ECE2021 Audio Eposter Presentations Pituitary and Neuroendocrinology (113 abstracts)
Effectiveness of bilataral inferior petrosal sinus sampling in diagnosis of ACTH dependent cushing syndrome
Selvinaz Erol 1 , Feyza Yener Ozturk 1 , esra cil sen 1 , M.Masum Canat 1 , Sezin Dogan Cakir 2 , Emre Sedar Saygili 3 , adnan batman 4 , seda erem basmaz 5 , duygu yildiz 1 & Yuksel Altuntas 1
1University of Health Sciences, School of Medicine, Sisli Hamidiye Etfal Training and Research Hospital, Department of Endocrinology and Metabolism, istanbul, Turkey; 2Adıyaman University Training and Research Hospital, Department of Endocrinology and Metabolism, adıyaman, Turkey; 3Mehmet Akif Ersoy Canakkale State Hospital, Endocrinology Clinic, canakkale, Turkey; 4Aksaray University Training and Research Hospital, Endocrinology Clinic, Aksaray, Turkey; 5Karabük University Karabük Training and Research Hospital, Department of Endocrinology and Metabolism, Karabuk, Turkey
Purpose
We aimed to determine the effectiveness of bilateral inferior petrosal sinus sampling (IPSS) in the differential diagnosis of adrenocorticotropic hormone-dependent Cushing Syndrome (ACTH-dependent CS).
Method
51 patients diagnosed with ACTH-dependent CS between 2010-2019 in the Endocrinology Clinic in Şişli Hamidiye Etfal Health Training and Research Hospital were included in the study. The diagnosis of Cushing’s Disease (CH) was made when the basal central/peripheral ACTH ratio was> 2 and/or the rate after CRH stimulation was> 3 in the IPSS procedure. With the inter-sinus ratio> 1.4, lateralization was determined. The diagnosis of CD was confirmed by immunohistochemical staining of pathology specimens. Sensitivity, specificity, positive and negative predictive values were calculated.
Results
In 51 patients with ACTH-dependent CS, IPSS was performed in 31 patients whose mass was not found on MRI or whose mass size was < 6 mm. One patients whose IPSS failed due to anatomical variation and 5 patients whose pathological confirmation could not be made were excluded. The data of 22 patients with pituitary cushing syndrome and 3 patients with ectopic CS (total 25 patients) were examined. In 2 0f 3 patients, ectopic CS was diagnosed primarily with the results of 8 mg dexamethasone suppression test, CRH stimulation test and sella MRI, and postoperative immunohistochemical staining was confirmed. While the sensitivity, specificity, positive and negative predictive values of IPSS in the differential diagnosis of pituitary and ectopic ACTH-dependent CS were 75%, 100%, 100%, 14, 28% before CRH stimulation, they were 87.5%, 100%, 100%, and 25% after CRH stimulation, respectively. When the results were evaluated together before and after stimulation, these rates were found as 91, 6%, 100%, 100%, and 33, 3%, respectively. In 17 (77.27%) of 22 patients whose IPSS showed the pituitary, correct lateralization was confirmed by the operation.
Conclusion
IPSS is an effective test in the differential diagnosis of ACTH-dependent CS.Its sensitivity increases after CRH stimulation. However, while the efficacy of this procedure is high in the central/ectopic distinction, its capacity to lateralize the lesion is limited.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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