Reliability of cavernous sinus sampling in management of Cushing’s disease

Authors : Mahmut ÇAMLAR, Burak KINALI, Necmettin TANRIÖVER, Pınar KADIOĞLU, Seçil ERDEN, Civan ISLAK, Naci KOCER, Osman KIZILKILIC, Meryem ÖREN, Nurperi GAZİOĞLU

Pages : 100-106

Doi:10.18621/eurj.763928

View : 15 | Download : 5

Publication Date : 2021-01-04

Article Type : Research Paper

Abstract :Objectives: The purpose of this study is to find out the accuracy of bilateral cavernous sinus sampling insert ignore into journalissuearticles values(CSS); for preoperative tumor lateralization within the pituitary in Cushing’s disease insert ignore into journalissuearticles values(CD);. Methods: Sixty-five patients who had undergone transsphenoidal surgery insert ignore into journalissuearticles values(TSS); following CSS for CD between 2000-2016 at our institution were analyzed retrospectively. All patients underwent bilaterally CSS with corticotropin-releasing hormone insert ignore into journalissuearticles values(CRH); stimulation. Radiological, preoperative, and pathological findings with remission status were correlated with CSS data. The accuracy of CSS is decided according to compliance with the magnetic resonance imaging insert ignore into journalissuearticles values(MRI);, pathology or remission after surgery of the normal MRI cases. Results: CSS indicated the correct lateralization in 52 insert ignore into journalissuearticles values(80%); patients. There was the same level elevation of both sides in 3 patients who had central adenoma. Remission rate in the final follow-up was 83.87% for 65 patients. We found out the contralateral pathological side in 13 insert ignore into journalissuearticles values(20%); of the patients showing false lateralization. Twenty-four patients with normal MRI had a positive accuracy rate of 83%. Of those patients, with a positive accuracy of CSS sampling, 18 insert ignore into journalissuearticles values(90%); had a positive remission. As a result of the Kappa analysis, statistically significance and relation was found between the final diagnosis and lateralization test insert ignore into journalissuearticles values(κ=0,63 p < 0.001);. Conclusions: Our results showed that CSS is a safe and reliable method for microadenomas which has high diagnostic accuracy insert ignore into journalissuearticles values(80%); in indicating the correct lateralization in CD, providing us higher remission rates in a challenging pathology. 
Keywords : Cushings disease, pituitary tumor, Adrenocorticotropic hormone, Cavernous sinus sampling, Venous sampling