ArticleBMC endocrine disorders2025
Revamped perspective on conventional interpretation: the foreboding prognostic significance of low-lateralization in inferior petrosal sinus sampling for diagnosis of Cushing's disease.
Article in BMC endocrine disorders, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
contextBilateral inferior petrosal sinus sampling (BIPSS) is widely used to differentially diagnose ectopic ACTH syndrome (EAS) and Cushing's disease (CD) with pituitary lesions less than 6 mm detected on MRI. PURPOSE: This study aimed to investigate the diagnostic accuracy of BIPSS and prognosis of low-lateralization [lateralization ratio of bilateral inferior petrosal sampling (IPS) ≤ 1.4] CD with microadenoma (≤ 6 mm).
methodsThis single-centre retrospective study (2011-2019) included 25 EAS and 179 CD (microadenoma ≤ 6 mm) patients whose diagnoses were confirmed by pathology. All CD patients received two to ten years of follow-up.
resultsAccording to the multivariable regression results, a false-negative diagnosis at baseline might be associated with a lateralization ratio ≤ 1.4 (adjusted OR = 12.69, 95% CI 4.14-38.86; P < 0.001). CD patients were divided into a low-lateralization group (lateralization ratio ≤ 1.4) and a high-lateralization group (> 1.4). An inferior petrosal sinus-to-peripheral ACTH ratio (IPS: P-ACTH) ≥ 2.0 had a sensitivity of 55.0% (95% CI 39.8%-69.3%) for the low-lateralization group (n = 40), which was lower than the sensitivity of 93.5% (95% CI 88.2%-96.6%) for the high-lateralization group (n = 139) (P < 0.001).
conclusionLower diagnostic accuracy and poorer surgical outcomes were found for the low-lateralization group, with a lesser likelihood of remission and more impaired pituitary function after pituitary surgery. CLINICAL TRIAL NUMBER: Not applicable.
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