Download PDF
J Neurol Surg B Skull Base 2015; 76(03): 218-224
DOI: 10.1055/s-0034-1543970
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Preoperative Lateralization Modalities for Cushing Disease: Is Dynamic Magnetic Resonance Imaging or Cavernous Sinus Sampling More Predictive of Intraoperative Findings?

Hai Sun
1   Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, United States
,
Chris Yedinak
1   Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, United States
,
Alp Ozpinar
1   Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, United States
,
Jim Anderson
2   Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon, United States
,
Aclan Dogan
1   Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, United States
,
Johnny Delashaw
3   Department of Neurological Surgery, Swedish Medical Center, Seattle, Washington, United States
,
Maria Fleseriu
1   Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, United States
4   Department of Medicine, Oregon Health & Science University, Portland, Oregon, United States
› Author Affiliations
Further Information

Publication History

14 August 2014

16 November 2014

Publication Date:
21 January 2015 (online)

    Permissions and Reprints

Abstract

Objective To analyze whether cavernous sinus sampling (CSS) and dynamic magnetic resonance imaging (dMRI) are consistent with intraoperative findings in Cushing disease (CD) patients.

Design Retrospective outcomes study.

Setting Oregon Health & Science University; 2006 and 2013.

Participants A total of 37 CD patients with preoperative dMRI and CSS to confirm central adrenocorticotropic hormone (ACTH) hypersecretion. Patients were 78% female; mean age was 41 years (at diagnosis), and all had a minimum of 6 months of follow-up.

Main Outcome Measures Correlations among patient characteristics, dMRI measurements, CSS results, and intraoperative findings.

Results All CSS indicated presence of CD. Eight of 37 patients had no identifiable tumor on dMRI. Three of 37 patients had no tumor at surgery. dMRI tumor size was inversely correlated with age (rs = − 0.4; p = 0.01) and directly correlated to intraoperative lateralization (rs = 0.3; p < 0.05). Preoperative dMRI was directly correlated to intraoperative lateralization (rs = 0.5; p < 0.002). CSS lateralization showed no correlation with intraoperative findings (rs = 0.145; p = 0.40) or lateralization observed on preoperative dMRI (rs = 0.17; p = 0.29). Postoperative remission rate was 68%.

Conclusion dMRI localization was most consistent with intraoperative findings; CSS results were less reliable. Results suggest that small ACTH-secreting tumors continue to pose a challenge to reliable preoperative localization.

Keywords

cavernous sinus sampling - Cushing disease - magnetic resonance imaging - intraoperative lateralization
 

  • References

  • 1 Acebes JJ, Martino J, Masuet C, Montanya E, Soler J. Early post-operative ACTH and cortisol as predictors of remission in Cushing's disease. Acta Neurochir (Wien) 2007; 149 (5) 471-477 ; discussion 477–479
    CrossrefPubMedGoogle Scholar
  • 2 Clayton RN, Raskauskiene D, Reulen RC, Jones PW. Mortality and morbidity in Cushing's disease over 50 years in Stoke-on-Trent, UK: audit and meta-analysis of literature. J Clin Endocrinol Metab 2011; 96 (3) 632-642
    CrossrefPubMedGoogle Scholar
  • 3 Daly AF, Rixhon M, Adam C, Dempegioti A, Tichomirowa MA, Beckers A. High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium. J Clin Endocrinol Metab 2006; 91 (12) 4769-4775
    CrossrefPubMedGoogle Scholar
  • 4 Fernandez A, Karavitaki N, Wass JA. Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol (Oxf) 2010; 72 (3) 377-382
    CrossrefPubMedGoogle Scholar
  • 5 Deipolyi AR, Hirsch JA, Oklu R. Bilateral inferior petrosal sinus sampling. J Neurointerv Surg 2012; 4 (3) 215-218
    CrossrefPubMedGoogle Scholar
  • 6 Biller BM, Grossman AB, Stewart PM , et al. Treatment of adrenocorticotropin-dependent Cushing's syndrome: a consensus statement. J Clin Endocrinol Metab 2008; 93 (7) 2454-2462
    CrossrefPubMedGoogle Scholar
  • 7 Lindsay JR, Oldfield EH, Stratakis CA, Nieman LK. The postoperative basal cortisol and CRH tests for prediction of long-term remission from Cushing's disease after transsphenoidal surgery. J Clin Endocrinol Metab 2011; 96 (7) 2057-2064
    CrossrefPubMedGoogle Scholar
  • 8 Locatelli M, Vance ML, Laws ER. Clinical review: the strategy of immediate reoperation for transsphenoidal surgery for Cushing's disease. J Clin Endocrinol Metab 2005; 90 (9) 5478-5482
    CrossrefPubMedGoogle Scholar
  • 9 Srinivasan L, Laws ER, Dodd RL , et al. The dynamics of post-operative plasma ACTH values following transsphenoidal surgery for Cushing's disease. Pituitary 2011; 14 (4) 312-317
    CrossrefPubMedGoogle Scholar
  • 10 Valassi E, Biller BM, Swearingen B , et al. Delayed remission after transsphenoidal surgery in patients with Cushing's disease. J Clin Endocrinol Metab 2010; 95 (2) 601-610
    CrossrefPubMedGoogle Scholar
  • 11 Frank SJ, Gesundheit N, Doppman JL , et al. Preoperative lateralization of pituitary microadenomas by petrosal sinus sampling: utility in two patients with non-ACTH-secreting tumors. Am J Med 1989; 87 (6) 679-682
    CrossrefPubMedGoogle Scholar
  • 12 Graham KE, Samuels MH, Nesbit GM , et al. Cavernous sinus sampling is highly accurate in distinguishing Cushing's disease from the ectopic adrenocorticotropin syndrome and in predicting intrapituitary tumor location. J Clin Endocrinol Metab 1999; 84 (5) 1602-1610
    CrossrefPubMedGoogle Scholar
  • 13 Invitti C, Pecori Giraldi F, de Martin M, Cavagnini F. Study Group of the Italian Society of Endocrinology on the Pathophysiology of the Hypothalamic-Pituitary-Adrenal Axis. Diagnosis and management of Cushing's syndrome: results of an Italian multicentre study. J Clin Endocrinol Metab 1999; 84 (2) 440-448
    CrossrefPubMedGoogle Scholar
  • 14 Jehle S, Walsh JE, Freda PU, Post KD. Selective use of bilateral inferior petrosal sinus sampling in patients with adrenocorticotropin-dependent Cushing's syndrome prior to transsphenoidal surgery. J Clin Endocrinol Metab 2008; 93 (12) 4624-4632
    CrossrefPubMedGoogle Scholar
  • 15 Bochicchio D, Losa M, Buchfelder M. Factors influencing the immediate and late outcome of Cushing's disease treated by transsphenoidal surgery: a retrospective study by the European Cushing's Disease Survey Group. J Clin Endocrinol Metab 1995; 80 (11) 3114-3120
    CrossrefPubMedGoogle Scholar
  • 16 Woo YS, Isidori AM, Wat WZ , et al. Clinical and biochemical characteristics of adrenocorticotropin-secreting macroadenomas. J Clin Endocrinol Metab 2005; 90 (8) 4963-4969
    CrossrefPubMedGoogle Scholar
  • 17 Tabarin A, Laurent F, Catargi B , et al. Comparative evaluation of conventional and dynamic magnetic resonance imaging of the pituitary gland for the diagnosis of Cushing's disease. Clin Endocrinol (Oxf) 1998; 49 (3) 293-300
    CrossrefPubMedGoogle Scholar
  • 18 Daousi C, Nixon T, Javadpour M, Hayden K, MacFarlane IA. Inferior petrosal sinus ACTH and prolactin responses to CRH in ACTH-dependent Cushing's syndrome: a single centre experience from the United Kingdom. Pituitary 2010; 13 (2) 95-104
    CrossrefPubMedGoogle Scholar
  • 19 Kaskarelis IS, Tsatalou EG, Benakis SV , et al. Bilateral inferior petrosal sinuses sampling in the routine investigation of Cushing's syndrome: a comparison with MRI. AJR Am J Roentgenol 2006; 187 (2) 562-570
    CrossrefPubMedGoogle Scholar
  • 20 Wind JJ, Lonser RR, Nieman LK, DeVroom HL, Chang R, Oldfield EH. The lateralization accuracy of inferior petrosal sinus sampling in 501 patients with Cushing's disease. J Clin Endocrinol Metab 2013; 98 (6) 2285-2293
    CrossrefPubMedGoogle Scholar
  • 21 Liu C, Lo JC, Dowd CF , et al. Cavernous and inferior petrosal sinus sampling in the evaluation of ACTH-dependent Cushing's syndrome. Clin Endocrinol (Oxf) 2004; 61 (4) 478-486
    CrossrefPubMedGoogle Scholar
  • 22 Doppman JL, Chang R, Oldfield EH, Chrousos G, Stratakis CA, Nieman LK. The hypoplastic inferior petrosal sinus: a potential source of false-negative results in petrosal sampling for Cushing's disease. J Clin Endocrinol Metab 1999; 84 (2) 533-540
    CrossrefPubMedGoogle Scholar
  • 23 Lefournier V, Martinie M, Vasdev A , et al. Accuracy of bilateral inferior petrosal or cavernous sinuses sampling in predicting the lateralization of Cushing's disease pituitary microadenoma: influence of catheter position and anatomy of venous drainage. J Clin Endocrinol Metab 2003; 88 (1) 196-203
    CrossrefPubMedGoogle Scholar
  • 24 Mamelak AN, Dowd CF, Tyrrell JB, McDonald JF, Wilson CB. Venous angiography is needed to interpret inferior petrosal sinus and cavernous sinus sampling data for lateralizing adrenocorticotropin-secreting adenomas. J Clin Endocrinol Metab 1996; 81 (2) 475-481
    CrossrefPubMedGoogle Scholar
  • 25 Guo Q, Young WF, Erickson D, Erickson B. Usefulness of dynamic MRI enhancement measures for the diagnosis of ACTH-producing pituitary adenomas. Clin Endocrinol (Oxf) 2014; ; May 6 (Epub ahead of print)
    PubMedGoogle Scholar
  • 26 Potts MB, Shah JK, Molinaro AM , et al. Cavernous and inferior petrosal sinus sampling and dynamic magnetic resonance imaging in the preoperative evaluation of Cushing's disease. J Neurooncol 2014; 116 (3) 593-600
    CrossrefPubMedGoogle Scholar
  • 27 Hameed N, Yedinak CG, Brzana J , et al. Remission rate after transsphenoidal surgery in patients with pathologically confirmed Cushing's disease, the role of cortisol, ACTH assessment and immediate reoperation: a large single center experience. Pituitary 2013; 16 (4) 452-458
    CrossrefPubMedGoogle Scholar
  • 28 Oldfield EH, Doppman JL, Nieman LK , et al. Petrosal sinus sampling with and without corticotropin-releasing hormone for the differential diagnosis of Cushing's syndrome. N Engl J Med 1991; 325 (13) 897-905
    Google Scholar
  • 29 Mulligan GB, Faiman C, Gupta M , et al. Prolactin measurement during inferior petrosal sinus sampling improves the localization of pituitary adenomas in Cushing's disease. Clin Endocrinol (Oxf) 2012; 77 (2) 268-274
    CrossrefPubMedGoogle Scholar
  • 30 Blevins Jr LS, Christy JH, Khajavi M, Tindall GT. Outcomes of therapy for Cushing's disease due to adrenocorticotropin-secreting pituitary macroadenomas. J Clin Endocrinol Metab 1998; 83 (1) 63-67
    CrossrefPubMedGoogle Scholar
  • 31 McCance DR, Besser M, Atkinson AB. Assessment of cure after transsphenoidal surgery for Cushing's disease. Clin Endocrinol (Oxf) 1996; 44 (1) 1-6
    CrossrefPubMedGoogle Scholar