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Transsphenoidal Surgery for Cushing's Disease after Non-diagnostic Inferior Petrosal Sinus Sampling.
MedLine Citation:
PMID:  22353796     Owner:  NLM     Status:  Publisher    
BACKGROUND: Inferior petrosal sinus sampling (IPSS) is a useful technique for confirming a pituitary source of ACTH overproduction in Cushing's disease (CD). Uncertainty still remains regarding the appropriate course of therapy when an ectopic tumor is predicted by IPSS but none can be found, and in circumstances when the procedure cannot be successfully completed due to technical or anatomical limitations. OBJECTIVE: To determine an appropriate course of action following non-diagnostic IPSS. METHODS: We reviewed 288 IPSS procedures in 283 patients between 1986 and 2010 at our Center. An IPS:peripheral (IPS:P) ACTH ratio ≥2 at baseline or ≥3 after corticotropin releasing hormone (CRH) was considered predictive of a pituitary source of ACTH. A procedure was considered "non-diagnostic" if 1) the procedure was successfully performed and the results predicted an ectopic source, but none could be found despite extensive imaging, or 2) the IPS could not be bilaterally cannulated because of technical difficulties or anatomic variants. RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive value of IPSS for detecting a pituitary source in CD were 94%, 50%, 98%, and 29%, respectively. We identified 3 categories of non-diagnostic IPSS, comprising 44 of the total procedures. These patients underwent exploratory transsphenoidal surgery (TSS), and in 42 of these (95%), a pituitary source was surgically proven, with a remission rate of 83%. CONCLUSION: TSS should be considered in cases of ACTH-dependent Cushing's and non-centralized or technically unsuccessful IPSS without evidence of ectopic tumor.
Sameer A Sheth; Matthew K Mian; Jonathan Neal; Nicholas A Tritos; Lisa Nachtigall; Anne Klibanski; Beverly M K Biller; Brooke Swearingen
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-17
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA 2Harvard Medical School, Boston, MA, USA 3Department of Medicine, Division of Neuroendocrinology, Massachusetts General Hospital, Boston, MA, USA.
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