Influence of inferior petrosal sinus drainage symmetry on detection of adenomas in Cushing's syndrome.

Andereggen, Lukas; Gralla, Jan; Schroth, Gerhard; Mordasini, Pasquale; Andres, Robert; Widmer, Hans Rudolf; Lüdi, Markus; Kellner-Weldon, Frauke; Beck, Jürgen; Mariani, Luigi; Ozdoba, Christoph; Christ, Emanuel (2019). Influence of inferior petrosal sinus drainage symmetry on detection of adenomas in Cushing's syndrome. (In Press). Journal of neuroradiology Elsevier Masson 10.1016/j.neurad.2019.05.004

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Andereggen, Lukas; Gralla, Jan; Schroth, Gerhard; Mordasini, Pasquale; Andres, Robert; Widmer, Hans Rudolf; Lüdi, Markus; Kellner-Weldon, Frauke; Beck, Jürgen and Ozdoba, Christoph

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0150-9861

Publisher:

Elsevier Masson

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

05 Aug 2019 17:51

Last Modified:

22 Oct 2019 19:09

Publisher DOI:

10.1016/j.neurad.2019.05.004

PubMed ID:

31228539

Uncontrolled Keywords:

Cushing’s syndrome angiography digital subtraction venous anatomy

BORIS DOI:

10.7892/boris.131565

URI:

https://boris.unibe.ch/id/eprint/131565

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