Endocrine Abstracts

Introduction: Cushing’s disease with negative hypothalamic–pituitary imaging is not a rare situation, since it is found in 1/3 of cases. This is a situation that complicates the etiological and therapeutic approach of the pathology, questioning the practitioner as to the effectiveness of pituitary surgery in this case.

Objective of the study: The aim of our study was to compare the results of pituitary surgery in the groups of patients with and without visualization of the adenoma on imaging and the contribution of petrous sinus catheterization in the latter.

Patients and methods: This is a retrospective study including 69 patients with Cushing’s disease, over a period from January 1999 to August 2022, admitted to the endocrinology department of EPH Bologhine. Patients with exogenous Cushing’s syndrome, ACTH-dependent Cushing’s syndrome of paraneoplastic origin, and pseudo-Cushing’s were excluded from the study. The statistical test used in this study is the T-student with P-value < 0.05 considered significant.

Results: Our series delivered 69 patients (55 women and 14 men) with Cushing’s disease. 13 patients had a normal hypothalamic–pituitary MRI, ie 18.84% of cases, and 7 of them had undergone petrous sinus catheterization (53.84%). In 85.71% of cases, i.e. in 6 patients, catheterization revealed a centro-peripheral gradient, with lateralization of secretion in 57.14% of our patients (75% on the right and 25% on the left). Transsphenoidal surgery was the preferred approach in 6 of these patients (46.15%) with clinical and biological remission of Cushing’s syndrome in 38% of cases in the group with normal hypothalamic–pituitary MRI, compared to 35.71% in patients with adenoma visualized on imaging (P-value=0.046). Patients who did not obtain surgery were either lost to follow-up (6 patients) or died (1 case)

Conclusion: The etiological diagnosis of ACTH-dependent hypercorticism is not always easy. It turns out that in a third of the cases, the imaging techniques, as advanced as they are, do not make it possible to highlight the microadenoma in question. This is where catheterization of the petrous sinuses should provide the topographical diagnosis of Cushing’s syndrome. In first intention, surgery via the transsphenoidal approach should be preferred. However, drug treatments remain important in the event of failure of surgery or while waiting for the appearance of a pituitary image.