Abstract
Object Diagnosis and treatment of Cushing's disease (CD) is a demanding endeavor. We evaluated
the effectiveness of inferior petrosal sinus sampling (IPSS) in preoperative tumor
lateralization and surgical outcomes.
Methods Fifty-two consecutive patients with CD and normal magnetic resonance imaging (MRI)
were enrolled between 2009 and 2015. Selective catheterization of petrosal sinuses
for IPSS was performed. All patients underwent microsurgical dissection, and if a
lesion was found, underwent lesion resection. Demographic, biochemical, and intraoperative
findings were prospectively collected and reviewed 6 and 12 months postoperatively.
Results Forty-five patients (86.4%) had clear lateralization while seven patients had bilateral
elevation. Twenty-two patients (42%) were found to have a macroscopic lesion, defined
as an abnormal tissue during microsurgical dissection, which was thus resected. No
patient had a lesion larger than 4 mm. Eighty-one percent of patients had the lesion
where IPSS had been predicted. Hemi-hypophysectomy was performed on twenty-eight patients
based on IPSS findings, since no lesion was found. Eighty-six percent of patients
with lesion resection had biochemical remission by 12 months. Biochemical remission
was documented in 78 and 71% of patients who underwent hemi-hypophysectomy by 6 and
12 months, respectively.
Conclusion With careful microsurgical dissection, a macroscopic lesion could be found in a significant
number of patients with normal MRI. When no lesion was found, we recommend performing
a hemi-hypophysectomy based on IPSS findings, since prediction accuracy was high and
remission rates were significant.
Keywords
petrosal sinuses sampling - Cushing's disease - tumor lateralization
