Lukas Andereggen1, Jan Gralla2, Gerhard Schroth2, Pasquale Mordasini2, Robert H Andres1, Hans Rudolf Widmer1, Markus M Luedi3, Frauke Kellner2, Jürgen Beck1, Luigi Mariani4, Christoph Ozdoba2, Emanuel Christ5. 1. Department of neurosurgery, Inselspital, Bern university hospital, university of Bern, Bern, Switzerland. 2. Department of neuroradiology, Inselspital, Bern university hospital, university of Bern, Bern, Switzerland. 3. Department of anaesthesiology and pain medicine, Inselspital, Bern university hospital, university of Bern, Bern, Switzerland. 4. Department of neurosurgery, university hospital of Basel, Basel, Switzerland. 5. Department of endocrinology, diabetology and metabolism, university hospital of Basel, Basel, Switzerland. Electronic address: emanuel.christ@usb.ch.
Abstract
BACKGROUND: Asymmetric inferior petrosal sinuses (IPS) are not infrequently encountered during bilateral IPS sampling. There is little data on whether IPS symmetry influences success in predicting the adenoma side in patients with ACTH-dependent Cushing's syndrome (CS). OBJECTIVE: To assess the influence of IPS drainage patterns on detection of an adenoma in CS. METHODS: Retrospective single-center cohort analysis reviewing records of patients with CS and negative MRI findings who subsequently underwent BIPSS. RESULTS: BIPSS was performed in 38 patients with a mean age of 45±15 years. The overall technical success rate was 97% for bilateral cannulation. Asymmetric IPS were observed in 11 (39%) patients with Cushing's disease (CD). A side-to-side ACTH ratio was not significantly different between patients with symmetric outflow and those with asymmetric outflow at baseline (8.6±2.7 versus 16.4±6.0; P=0.45), but ratios were significantly different after ovine corticotropin-releasing hormone (oCRH) stimulation (6.0±2.5 versus 35.7±22.5; P=0.03). BIPSS correctly predicted the side of the adenoma in 25 (96%) patients with CD. Prediction was better when the venous outflow was symmetric (100%) rather than asymmetric (93%), although the difference was not significant (P=0.42). Remission from CS was achieved in 32 patients (87%), independent of the symmetry of IPS. CONCLUSIONS: Bearing in mind the sample size of this audit, asymmetric IPS at least do not seem to diminish the accuracy of diagnosis of ACTH-dependent CS, nor do they influence the clinical outcome.
BACKGROUND: Asymmetric inferior petrosal sinuses (IPS) are not infrequently encountered during bilateral IPS sampling. There is little data on whether IPS symmetry influences success in predicting the adenoma side in patients with ACTH-dependent Cushing's syndrome (CS). OBJECTIVE: To assess the influence of IPS drainage patterns on detection of an adenoma in CS. METHODS: Retrospective single-center cohort analysis reviewing records of patients with CS and negative MRI findings who subsequently underwent BIPSS. RESULTS: BIPSS was performed in 38 patients with a mean age of 45±15 years. The overall technical success rate was 97% for bilateral cannulation. Asymmetric IPS were observed in 11 (39%) patients with Cushing's disease (CD). A side-to-side ACTH ratio was not significantly different between patients with symmetric outflow and those with asymmetric outflow at baseline (8.6±2.7 versus 16.4±6.0; P=0.45), but ratios were significantly different after ovine corticotropin-releasing hormone (oCRH) stimulation (6.0±2.5 versus 35.7±22.5; P=0.03). BIPSS correctly predicted the side of the adenoma in 25 (96%) patients with CD. Prediction was better when the venous outflow was symmetric (100%) rather than asymmetric (93%), although the difference was not significant (P=0.42). Remission from CS was achieved in 32 patients (87%), independent of the symmetry of IPS. CONCLUSIONS: Bearing in mind the sample size of this audit, asymmetric IPS at least do not seem to diminish the accuracy of diagnosis of ACTH-dependent CS, nor do they influence the clinical outcome.
Authors: Lukas Andereggen; Janine Frey; Robert H Andres; Markus M Luedi; Jan Gralla; Gerrit A Schubert; Jürgen Beck; Luigi Mariani; Emanuel Christ Journal: J Clin Transl Endocrinol Date: 2021-06-17
Authors: Lukas Andereggen; Janine Frey; Robert H Andres; Markus M Luedi; Hans Rudolf Widmer; Jürgen Beck; Luigi Mariani; Emanuel Christ Journal: Sci Rep Date: 2021-03-04 Impact factor: 4.379
Authors: Lukas Andereggen; Luigi Mariani; Jürgen Beck; Robert H Andres; Jan Gralla; Markus M Luedi; Joachim Weis; Emanuel Christ Journal: Acta Neurochir (Wien) Date: 2021-04-03 Impact factor: 2.816
Authors: Markus Huber; Markus M Luedi; Gerrit A Schubert; Christian Musahl; Angelo Tortora; Janine Frey; Jürgen Beck; Luigi Mariani; Emanuel Christ; Lukas Andereggen Journal: Front Endocrinol (Lausanne) Date: 2022-02-16 Impact factor: 5.555
Authors: L Andereggen; J Frey; R H Andres; M M Luedi; M El-Koussy; H R Widmer; J Beck; L Mariani; R W Seiler; E Christ Journal: J Endocrinol Invest Date: 2021-04-13 Impact factor: 4.256