scholarly journals Pituitary magnetic resonance imaging vs. bilateral inferior petrosal sinus sampling: comparison between non-invasive and invasive diagnostic techniques for Cushing’s disease—a narrative review

Gland Surgery ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 2260-2268
Author(s):  
Fabio Tortora ◽  
Alberto Negro ◽  
Francesco Briganti ◽  
Maria Laura Del Basso De Caro ◽  
Luigi Maria Cavallo ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cushing’S Disease ◽  
Diagnostic Techniques ◽  
Narrative Review ◽  
Cushing's Disease ◽  
Inferior Petrosal Sinus ◽  
Resonance Imaging ◽  
Inferior Petrosal Sinus Sampling ◽  
Non Invasive

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.

Cushing's Disease in Children and Adolescents: 20 Years of Experience in a Single Neurosurgical Center

Neurosurgery ◽  
2005 ◽  
Vol 57 (2) ◽  
pp. 281-285 ◽  
Author(s):  
Shabin M. Joshi ◽  
Richard Jonathan David Hewitt ◽  
Helen L. Storr ◽  
Kia Rezajooi ◽  
Habib Ellamushi ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Postoperative Complications ◽  
Children And Adolescents ◽  
Cushing’S Disease ◽  
Transsphenoidal Surgery ◽  
Cushing's Disease ◽  
Surgical Removal ◽  
Resonance Imaging

ABSTRACT OBJECTIVE: This is a retrospective analysis of 25 consecutive pediatric patients with Cushing's disease who underwent transsphenoidal surgery performed by a single neurosurgeon in a specialist center during a 20-year period. This article discusses the presentation of Cushing's disease, the endocrinological investigation with particular reference to bilateral inferior petrosal sinus sampling (BIPSS), the operative management with reference to specific pediatric difficulties of the transsphenoidal approach and the use of intraoperative image guidance, and the analysis of these cases as regards postoperative complications and outcomes of this rare condition in young patients. METHODS: All patients underwent detailed endocrine investigation and imaging in the form of computed tomography and/or magnetic resonance imaging. BIPSS was performed in 19 patients (76%), with successful lateralization of the side of the microadenoma in 14 (74%) and prediction of a central tumor in four (94% total prediction rate). Surgical removal was via the sublabial, paraseptal, transsphenoidal route. RESULTS: There were 15 male and 10 female patients, with a mean age of 13.4 years (range, 6.6–17.8 yr). Weight gain was the most common presentation (100%), and then growth impairment (96%), fatigue and skin changes (64%), and hypertension (32%). Postoperative complications included growth hormone deficiency (36%), transient diabetes insipidus (12%), panhypopituitarism (4%), and transient cerebrospinal fluid rhinorrhea (4%). The median follow-up period was 59.5 months (range, 6–126 mo). Overall, 15 patients (60%) achieved surgical cure or remission, of which 14 outcomes were obtained using the results of BIPSS. Ten patients (40%) required postoperative radiotherapy to achieve “remission.” There were no cases of meningitis, no neurological deficits, no reoperations, and no mortality. CONCLUSION: Cushing's disease in children and adolescents is a rare illness. The accurate preoperative localization of the adenoma is essential for achieving good results. In this series, BIPSS was far more accurate in localizing the adenoma than computed tomography or magnetic resonance imaging. Imaging, however, is useful for the exclusion of other intracranial problems. Transsphenoidal surgery was safe and efficacious in achieving cure in the majority of cases. The challenge of transsphenoidal surgery in this age group is the small pituitary fossa and the absence of sphenoid sinus aeration in some cases. We found the use of intraoperative neuronavigation to be an excellent aid in overcoming such anatomic difficulties.

scholarly journals Outcomes of three-Tesla magnetic resonance imaging for the identification of pituitary adenoma in patients with Cushing’s disease

2019 ◽  
Vol 66 (3) ◽  
pp. 259-264 ◽  
Author(s):  
Noriaki Fukuhara ◽  
Naoko Inoshita ◽  
Mitsuo Yamaguchi-Okada ◽  
Keita Tatsushima ◽  
Akira Takeshita ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Pituitary Adenoma ◽  
Magnetic Resonance ◽  
Cushing’S Disease ◽  
Cushing's Disease ◽  
Resonance Imaging ◽  
Three Tesla

Silent necrosis of a pituitary corticotroph adenoma revealed by timely magnetic resonance imaging: a cause of spontaneous remission of Cushing's disease

1994 ◽  
Vol 130 (5) ◽  
pp. 469-471 ◽  
Author(s):  
Elisabeth Le Nestour ◽  
Jean-Paul Abécassis ◽  
Xavier Bertagna ◽  
André Bonnin ◽  
Jean-Pierre Luton
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cushing’S Disease ◽  
Sella Turcica ◽  
Spontaneous Remission ◽  
Empty Sella ◽  
Cushing's Disease ◽  
Resonance Imaging ◽  
Corticotroph Adenoma ◽  
Limited Mass

Le Nestour E, Abécassis J-P, Bertagna X, Bonnin A, Luton J-P. Silent necrosis of a pituitary corticotroph adenoma revealed by timely magnetic resonance imaging: a cause of spontaneous remission of Cushing's disease. Eur J Endocrinol 1994;130:469–71. ISSN 0804–4643 Spontaneous necrosis of a corticotroph adenoma is rare and is a very unlikely way of curing Cushing's disease. We report hereafter a case where magnetic resonance imaging of the pituitary provided clear evidence of the event. Successive and timely pituitary magnetic resonance imaging in this patient showed first a typical microadenoma as a well-limited mass with a low signal intensity before the necrosis, then a bright signal before gadolinium injection in the T1-weighted image at the time of the event and, finally, the aspect of an empty sella turcica with a small arachnoidocele 1 year later. The necrosis of a corticotroph adenoma is more frequent in macro- than in microadenomas, and is usually heralded by headache and visual disturbances. In this case, pituitary necrosis was entirely asymptomatic, and cured the patient as well as the surgeon's knife would have. Nevertheless, this exceptional occurrence does not rule out the possibility of a recurrence. X Bartagna, Clinique des Maladies Endocriniennes et Métaboliques, Hôpital Cochin, 27 rue due Faubourg Saint Jacques, 75014 Paris, France

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