| Diagnosis and Therapy for Cushing's Disease with Negative Dynamic MRI finding: a single-centre experience. | |
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MedLine Citation:
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PMID: 22050513 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Objective: Most patients with Cushing's disease (CD) will have evidence of an adenoma on high resolution magnetic resonance imaging (MRI). However, a significant minority of patients with CD and biochemical hypercortisolaemia have no visible adenoma on MRI. The purpose of this study was to evaluate the diagnostic value of preoperative biochemical assessment and accuracy of MRI findings on surgical outcome. Design: Retrospective data set analyses. Patients and measurement: The clinical, endocrinological, histopathological and surgical outcomes of 24 consecutive CD patients with negative-MRI findings were compared with those of 95 consecutive age- and sex-matched CD patients with pituitary adenomas on MRI. Results: The total remission rate was 86.6%. Among all patients, 87 had concordant positive endocrine tests and underwent neurosurgery, while bilateral inferior petrosal sinus sampling (BIPSS) was performed in 12 and 50 other patients with negative and positive MRI respectively. A pituitary adenoma, confirmed by pathological examination, was found in 83.3% and 93.6% of patients with negative and positive MRI respectively. The remission rate was not different between patients with negative and positive MRI (87.5% and 86.3% respectively; p>0.05) or between patients who did not undergo BIPSS with negative MRI and patients with positive MRI (p>0.05). The remission rate of patients who underwent BIPSS with negative MRI was not different from those not undergoing BIPSS (p>0.05). The recurrence rate was higher, although not statistically different, in patients with negative MRI compared to positive ones. Conclusions: Based on the findings outlined, MRI-negative CD may be a surgically remediable syndrome, with a pathophysiological basis that primarily involves a pituitary cause of the hypercortisolaemia. |
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Authors:
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Yuhao Sun; Qingfang Sun; Changyan Fan; Jiankang Shen; Weiguo Zhao; Yan Guo; Tingwei Su; Weiqing Wang; Guang Ning; Liuguan Bian |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-11-2 |
Journal Detail:
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Title: Clinical endocrinology Volume: - ISSN: 1365-2265 ISO Abbreviation: - Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-11-4 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0346653 Medline TA: Clin Endocrinol (Oxf) Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011 Blackwell Publishing Ltd. |
Affiliation:
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Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China Department of Neurology, Wuxi No.3 People's Hospital, Wuxi 214041, China Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong Unviersity School of Medicine, Shanghai 200025, China. |
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