Bilateral inferior petrosal sinus sampling: validity, diagnostic accuracy in lateralization of pituitary microadenoma, and treatment in eleven patients with Cushing's syndrome - a single-center retrospective cohort study.
BIPSS
Bilateral inferior petrosal sinus sampling
Cushing’s Disease
Cushing’s syndrome
EAS
Journal
BMC endocrine disorders
ISSN: 1472-6823
Titre abrégé: BMC Endocr Disord
Pays: England
ID NLM: 101088676
Informations de publication
Date de publication:
23 Oct 2023
23 Oct 2023
Historique:
received:
05
07
2023
accepted:
19
10
2023
medline:
30
10
2023
pubmed:
24
10
2023
entrez:
23
10
2023
Statut:
epublish
Résumé
This single-center retrospective cohort study aimed to describe the findings and validity of Bilateral inferior petrosal sinus sampling (BIPSS) in the differential diagnosis of patients with ACTH-dependent Cushing's syndrome (CS). Eleven patients underwent BIPSS due to equivocal biochemical tests and imaging results. Blood samples were taken from the right inferior petrosal sinus (IPS), left IPS, and a peripheral vein before and after stimulation with desmopressin (DDAVP). ACTH and prolactin levels were measured. The diagnosis was based on the ACTH ratio between the IPS and the peripheral vein. Also, lateralization of pituitary adenoma in patients with Cushing's disease (CD) was predicted. No significant complications were observed with BIPSS. Based on the pathology report, eight patients had CD, and three had ectopic ACTH syndrome (EAS). Unstimulated BIPSS resulted in a sensitivity of 87.5%, specificity of 100%, PPV of 100%, NPV of 75%, and accuracy of 91%. Stimulated BIPSS resulted in a sensitivity of 100%, specificity of 100%, PPV of 100%, NPV of 100%, and accuracy of 100%. However, pituitary magnetic resonance imaging (MRI) had a lower diagnostic accuracy (sensitivity:62.5%, specificity:33%, PPV:71%, NPV:25%, accuracy:54%). BIPSS accurately demonstrated pituitary adenoma lateralization in 75% of patients with CD. This study suggests that BIPSS may be a reliable and low-complication technique in evaluating patients with ACTH-dependent CS who had inconclusive imaging and biochemical test results. The diagnostic accuracy is improved by DDAVP stimulation. Pituitary adenoma lateralization can be predicted with the aid of BIPSS.
Sections du résumé
BACKGROUND
BACKGROUND
This single-center retrospective cohort study aimed to describe the findings and validity of Bilateral inferior petrosal sinus sampling (BIPSS) in the differential diagnosis of patients with ACTH-dependent Cushing's syndrome (CS).
METHODS
METHODS
Eleven patients underwent BIPSS due to equivocal biochemical tests and imaging results. Blood samples were taken from the right inferior petrosal sinus (IPS), left IPS, and a peripheral vein before and after stimulation with desmopressin (DDAVP). ACTH and prolactin levels were measured. The diagnosis was based on the ACTH ratio between the IPS and the peripheral vein. Also, lateralization of pituitary adenoma in patients with Cushing's disease (CD) was predicted. No significant complications were observed with BIPSS.
RESULTS
RESULTS
Based on the pathology report, eight patients had CD, and three had ectopic ACTH syndrome (EAS). Unstimulated BIPSS resulted in a sensitivity of 87.5%, specificity of 100%, PPV of 100%, NPV of 75%, and accuracy of 91%. Stimulated BIPSS resulted in a sensitivity of 100%, specificity of 100%, PPV of 100%, NPV of 100%, and accuracy of 100%. However, pituitary magnetic resonance imaging (MRI) had a lower diagnostic accuracy (sensitivity:62.5%, specificity:33%, PPV:71%, NPV:25%, accuracy:54%). BIPSS accurately demonstrated pituitary adenoma lateralization in 75% of patients with CD.
CONCLUSIONS
CONCLUSIONS
This study suggests that BIPSS may be a reliable and low-complication technique in evaluating patients with ACTH-dependent CS who had inconclusive imaging and biochemical test results. The diagnostic accuracy is improved by DDAVP stimulation. Pituitary adenoma lateralization can be predicted with the aid of BIPSS.
Identifiants
pubmed: 37872539
doi: 10.1186/s12902-023-01495-z
pii: 10.1186/s12902-023-01495-z
pmc: PMC10591461
doi:
Substances chimiques
Deamino Arginine Vasopressin
ENR1LLB0FP
Adrenocorticotropic Hormone
9002-60-2
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
232Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
J Clin Endocrinol Metab. 2020 Apr 1;105(4):
pubmed: 31758170
Ann Lab Med. 2021 Nov 1;41(6):521-531
pubmed: 34108279
BMC Endocr Disord. 2020 Sep 17;20(1):143
pubmed: 32943040
Endocr Connect. 2016 Jul;5(4):R12-25
pubmed: 27352844
J Clin Endocrinol Metab. 2007 Nov;92(11):4123-9
pubmed: 17698908
Endocrine. 2015 Mar;48(2):644-52
pubmed: 25030549
Clin Endocrinol (Oxf). 2017 Nov;87(5):515-522
pubmed: 28626863
Front Endocrinol (Lausanne). 2022 Oct 06;13:955945
pubmed: 36277711
J Clin Endocrinol Metab. 2003 Jan;88(1):196-203
pubmed: 12519852
Rev Endocr Metab Disord. 2022 Oct;23(5):881-892
pubmed: 35478451
J Clin Endocrinol Metab. 2008 May;93(5):1553-62
pubmed: 18334594
Clin Endocrinol (Oxf). 2012 Jan;76(1):12-8
pubmed: 21988204
J Clin Endocrinol Metab. 2013 Jun;98(6):2285-93
pubmed: 23553862
Eur J Endocrinol. 2001 May;144(5):499-507
pubmed: 11331216
Neurosurg Focus. 2007;23(3):E1
pubmed: 17961030
J Clin Endocrinol Metab. 2008 May;93(5):1526-40
pubmed: 18334580
Cancer. 2004 Aug 1;101(3):613-9
pubmed: 15274075
J Endocrinol Invest. 2013 Dec;36(11):1112-6
pubmed: 23887034
Neurosurg Clin N Am. 2009 Jul;20(3):361-7
pubmed: 19778704
Eur J Endocrinol. 2023 May 18;:
pubmed: 37200460
J Clin Endocrinol Metab. 2003 Dec;88(12):5593-602
pubmed: 14671138
Arch Intern Med. 2000 Nov 13;160(20):3045-53
pubmed: 11074733
Br Med J (Clin Res Ed). 1985 Nov 23;291(6507):1453-7
pubmed: 2998540
Eur J Endocrinol. 2007 Sep;157(3):271-7
pubmed: 17766708
J Clin Endocrinol Metab. 2021 Apr 23;106(5):e1953-e1967
pubmed: 33421066
Clin Epidemiol. 2015 Apr 17;7:281-93
pubmed: 25945066
Neurosurg Focus. 2007;23(3):E2
pubmed: 17961020
J Neurointerv Surg. 2017 Feb;9(2):196-199
pubmed: 26880723
Neurosurg Focus. 2007;23(3):E4; discussion E4a
pubmed: 17961029
J Endocrinol Invest. 2023 Jun 14;:
pubmed: 37314685
J Clin Endocrinol Metab. 2023 Apr 13;108(5):e178-e188
pubmed: 36453141
J Clin Endocrinol Metab. 2006 Feb;91(2):371-7
pubmed: 16303835