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Selective use of bilateral inferior petrosal sinus sampling in patients with adrenocorticotropin dependent cushing's syndrome prior to transsphenoidal


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Thought this was interesting:



Context: Few data are available on the selective use of bilateral inferior petrosal sinus sampling (BIPSS) in the presurgical evaluation of patients with adrenocorticotropin hormone (ACTH) dependent Cushing's syndrome (CS) so we investigated whether its use only in patients without a clear adenoma on MRI 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: 193 consecutive adult patients who underwent initial 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 1(st) TS was 80.8% overall, 79.1% in the BIPSS (n=105) and 83.0% in the No-BIPSS (n=88) groups. Recurrences occurred in 13.5% after 1(st) TS at a mean of 4.8 +/- 3.5 yrs (range 0.7 - 12.4 yrs) with no difference between BIPSS and No-BIPSS groups. Long-term remission was achieved after surgeries and RT in 85% (86.7% of BIPSS, 83.0% of No-BIPSS groups). 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 nor adversely affect remission rates or long-term outcome.

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Mertie this is interesting, especially for me since that is the facility

that I went to for the sampling. It was 2 years later but Post(neuro) is

still there at Mt Sinai and Dr Patel did my testing. The testing was

not that bad and Dr Patel is nice, handsome, I might add and very comforting.

I had the sampling as my tumor was not seen on MRI and my urine

was never high--but the sampling brought out high acth #'s 5400 on the

bad side. All is well- I am doing better thank goodness.



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