Pediatric Cushing's Disease: Dichotomy in Lateralization Between Imaging and Inferior Petrosal Sinus Sampling with Review of Literature

Overview

Journal J Pediatr Neurosci

Specialty Pediatrics

Date 2018 Apr 21

PMID 29675075

Citations 1

Authors

Salman Tehran Shaikh

Vikram S Karmarkar

Chandrashekhar Eknath Deopujari

Affiliations

Soon will be listed here.

Abstract

Inferior petrosal sinus sampling (IPSS) is a minimally invasive method done in adrenocorticotrophic hormone (ACTH)-dependent pituitary adenoma cases where magnetic resonance imaging (MRI) either gives equivocal results or fails to localize it. A 12-year-girl with cushingoid features and raised ACTH levels presented to us with two consecutive MRI's done outside showing gross change in the morphology of a left-sided pituitary adenoma. Hence, a bilateral IPSS was done which showed a higher IPS/periphery ACTH ratio on the right side as compared to left. Transsphenoidal endoscopic excision of the left pituitary adenoma along with right hemihypophysectomy was performed. ACTH levels fell postoperatively. This case stands distinct in highlighting the discordance in lateralization of pituitary adenoma on MRI and IPSS. Review of literature tells us that while IPSS is more sensitive in accurately diagnosing Cushing's disease, MRI provides better accuracy in lateralizing the site of adenoma.

Citing Articles

Utility of bilateral inferior petrosal sinus sampling for diagnosis and lateralization of Cushing's disease in the pediatric population: case series and review of the literature.

Kang K, Muralidharan K, Knowlton H, Hassan K, Yekula A, Misra M J Endocrinol Invest. 2021; 45(3):617-627.

PMID: 34655038 DOI: 10.1007/s40618-021-01680-8.

References

Oldfield E, Doppman J, Nieman L, Chrousos G, Miller D, Katz D . Petrosal sinus sampling with and without corticotropin-releasing hormone for the differential diagnosis of Cushing's syndrome. N Engl J Med. 1991; 325(13):897-905. DOI: 10.1056/NEJM199109263251301. View

Doppman J, Oldfield E, KRUDY A, Chrousos G, Schulte H, Schaaf M . Petrosal sinus sampling for Cushing syndrome: anatomical and technical considerations. Work in progress. Radiology. 1984; 150(1):99-103. DOI: 10.1148/radiology.150.1.6316418. View

Magiakou M, Chrousos G . Cushing's syndrome in children and adolescents: current diagnostic and therapeutic strategies. J Endocrinol Invest. 2002; 25(2):181-94. DOI: 10.1007/BF03343985. View

Newell-Price J, Trainer P, Besser M, Grossman A . The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states. Endocr Rev. 1998; 19(5):647-72. DOI: 10.1210/edrv.19.5.0346. View

Wind J, Lonser R, Nieman L, DeVroom H, Chang R, Oldfield E . The lateralization accuracy of inferior petrosal sinus sampling in 501 patients with Cushing's disease. J Clin Endocrinol Metab. 2013; 98(6):2285-93. PMC: 3667263. DOI: 10.1210/jc.2012-3943. View

Boscaro M, Arnaldi G . Approach to the patient with possible Cushing's syndrome. J Clin Endocrinol Metab. 2009; 94(9):3121-31. DOI: 10.1210/jc.2009-0612. View

Ezzat S, Asa S, Couldwell W, Barr C, Dodge W, Vance M . The prevalence of pituitary adenomas: a systematic review. Cancer. 2004; 101(3):613-9. DOI: 10.1002/cncr.20412. View

Das N, Lyngdoh B, Bhakri B, Behari S, Bhatia V, Jain V . Surgical management of pediatric Cushing's disease. Surg Neurol. 2007; 67(3):251-7. DOI: 10.1016/j.surneu.2006.05.067. View

Gross B, Mindea S, Pick A, Chandler J, Batjer H . Diagnostic approach to Cushing disease. Neurosurg Focus. 2007; 23(3):E1. DOI: 10.3171/foc.2007.23.3.2. View

10.

Joshi S, Hewitt R, Storr H, Rezajooi K, Ellamushi H, Grossman A . Cushing's disease in children and adolescents: 20 years of experience in a single neurosurgical center. Neurosurgery. 2005; 57(2):281-5. DOI: 10.1227/01.neu.0000166580.94215.53. View

11.

Mamelak A, Dowd C, Tyrrell J, McDonald J, Wilson C . Venous angiography is needed to interpret inferior petrosal sinus and cavernous sinus sampling data for lateralizing adrenocorticotropin-secreting adenomas. J Clin Endocrinol Metab. 1996; 81(2):475-81. DOI: 10.1210/jcem.81.2.8636253. View

12.

Doppman J, Chang R, Oldfield E, Chrousos G, Stratakis C, Nieman L . The hypoplastic inferior petrosal sinus: a potential source of false-negative results in petrosal sampling for Cushing's disease. J Clin Endocrinol Metab. 1999; 84(2):533-40. DOI: 10.1210/jcem.84.2.5475. View

13.

Kunwar S, Wilson C . Pediatric pituitary adenomas. J Clin Endocrinol Metab. 1999; 84(12):4385-9. DOI: 10.1210/jcem.84.12.6240. View

14.

Hardy J . Transphenoidal microsurgery of the normal and pathological pituitary. Clin Neurosurg. 1969; 16:185-217. DOI: 10.1093/neurosurgery/16.cn_suppl_1.185. View

15.

Marcovitz S, Wee R, Chan J, Hardy J . Diagnostic accuracy of preoperative CT scanning of pituitary prolactinomas. AJNR Am J Neuroradiol. 1988; 9(1):13-7. PMC: 8331526. View

16.

Corrigan D, Schaaf M, WHALEY R, Czerwinski C, EARLL J . Selective venous sampling to differentiate ectopic ACTH secretion from pituitary Cushing's syndrome. N Engl J Med. 1977; 296(15):861-2. DOI: 10.1056/NEJM197704142961508. View

17.

Colao A, Faggiano A, Pivonello R, Pecori Giraldi F, Cavagnini F, Lombardi G . Inferior petrosal sinus sampling in the differential diagnosis of Cushing's syndrome: results of an Italian multicenter study. Eur J Endocrinol. 2001; 144(5):499-507. DOI: 10.1530/eje.0.1440499. View