Usefulness of the Corticotropin-Releasing Hormone Test during Bilateral Inferior Petrosal Sinus Sampling for the Diagnosis of Cushing’s Disease

Tabarin, Antoine; Greselle, Jean François; San-Galli, F.; Leprat, F.; Caille, Jean Marie; Latapie, J. L.; Guérin, J.; Roger, Patrick

doi:10.1210/jcem-73-1-53

Cited by 103 publications

(47 citation statements)

References 29 publications

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“…Corticotroph macroadenomas have previously been considered to be associated with a more indolent disease (13), although to date this has not been systematically investigated, but other data from six previously published series (5,6,(16)(17)(18)(19) confirm our present observations (Table 5). Our results also suggest that corticotroph macroadenomas are less responsive to suppression by high-dose dexamethasone.…”

Section: Discussionsupporting

confidence: 82%

Cushing's disease: a comparison of pituitary corticotroph microadenomas and macroadenomas

Selvais

Donckier

Buysschaert

et al. 1998

European Journal of Endocrinology

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Cushing's disease appears as a functionally heterogeneous disease, but criteria that are able to distinguish between different clinical forms remain elusive. We compared two subgroups of patients with proven Cushing's disease according to the size of the pituitary adenoma, evaluated by computed tomography or magnetic resonance imaging. Our series comprised 11 patients with a microadenoma and 10 with a macroadenoma (median volumes (range): 173 (13-270) and 3022 (500-10312) mm 3 respectively; P < 0:0001). The clinical presentation was similar in the two groups, but the time elapsed before diagnosis was longer, and visual impairment was less frequent in the patients with a microadenoma (1:5 Ϯ 0:8 years and 0%) than in those with a macroadenoma (0:7 Ϯ 0:6 years and 40%; P < 0:05). Morning and evening peripheral concentrations of ACTH were greater in patients with macroadenoma (134 Ϯ 78 and 130 Ϯ 7 ng/l respectively) than in those with microadenoma (52 Ϯ 28 and 56 Ϯ 19 ng/l, P < 0:05). Hypokalaemia and lymphopenia were also more pronounced in patients with macroadenoma (3:4 Ϯ 0:3 mmol/l and 1273 Ϯ 401 lymphocytes/mm 3 ) than in those with microadenoma (3:8 Ϯ 0:3 mmol/l and 1852Ϯ668 lymphocytes/mm 3 ; P < 0:05), although morning and evening plasma cortisol concentrations were similar in both groups. In patients with macroadenoma, there was less relative nycthemeral variation of ACTH concentrations (28 Ϯ 24%, compared with 62 Ϯ 39% in those with microadenoma; P < 0:05), less suppression of plasma cortisol by high doses of dexamethasone (¹30 Ϯ 14%, compared with ¹61 Ϯ 25%; P < 0:05), and a reduced concentration ratio of mean basal cortisol to ACTH (7 Ϯ 3, compared with 12 Ϯ 5; P < 0:05). Plasma IGF-I concentration and the TSH peak response to TRH were significantly lower in patients with macroadenoma than in those with microadenoma (0:4 Ϯ 0:2 × 10 3 IU/l and 2:3 Ϯ 1:8 mIU/l, compared with 1:8 Ϯ 0:6 × 10 3 IU/l and 5:2 Ϯ 1:6 mUI/l; P < 0:05). Thus, in comparison with microadenomas, corticotroph macroadenomas are characterized by a greater and more autonomous ACTH secretion, inducing more pronounced biological signs of hypercorticism, and are more often accompanied by visual field defects and impairment of other pituitary hormonal secretions. European Journal of Endocrinology 138 153-159

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Section: Discussionsupporting

confidence: 82%

Cushing's disease: a comparison of pituitary corticotroph microadenomas and macroadenomas

Selvais

Donckier

Buysschaert

et al. 1998

European Journal of Endocrinology

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“…The petrosal sinus to peripheral gradient may be increased by the administration of CRH (18)(19)(20)(21). In a large series, a petrosal sinus to peripheral gradient of 3·0 after CRH administration showed a 100% sensitivity and specificity in those patients in whom Cushing's disease could be confirmed by surgery (1).…”

Section: Journal Of Endocrinology (1998) 139mentioning

confidence: 99%

“…A serious potential complication of leaving a cannula in situ in both inferior petrosal sinuses is cavernous sinus thrombosis, a condition which carries a high morbidity and mortality (22,23). Although BSimIPSS has been performed without heparinisation (21), most groups use heparin to avoid this dangerous complication. However, heparinisation may itself be hazardous in hypercortisolaemic patients, and in the event of perforation of the petrosal sinus, a complication that has occurred during petrosal sinus catheterisation (24) for other indications, anticoagulation may prove catastrophic.…”

Section: Journal Of Endocrinology (1998) 139mentioning

confidence: 99%

“…Several studies have shown that using BSimIPSS with CRH stimulation, lateralisation of the adenoma within the pituitary gland may be achieved (1, 14, 16,35) in some or all patients, and hemihypophysectomy of the suspected side has been advised if an adenoma cannot be identified during surgical exploration. Others, however, have found lateralisation by inferior petrosal sinus sampling to be misleading (17,21), and in one report the intraoperative measurement of ACTH in the peri-pituitary blood was used to correct the misleading results from inferior petrosal sinus sampling (36). The value of inferior petrosal sinus sampling in the lateralisation of a pituitary source of ACTH is uncertain.…”

Section: Journal Of Endocrinology (1998) 139mentioning

confidence: 99%

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Bilateral sequential inferior petrosal sinus sampling with corticotrophin-releasing hormone stimulation in the diagnosis of Cushing's disease

Padayatty

Orme²,

Nelson³

et al. 1998

European Journal of Endocrinology

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Objective: The demonstration of a central to peripheral ACTH gradient in a hypercortisolaemic patient is diagnostic of Cushing's disease. We tried to determine whether single blood samples for ACTH obtained sequentially from each of the inferior petrosal sinuses following human corticotrophin-releasing hormone (hCRH) stimulation can reliably establish such a gradient. Design: Prospective study. Patients: Seventeen patients with clinical and biochemical features of Cushing's syndrome. Methods: After the administration of hCRH, the patients underwent bilateral sequential inferior petrosal sinus sampling, with a single blood sample obtained from each of the inferior petrosal sinuses sequentially, along with a peripheral venous sample. The petrosal sinus catheter was withdrawn immediately after obtaining a blood sample. Patients did not require indwelling catheters in the petrosal sinuses, nor heparinisation. Results: Bilateral sequential inferior petrosal sinus sampling correctly identified a pituitary source of ACTH, as shown by a central to peripheral ACTH ratio >2, in all patients in whom the procedure was successfully carried out. All patients underwent transsphenoidal pituitary surgery resulting in remission. Conclusions: The simplified method of inferior petrosal sinus sampling, using a single sequential sample from each of the inferior petrosal sinuses, following initial hCRH stimulation, is as accurate as the more complex test using multiple bilateral simultaneous inferior petrosal sinus samples. It avoids the use of indwelling cerebral venous catheters and is therefore unlikely to cause brain stem damage.

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“…[14][15][16] CRF administration during IPS sampling should reduce the incidence of false-negative result in patients with Cushing disease. 7,11 The safety and consistency of simultaneous bilateral sampling of the IPS with CRH stimulation and its high diagnostic accuracy have been reported.…”

mentioning

confidence: 99%

The Impact of Cavernous Sinus Drainage Pattern on the Results of Venous Sampling in Patients With Suspected Cushing Syndrome

Hayashi¹,

Kurimoto²,

Kubo³

et al. 2007

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Selective venous sampling from the posterior portion of the cavernous sinus (CS) is recommended for the diagnosis of Cushing disease, because samples from the posterior portion yield higher adrenocorticotropic hormone (ACTH) levels than those from the anterior and middle portions. We prospectively assessed this intracavernous gradient of ACTH level to determine which site in the CS yields adequate sampling.

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Usefulness of the Corticotropin-Releasing Hormone Test during Bilateral Inferior Petrosal Sinus Sampling for the Diagnosis of Cushing’s Disease

Cited by 103 publications

References 29 publications

Cushing's disease: a comparison of pituitary corticotroph microadenomas and macroadenomas

Cushing's disease: a comparison of pituitary corticotroph microadenomas and macroadenomas

Bilateral sequential inferior petrosal sinus sampling with corticotrophin-releasing hormone stimulation in the diagnosis of Cushing's disease

The Impact of Cavernous Sinus Drainage Pattern on the Results of Venous Sampling in Patients With Suspected Cushing Syndrome

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