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Influence of inferior petrosal sinus drainage symmetry on detection of adenomas in Cushing's syndrome - 28/06/19

Doi : 10.1016/j.neurad.2019.05.004 
Lukas Andereggen a, Jan Gralla b, Gerhard Schroth b, Pasquale Mordasini b, Robert H. Andres a, Hans Rudolf Widmer a, Markus M. Luedi c, Frauke Kellner b, Jürgen Beck a, Luigi Mariani d, Christoph Ozdoba b, Emanuel Christ e,
a Department of neurosurgery, Inselspital, Bern university hospital, university of Bern, Bern, Switzerland 
b Department of neuroradiology, Inselspital, Bern university hospital, university of Bern, Bern, Switzerland 
c Department of anaesthesiology and pain medicine, Inselspital, Bern university hospital, university of Bern, Bern, Switzerland 
d Department of neurosurgery, university hospital of Basel, Basel, Switzerland 
e Department of endocrinology, diabetology and metabolism, university hospital of Basel, Basel, Switzerland 

Corresponding author at: Division of endocrinology, diabetology and metabolism, university of Basel, Petersgraben 4, 4031 Basel, Switzerland.Division of endocrinology, diabetology and metabolism, university of BaselPetersgraben 4Basel4031Switzerland
En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Friday 28 June 2019
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Resumen

Graphical abstract




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Highlights

Asymmetric inferior petrosal sinuses (IPS) drainage patterns are frequently encountered during bilateral IPS sampling.
Asymmetric venous outflow does not seem to diminish accuracy in predicting the adenoma side nor does it influence the remission rate from ACTH-dependent Cushing's syndrome (CS).
Asymmetric venous outflow does not influence the remission rate from CS.

El texto completo de este artículo está disponible en PDF.

Abstract

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

To assess the influence of IPS drainage patterns on detection of an adenoma in CS.

Methods

Retrospective single-center cohort analysis reviewing records of patients with CS and negative MRI findings who subsequently underwent BIPSS.

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

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.

El texto completo de este artículo está disponible en PDF.

Keywords : Angiography, Digital subtraction, Cushing's syndrome, Venous anatomy

Abbreviations : ACTH, BIPPS, CD, CS, CT, EAS, IPS, MRI, oCRH


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© 2019  Publicado por Elsevier Masson SAS.
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