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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 Dec; 93(12):4624-32.JC

Abstract

CONTEXT

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.

Authors+Show Affiliations

Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York 10029, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

18796519

Citation

Jehle, Sigrid, et al. "Selective Use of Bilateral Inferior Petrosal Sinus Sampling in Patients With Adrenocorticotropin-dependent Cushing's Syndrome Prior to Transsphenoidal Surgery." The Journal of Clinical Endocrinology and Metabolism, vol. 93, no. 12, 2008, pp. 4624-32.
Jehle S, Walsh JE, Freda PU, et al. 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):4624-32.
Jehle, S., Walsh, J. E., Freda, P. U., & Post, K. D. (2008). Selective use of bilateral inferior petrosal sinus sampling in patients with adrenocorticotropin-dependent Cushing's syndrome prior to transsphenoidal surgery. The Journal of Clinical Endocrinology and Metabolism, 93(12), 4624-32. https://doi.org/10.1210/jc.2008-0979
Jehle S, et al. 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):4624-32. PubMed PMID: 18796519.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Selective use of bilateral inferior petrosal sinus sampling in patients with adrenocorticotropin-dependent Cushing's syndrome prior to transsphenoidal surgery. AU - Jehle,Sigrid, AU - Walsh,Jane E, AU - Freda,Pamela U, AU - Post,Kalmon D, Y1 - 2008/09/16/ PY - 2008/9/18/pubmed PY - 2009/1/28/medline PY - 2008/9/18/entrez SP - 4624 EP - 32 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 93 IS - 12 N2 - CONTEXT: 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. SN - 0021-972X UR - https://www.unboundmedicine.com/medline/citation/18796519/full_citation/EXTENSIVE_CLINICAL_EXPERIENCE__Selective_use_of_bilateral_inferior_petrosal_sinu_sampling_in_patients_with_adrenocorticotropin_dependent_cushing L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2008-0979 DB - PRIME DP - Unbound Medicine ER -