suspected abnormality on pituitary MRI was seen in five of eight patients with residual or recurrent Cushing's syndrome following first TSS (and pituitary radiotherapy in two cases). Two patients elected to undergo repeat TSS with histology confirming a corticotroph tumour in each case. In two patients with the ectopic ACTH syndrome, 11 C-methionine was concentrated in sites of distant metastases, with minimal uptake in the sellar region. Conclusions:11 C-methionine PET-CT can aid the detection of ACTH-secreting tumours in Cushing's syndrome and facilitate targeted therapy.

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Section: European Journal Of Endocrinologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A role for 11C-methionine PET imaging in ACTH-dependent Cushing's syndrome

Koulouri

Steuwe

Gillett

et al. 2015

European Journal of Endocrinology

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“…This method remains the gold standard for the differential diagnosis of ACTH-dependent Cushing's syndrome with an accuracy of approximately 90-98% (143)(144)(145).…”

Section: Bilateral and Simultaneous Inferior Petrosal Sinus Samplingmentioning

confidence: 99%

“…False negatives can occur in approximately 5-10% of cases due to technical difficulties, anatomical variations such as plexiform presentation, unresponsiveness to secretagogues or use of drugs that modulate ACTH secretion. One study reported that false negatives only occurred in cases where the ACTH peak was lower than 400 pg/mL (145).…”

Section: Bilateral and Simultaneous Inferior Petrosal Sinus Samplingmentioning

confidence: 99%

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Recommendations of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism for the diagnosis of Cushing’s disease in Brazil

Machado

Fragoso

Moreira

et al. 2016

Arch. Endocrinol. Metab.

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Although it is a rare condition, the accurate diagnosis and treatment of Cushing's disease is important due to its higher morbidity and mortality compared to the general population, which is attributed to cardiovascular diseases, diabetes mellitus and infections. Screening for hypercortisolism is recommended for patients who present multiple and progressive clinical signs and symptoms, especially those who are considered to be more specific to Cushing's syndrome, abnormal findings relative to age (e.g., spinal osteoporosis and high blood pressure in young patients), weight gain associated with reduced growth rate in the pediatric population and for those with adrenal incidentalomas. Routine screening is not recommended for other groups of patients, such as those with obesity or diabetes mellitus. Magnetic resonance imaging (MRI) of the pituitary, the corticotropin-releasing hormone (CRH) test and the high-dose dexamethasone suppression test are the main tests for the differential diagnosis of ACTH-dependent Cushing's syndrome. Bilateral and simultaneous petrosal sinus sampling is the gold standard method and is performed when the triad of initial tests is inconclusive, doubtful or conflicting. The aim of this article is to provide information on the early detection and establishment of a proper diagnosis of Cushing's disease, recommending follow-up of these patients at experienced referral centers. Arch Endocrinol Metab. 2016;60(3):267-86

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Physiological Basis for the Etiology, Diagnosis, and Treatment of Adrenal Disorders: Cushing's Syndrome, Adrenal Insufficiency, and Congenital Adrenal Hyperplasia

Raff

Sharma

Nieman

2014

Comprehensive Physiology

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122

105

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The hypothalamic-pituitary-adrenal (HPA) axis is a classic neuroendocrine system. One of the best ways to understand the HPA axis is to appreciate its dynamics in the variety of diseases and syndromes that affect it. Excess glucocorticoid activity can be due to endogenous cortisol overproduction (spontaneous Cushing’s syndrome) or exogenous glucocorticoid therapy (iatrogenic Cushing’s syndrome). Endogenous Cushing’s syndrome can be subdivided into ACTH-dependent and ACTH-independent, the latter of which is usually due to autonomous adrenal overproduction. The former can be due to a pituitary corticotroph tumor (usually benign) or ectopic ACTH production from tumors outside the pituitary; both of these tumor types overexpress the proopiomelanocortin gene. The converse of Cushing’s syndrome is the lack of normal cortisol secretion and is usually due to adrenal destruction (primary adrenal insufficiency) or hypopituitarism (secondary adrenal insufficiency). Secondary adrenal insufficiency can also result from a rapid discontinuation of long-term, pharmacological glucocorticoid therapy because of HPA axis suppression and adrenal atrophy. Finally, mutations in the steroidogenic enzymes of the adrenal cortex can lead to congenital adrenal hyperplasia and an increase in precursor steroids, particularly androgens. When present in utero, this can lead to masculinization of a female fetus. An understanding of the dynamics of the HPA axis is necessary to master the diagnosis and differential diagnosis of pituitary-adrenal diseases. Furthermore, understanding the pathophysiology of the HPA axis gives great insight into its normal control.

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The Lateralization Accuracy of Inferior Petrosal Sinus Sampling in 501 Patients With Cushing's Disease

Cited by 129 publications

References 23 publications

A role for 11C-methionine PET imaging in ACTH-dependent Cushing's syndrome

A role for 11C-methionine PET imaging in ACTH-dependent Cushing's syndrome

Recommendations of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism for the diagnosis of Cushing’s disease in Brazil

Physiological Basis for the Etiology, Diagnosis, and Treatment of Adrenal Disorders: Cushing's Syndrome, Adrenal Insufficiency, and Congenital Adrenal Hyperplasia

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