Efficiency of inferior petrosal sinus sampling in the diagnosis of Cushing’s disease and comparison with magnetic resonance imaging

INTRODUCTION: The purpose of this study is to assess the efficiency of inferior petrosal sinus sampling (IPSS) in the diagnosis of adrenocorticotropic hormone-dependent Cushing’s disease and to compare it with magnetic resonance imaging (MRI).
METHODS: The diagnostic efficiency of IPSS in the differentiation of pituitary Cushing’s disease from ectopic Cushing’s disease was retrospectively evaluated in 37 patients who had IPSS in our clinic. Six patients were excluded from the study due to missing data. Hypophysis MRI examinations of 31 patients before IPSS were also evaluated. The contributions of MRI and IPSS to the detection of pituitary adenoma and the determination of lateralization were researched.
RESULTS: Bilateral IPSS was successfully performed in 30 patients of the 31 patients in the study group. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of IPSS in differentiating between central and ectopic Cushing’s syndrome before corticotrophin-releasing hormone (CRH) stimulation were 93.3%, 100%, 100%, 33.3%, and 93%, respectively, whereas after CRH stimulation were 100%, 100%, 100%, 100%, and 100%, respectively. The accuracy of both the rates was significantly higher compared with MRI.
DISCUSSION AND CONCLUSION: IPSS has the highest diagnostic efficiency in differentiating central Cushing’s disease from ectopic Cushing’s disease.

Ýnferior Petrosal Sinüs Örneklemesinin Cushing Hastalýðýnýn Taný ve Tedavisine Katkýsý ve MRG ile karþýlaþtýrýlmasý

GÝRÝÞ ve AMAÇ: Bu çalýþmada Ýnferior petrosal sinüs örneklemesinin ACTH baðýmlý Cushing hastalýðýnýn tanýsýnda diagnostik etkinliðinin deðerlendirilmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Hastanemiz etik kurulu onayý ile retrospektif olarak giriþimsel radyoloji ünitemizde 2005-2015 yýllarý arasýnda ÝPSÖ yapýlan 37 hastada hipofizer Cushing hastalýðýný ektopik Cushing hastalýðýndan ayýrt etmede ÝPSÖ nin diagnostik etkinliði hasta dosyalarý ve hastane datasý incelenerek araþtýrýldý. Opere olan hastalarýn operasyon notlarý ve patoloji sonuçlarýna ulaþýldý. 6 hastadatalarýna ulaþýlamadýðý için çalýþmadan çýkarýldý. 31 hastanýn ÝPSÖ öncesi hipofiz MR incelemeleri de ayrýca araþtýrýldý. MRG ve ÝPSÖ nin pituiter adenomlarýn tespiti ve lateralizasyonunun belirlenmesindeki katkýlarý karþýlaþtýrýldý.
BULGULAR: Bir hasta hariç tüm hastalarda bilateral ÝPSÖ baþarýlý þekilde yapýldý (Baþarý oraný: %96) Kortikotropin salýným hormonu (CRH) uyarýmý öncesi merkezi ve ektopik Cushing sendromu arasýndaki farkýn belirlenmesinde IPSS'nin duyarlýlýðý, özgüllüðü, pozitif prediktif deðeri, negatif prediktif deðeri ve doðruluðu sýrasýyla % 93.3,% 100,% 100,% 33.3 ve% 93; CRH uyarýmý sonrasý sýrasýyla % 100,% 100,% 100,% 100 ve% 100 idi. Her iki oranýn doðruluðu, MRG'ye kýyasla anlamlý derecede yüksekti.
TARTIÞMA ve SONUÇ: ÝPSÖ santral Cushing hastalýðýný ektopik Cushing hastalýðýndan ayýrt etmede yüksek diagnostik etkinliðe sahiptir