Bilateral and Simultaneous Inferior Petrosal Sinus Sampling in the Early Diagnosis of an ACTH-Producing Pituitary Microadenoma and Its Detection by Magnetic Resonance One Year Later

1992 ◽  
Vol 37 (1-2) ◽  
pp. 64-67 ◽  
Author(s):  
Bartolomeo Merola ◽  
Annamaria Colao ◽  
Riccardo Rossi ◽  
Renato Spaziante ◽  
Alfredo Manco ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Early Diagnosis ◽  
Inferior Petrosal Sinus ◽  
Inferior Petrosal Sinus Sampling ◽  
Pituitary Microadenoma ◽  
One Year

scholarly journals Value of pituitary gland MRI at 7 T in Cushing’s disease and relationship to inferior petrosal sinus sampling: case report

2019 ◽  
Vol 130 (2) ◽  
pp. 347-351 ◽  
Author(s):  
Meng Law ◽  
Regina Wang ◽  
Chia-Shang J. Liu ◽  
Mark S. Shiroishi ◽  
John D. Carmichael ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Clinical Symptoms ◽  
Cushing's Disease ◽  
Inferior Petrosal Sinus ◽  
Contrast Imaging ◽  
Pituitary Mass ◽  
Endoscopic Endonasal ◽  
Inferior Petrosal Sinus Sampling ◽  
Pituitary Microadenoma ◽  
Pituitary Lesion

Cushing’s disease is caused by adrenocorticotrophic hormone (ACTH)–secreting pituitary adenomas, which are often difficult to identify on standard 1.5-T or 3-T MRI, including dynamic contrast imaging. Inferior petrosal and cavernous sinus sampling remains the gold standard for MRI-negative Cushing’s disease.The authors report on a 27-year-old woman with Cushing’s disease in whom the results of standard 1.5-T and 3-T MRI, including 1.5-T dynamic contrast imaging, were negative. Inferior petrosal sinus sampling showed a high central-to-peripheral ACTH ratio (148:1) as well as a right-to-left ACTH gradient (19:1), suggesting a right-sided pituitary microadenoma. The patient underwent 7-T MRI, which showed evidence of a right-sided pituitary lesion with focal hypoenhancement not visualized on 1.5-T or 3-T MRI. The patient underwent an endoscopic endonasal transsphenoidal operation, with resection of a right-sided pituitary mass. Postoperatively, she developed clinical symptoms suggestive of adrenal insufficiency and a nadir cortisol level of 1.6 μg/dl on postoperative day 3, and hydrocortisone therapy was initiated. Permanent histopathology specimens showed Crooke’s hyaline change and ACTH-positive cells suggestive of an adenoma.MRI at 7 T may be beneficial in identifying pituitary microadenoma location in cases of standard 1.5-T and 3-T MRI-negative Cushing’s disease. In the future, 7-T MRI may preempt inferior petrosal sinus sampling and help in cases of standard and dynamic contrast 1.5-T and 3-T MRI-negative Cushing’s disease.

Surgical Treatment of Recurrent Cushing's Disease

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1108-1118 ◽  
Author(s):  
Bernd M. Hofmann ◽  
Michal Hlavac ◽  
Jürgen Kreutzer ◽  
Gerd Grabenbauer ◽  
Rudolf Fahlbusch
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Adjuvant Therapy ◽  
Cushing’S Disease ◽  
Cushing's Disease ◽  
Magnetic Resonance Imaging Scan ◽  
Inferior Petrosal Sinus ◽  
Resonance Imaging ◽  
Inferior Petrosal Sinus Sampling ◽  
Resonance Imaging Scan

Abstract OBJECTIVE: The aim of this study was to evaluate the role of transsphenoidal selective adenomectomy alone or in combination with adjuvant therapy in treatment of recurrent Cushing's disease. METHODS: A total of 16 patients with recurrent Cushing's disease underwent reoperation, 15 via a transsphenoidal approach and one via a combined transsphenoidal/transcranial approach. Selective adenomectomies were performed in 13 patients and hemihypophysectomies were performed in three patients. Endocrinologically, recurrence was diagnosed by an overnight 2-mg dexamethasone suppression test. All patients underwent a 1.5-T magnetic resonance imaging scan, and eight patients underwent inferior petrosal sinus sampling. RESULTS: After selective adenomectomy, six of the 13 patients went into remission. Recurrence always occurred at the localization of the original tumor. In three patients without intraoperative tumor detection, hypophysectomy did not lead to remission. In 10 patients with persistent disease, adjuvant therapy (radiotherapy, adrenalectomy) led to normalization of basal cortisol levels in eight patients and clinical remission in one patient. One patient was lost to follow-up. In 10 patients, no evidence of an adenoma was visible on the preoperative magnetic resonance imaging scan. Inferior petrosal sinus sampling allowed correct prediction of the tumor localization in two of eight patients. CONCLUSION: By performing repeated selective adenomectomy, patients with recurrent Cushing's disease can be cured without the risk of endocrine deficits or major complications. Dynamic endocrine tests are of paramount importance for surgical decision making. Imaging and inferior petrosal sinus sampling are not helpful in locating the recurrent tumor. If normalization can not be achieved, adjuvant therapy is mandatory.

scholarly journals Incidentally detected sellar spine in a patient with Cushing’s syndrome: a case report

2020 ◽  
Vol 48 (7) ◽  
pp. 030006052094015
Author(s):  
Hyo-jae Lee ◽  
Yun Young Lee ◽  
Byung Hyun Baek ◽  
Woong Yoon ◽  
Seul Kee Kim
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Inferior Petrosal Sinus ◽  
Resonance Imaging ◽  
Operative Field ◽  
Anatomical Variant ◽  
Inferior Petrosal Sinus Sampling ◽  
Pituitary Microadenoma ◽  
Bony Spur ◽  
Exploratory Surgery

Sellar spine, a bony spur extending anteriorly from the dorsum sellae, is a very rare anatomical variant. Several hypotheses regarding its etiology have been proposed, including the strongly supported theory of a cephalic ossified notochordal remnant. Sellar spine is usually detected incidentally in patients who have no definite symptoms, but several cases have reportedly accompanied endocrinopathies such as precocious puberty, hypopituitarism, or galactorrhea/oligomenorrhea. However, no published reports have described sellar spine in a patient with Cushing’s syndrome. We herein report a case of sellar spine detected during the evaluation of Cushing’s disease in a 29-year-old woman who underwent inferior petrosal sinus sampling, computed tomography, magnetic resonance imaging, and exploratory surgery. There was no evidence of a pituitary microadenoma, but a sellar spine was present in the operative field. Thus, the sellar spine might have caused Cushing’s syndrome in this case, although the exact mechanism is unknown.

Successful Treatment of Congenital Shoulder Luxation in a Dog by Closed Pinning

1994 ◽  
Vol 07 (04) ◽  
pp. 170-172 ◽  
Author(s):  
R. A. Read
Keyword(s):  
Early Diagnosis ◽  
Successful Treatment ◽  
Humeral Head ◽  
One Year

Congenital shoulder luxation in the dog is commonly associated with deformity of the humeral head and glenoid, making reduction and stabilization difficult. Early diagnosis of congenital luxation of the shoulder in a Papillon made it possible to successfully reduce and stabilize the luxation using a closed pinning technique. One year later the joint was functionally and radiographically normal.

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