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Selective use of bilateral inferior petrosal sinus sampling in patients with adrenocorticotropin-dependent Cushing s syndrome prior to transsphenoidal surgery Jehle S; Walsh JE; Freda PU; Post KDJ Clin Endocrinol Metab 2008[Dec]; 93 (12): 4624-32CONTEXT: Few data are available on the selective use of bilateral inferior petrosal sinus sampling (BIPSS) in the presurgical evaluation of patients with ACTH-dependent Cushing's syndrome, so we investigated whether its use only in patients without a clear adenoma on magnetic resonance imaging and/or inconsistent biochemical testing affected remission and long-term outcome after surgery in patients with Cushing's disease (CD). SETTING: This was a retrospective review of patients treated for CD by one pituitary neurosurgeon at tertiary medical centers in New York City. PATIENTS: A total of 193 consecutive adult patients who underwent initial transsphenoidal surgery (TS) for presumed CD between 1987 and 2005 were included. MAIN OUTCOME MEASURES: We examined preoperative pituitary imaging and biochemical data, results of BIPSS and surgical pathology, and outcome based on biochemical tests after initial TS and long term after subsequent therapies. RESULTS: Remission rate after the first TS was 80.8% overall, 79.1% in the BIPSS group (n = 105), and 83.0% in the No-BIPSS group (n = 88). Recurrences occurred in 13.5% after the first TS at a mean of 4.8 +/- 3.5 yr (range, 0.7-12.4 yr) with no difference between BIPSS and No-BIPSS groups. Long-term remission was achieved after surgeries and radiotherapy in 85% (86.7% of BIPSS group, 83.0% of No-BIPSS group). CD was ultimately confirmed in all but one patient in each group. CONCLUSIONS: Selective use of BIPSS in the preoperative evaluation of patients with presumed CD did not lead to misdiagnosis in the No-BIPSS group or adversely affect remission rates or long-term outcome.|*Neurosurgical Procedures[MESH]|*Petrosal Sinus Sampling[MESH]|Adolescent[MESH]|Adrenocorticotropic Hormone/blood/*physiology[MESH]|Algorithms[MESH]|Child[MESH]|Child, Preschool[MESH]|Corticotropin-Releasing Hormone/metabolism[MESH]|Data Collection[MESH]|Female[MESH]|Humans[MESH]|Infant[MESH]|Infant, Newborn[MESH]|Magnetic Resonance Imaging[MESH]|Male[MESH]|Pituitary ACTH Hypersecretion/*diagnosis/diagnostic imaging/surgery[MESH]|Radiosurgery[MESH]|Recurrence[MESH]|Retrospective Studies[MESH]|Sphenoid Sinus/*surgery[MESH]|Tomography, X-Ray Computed[MESH]|Treatment Outcome[MESH] |
