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. 2020 Oct 22;6(10):e05299.
doi: 10.1016/j.heliyon.2020.e05299. eCollection 2020 Oct.

Lateralization of inferior petrosal sinus sampling in Cushing's disease correlates with cavernous sinus venous drainage patterns, but not tumor lateralization

Mohammad Ghorbani  1 , Hamideh Akbari  2   3 , Christoph J Griessenauer  4   5 , Christoph Wipplinger  6 , Alireza Dastmalchi  1 , Mojtaba Malek  3 , Iraj Heydari  3 , Reza Mollahoseini  1 , Mohammad E Khamseh  3
Affiliations

Lateralization of inferior petrosal sinus sampling in Cushing's disease correlates with cavernous sinus venous drainage patterns, but not tumor lateralization

Mohammad Ghorbani et al. Heliyon. .

Abstract

Background: Inferior petrosal sinus sampling (IPSS) is known as the gold standard to distinguish whether excessive adrenocorticotropin hormone (ACTH) production origins from the pituitary gland or an ectopic source. However, due to a number of factors, the value of IPSS for adenoma lateralization may be limited. Aim of this study was to evaluate the influence of parasellar venous drainage (VD) patterns on IPSS findings in predicting lateralization of pituitary microadenomas.

Methods: We retrospectively reviewed records of confirmed cases of Cushing's disease which were evaluated by IPSS prior to endoscopic tansnasal trans-sphenoidal surgery (ETSS) to assess the ability of IPSS to predict adenoma laterality.

Results: Seventeen patients with pathologically confirmed Cushing's disease were retrospectively reviewed. The median age of the included patients was 37 years. Laterality of parasellar VD perfectly associated with lateralization as measured by IPSS. Symmetrical VD was associated with symmetrical ACTH gradient on IPSS. However, lateralization measured by IPSS did not show any significant correlation with lateralization detected during ETSS.

Conclusion: Our study suggests that IPSS lateralization results strongly depend on parasellar VD pattern but show no significant correlation with the adenoma lateralization found during ETSS. Thus, IPSS does not appear to be an appropriate modality to predict adenoma lateralization.

Keywords: Anatomy; Clinical research; Cushing's disease; Endocrine system; Endocrinology; Inferior petrosal sinus sampling; Lateralization of microadenoma; Medical imaging; Neurology; Parasellar venous drainage.

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Figures

Figure 1
Figure 1
Superselective venography of bilateral inferior petrosal sinuses (IPS). (a & b) Left-sided dominance of venous drainage pattern is evident when right-sided injected contrast passes thorough the midline and fills the contralateral cavernous sinus (CS) and IPS while left-sided injection fills only the left side due to the direction of venous flow. (c & d) Right-sided dominance with a reverse pattern of parasellar venous drainage toward right CS and IPS. (e & f) Bilateral superselective venography shows symmetric pattern of parasellar venous drainage passing through the midline with bilateral injections.
Figure 2
Figure 2
Illustration of correlation between parasellar venous drainage pattern, site of microadenoma in MRI, and during endoscopic transsphenoidal surgery. (a & b) Superselective venography of bilateral IPS shows left dominance of parasellar venous drainage pattern that is compatible with an IPSS gradient higher on the left side. (c) Dynamic pituitary MRI shows a microadenoma on the right side of pituitary gland (curved arrow). (d & e) Endoscopic transsphenoidal view of the same patient during surgery shows herniation of the microadenoma at the right side of sella after dural incision that is compatible with the MRI finding and opposite to IPSS gradient.
See this image and copyright information in PMC

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