The lateralization accuracy of inferior petrosal sinus sampling in Cushing's disease: experiences of a tertiary center

Turk J Med Sci. 2022 Oct;52(5):1600-1608. doi: 10.55730/1300-0144.5500. Epub 2022 Oct 19.

Abstract

Background: The purpose of this study is to determine the accuracy of bilateral inferior petrosal sinus sampling (IPSS) in lateralization and to investigate variables associated with accurate IPSS lateralization prediction.

Methods: Initially, data from 55 patients who underwent IPSS in our institution were reviewed retrospectively. IPSS lateralization and pituitary magnetic resonance imaging (MRI) results of these patients were compared with postoperative follow-up and immunohistochemical data to calculate the positive predictive values (PPVs) for IPSS and MRI. Variables likely to be associated with the accurate prediction of IPSS lateralization were analyzed.

Results: Twenty-seven patients (85.2% female, mean age of 38.5 ± 13.1 years) were enrolled in the study. With IPSS, interpetrosal ratios were found to be ≥ 1.4 in 26 (96.2%) cases, and this ratio correctly predicted adenoma localization for 18 patients (PPV: 69.2%). For 16 (59.2%) patients, right lateralization was detected, while left lateralization was detected for 10 (37%) patients. Right-sided IPSS lateralization was associated with enhanced accuracy (p = 0.026). No masses were detected in the MRI images of 10 (37%) patients, while microadenoma of ≤ 6 mm was detected for 17 (63%) patients. MRI results (when positive) correctly identified adenoma localization for 14 of the patients with lateralization accuracy higher than that of IPSS (PPV: 82.3% vs. 69.2%).

Discussion: IPSS is a valuable procedure in detecting tumor lateralization, especially in patients with Cushing's disease who have negative pituitary MRI results. However, since lateralization has a limited reliability, the pituitary gland should be comprehensively evaluated by taking into account the MRI findings (if positive) as well as data on the side of IPSS lateralization.

Keywords: Cushing’s disease; bilateral inferior petrosal sinus sampling; lateralization; magnetic resonance imaging.

MeSH terms

  • Adenoma* / diagnostic imaging
  • Adenoma* / surgery
  • Adrenocorticotropic Hormone
  • Adult
  • Female
  • Humans
  • Male
  • Middle Aged
  • Petrosal Sinus Sampling / methods
  • Pituitary ACTH Hypersecretion* / complications
  • Pituitary ACTH Hypersecretion* / diagnosis
  • Pituitary ACTH Hypersecretion* / surgery
  • Reproducibility of Results
  • Retrospective Studies

Substances

  • Adrenocorticotropic Hormone