Ankara City Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey.
Yildirim Beyazit University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey.
Clin Neurol Neurosurg. 2021 Aug;207:106724. doi: 10.1016/j.clineuro.2021.106724. Epub 2021 Jun 1.
Bilateral inferior petrosal sinus sampling (BIPSS) is an important procedure in the diagnostic work-up of Cushing's syndrome (CS). In this study, we investigated the diagnostic performance of BIPSS in detecting the source of adrenocorticotropic hormone (ACTH) secretion in Cushing's disease (CD) without radiological evidence.
Thirty-five consecutive patients who underwent BIPSS due to ACTH-dependent CS between 2010 and 2019 in our clinic and subsequently underwent transsphenoidal surgery were included. The indication for BIPSS was biochemically proven ACTH-dependent CS but normal or ≤6 mm pituitary lesion in pituitary magnetic resonance imaging (MRI). Corticotropin releasing hormone (CRH) stimulation was applied to all patients during the BIPSS procedure. BIPSS data, MRI results, pathological findings, and follow-up results were analyzed. The diagnostic performance of BIPSS was calculated.
A total of 35 patients, 6 (17%) males and 29 (83%) females, were included in the study. Pituitary MRI was normal in 12 (34.3%) and revealed lesions ≤ 6 mm in 23 (65.7%) patients. BIPSS lateralized the right side in 13 (37.1%) and left side in 18 (51.4%) patients, while no lateralization was observed in the remaining 4 (11.5%) patients. BIPSS showed lateralization in the same direction with pituitary adenoma in 21 (60%) patients before CRH injection and in 29 (83%) patients after CRH injection (p = 0.034). The sensitivity of the BIPSS procedure was 88%. Accurate localization of the pituitary lesion was more frequent when based on BIPSS results than on MRI (83% vs. 51%, P = 0.005).
BIPSS appears to be a valuable and safe diagnostic tool in patients who are diagnosed with CD biochemically but do not have clear radiological evidence of ACTH-producing lesion.
双侧岩下窦取样（BIPSS）是库欣综合征（CS）诊断中的重要程序。在这项研究中，我们研究了 BIPSS 在检测无影像学证据的库欣病（CD）中促肾上腺皮质激素（ACTH）分泌源的诊断性能。
本研究纳入了 2010 年至 2019 年期间在我院因 ACTH 依赖性 CS 而行 BIPSS 且随后接受经蝶窦手术的 35 例连续患者。BIPSS 的适应证为生化证实的 ACTH 依赖性 CS，但垂体 MRI 正常或≤6mm 的垂体病变。所有患者在 BIPSS 过程中均应用促皮质素释放激素（CRH）刺激。分析了 BIPSS 数据、MRI 结果、病理发现和随访结果。计算了 BIPSS 的诊断性能。
共有 35 例患者，6 例（17%）为男性，29 例（83%）为女性。12 例（34.3%）患者垂体 MRI 正常，23 例（65.7%）患者显示病变≤6mm。BIPSS 右侧 13 例（37.1%），左侧 18 例（51.4%），其余 4 例（11.5%）无侧化。在未接受 CRH 注射时，BIPSS 显示 21 例（60%）患者与垂体腺瘤同方向侧化，在接受 CRH 注射后，29 例（83%）患者显示侧化（p=0.034）。BIPSS 检测的敏感性为 88%。与 MRI 相比，基于 BIPSS 结果的垂体病变准确定位更为常见（83% vs. 51%，P=0.005）。
BIPSS 似乎是一种有价值且安全的诊断工具，适用于生化诊断为 CD 但无 ACTH 产生病变明确影像学证据的患者。
