Influence of inferior petrosal sinus drainage symmetry on detection of adenomas in Cushing's syndrome.
Angiography
Cushing's syndrome
Digital subtraction
Venous anatomy
Journal
Journal of neuroradiology = Journal de neuroradiologie
ISSN: 0150-9861
Titre abrégé: J Neuroradiol
Pays: France
ID NLM: 7705086
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
06
04
2019
revised:
29
05
2019
accepted:
31
05
2019
pubmed:
23
6
2019
medline:
26
11
2021
entrez:
23
6
2019
Statut:
ppublish
Résumé
Asymmetric inferior petrosal sinuses (IPS) are not infrequently encountered during bilateral IPS sampling. There is little data on whether IPS symmetry influences success in predicting the adenoma side in patients with ACTH-dependent Cushing's syndrome (CS). To assess the influence of IPS drainage patterns on detection of an adenoma in CS. Retrospective single-center cohort analysis reviewing records of patients with CS and negative MRI findings who subsequently underwent BIPSS. BIPSS was performed in 38 patients with a mean age of 45±15 years. The overall technical success rate was 97% for bilateral cannulation. Asymmetric IPS were observed in 11 (39%) patients with Cushing's disease (CD). A side-to-side ACTH ratio was not significantly different between patients with symmetric outflow and those with asymmetric outflow at baseline (8.6±2.7 versus 16.4±6.0; P=0.45), but ratios were significantly different after ovine corticotropin-releasing hormone (oCRH) stimulation (6.0±2.5 versus 35.7±22.5; P=0.03). BIPSS correctly predicted the side of the adenoma in 25 (96%) patients with CD. Prediction was better when the venous outflow was symmetric (100%) rather than asymmetric (93%), although the difference was not significant (P=0.42). Remission from CS was achieved in 32 patients (87%), independent of the symmetry of IPS. Bearing in mind the sample size of this audit, asymmetric IPS at least do not seem to diminish the accuracy of diagnosis of ACTH-dependent CS, nor do they influence the clinical outcome.
Sections du résumé
BACKGROUND
BACKGROUND
Asymmetric inferior petrosal sinuses (IPS) are not infrequently encountered during bilateral IPS sampling. There is little data on whether IPS symmetry influences success in predicting the adenoma side in patients with ACTH-dependent Cushing's syndrome (CS).
OBJECTIVE
OBJECTIVE
To assess the influence of IPS drainage patterns on detection of an adenoma in CS.
METHODS
METHODS
Retrospective single-center cohort analysis reviewing records of patients with CS and negative MRI findings who subsequently underwent BIPSS.
RESULTS
RESULTS
BIPSS was performed in 38 patients with a mean age of 45±15 years. The overall technical success rate was 97% for bilateral cannulation. Asymmetric IPS were observed in 11 (39%) patients with Cushing's disease (CD). A side-to-side ACTH ratio was not significantly different between patients with symmetric outflow and those with asymmetric outflow at baseline (8.6±2.7 versus 16.4±6.0; P=0.45), but ratios were significantly different after ovine corticotropin-releasing hormone (oCRH) stimulation (6.0±2.5 versus 35.7±22.5; P=0.03). BIPSS correctly predicted the side of the adenoma in 25 (96%) patients with CD. Prediction was better when the venous outflow was symmetric (100%) rather than asymmetric (93%), although the difference was not significant (P=0.42). Remission from CS was achieved in 32 patients (87%), independent of the symmetry of IPS.
CONCLUSIONS
CONCLUSIONS
Bearing in mind the sample size of this audit, asymmetric IPS at least do not seem to diminish the accuracy of diagnosis of ACTH-dependent CS, nor do they influence the clinical outcome.
Identifiants
pubmed: 31228539
pii: S0150-9861(19)30233-0
doi: 10.1016/j.neurad.2019.05.004
pii:
doi:
Substances chimiques
Adrenocorticotropic Hormone
9002-60-2
Corticotropin-Releasing Hormone
9015-71-8
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
10-15Informations de copyright
Copyright © 2019 Elsevier Masson SAS. All rights reserved.