Bilateral Inferior Petrosal Sinus Sampling Without Lateralization Is Less Accurate for the Diagnosis of Cushing Disease

Shi Chen; Xiaohong Lyu; Weixin Hong; Dingyue Zhang; Yuelun Zhang; Daiyu Yang; Yijing Xu; Zhen Shen; Hui Pan; Huijuan Zhu; Xiaobo Zhang; Lin Lu

doi:10.1210/jendso/bvae056

Bilateral Inferior Petrosal Sinus Sampling Without Lateralization Is Less Accurate for the Diagnosis of Cushing Disease

J Endocr Soc. 2024 Mar 20;8(5):bvae056. doi: 10.1210/jendso/bvae056. eCollection 2024 Mar 12.

Authors

Shi Chen¹, Xiaohong Lyu^{1

2}, Weixin Hong^{3

4}, Dingyue Zhang¹, Yuelun Zhang⁵, Daiyu Yang¹, Yijing Xu¹, Zhen Shen^{3

4}, Hui Pan¹, Huijuan Zhu¹, Xiaobo Zhang⁶, Lin Lu¹

Affiliations

¹ Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
² Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
³ State Key Laboratory of Multimodal Artificial Intelligence Systems, Beijing Engineering Research Center of Intelligent Systems and Technology, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China.
⁴ School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing 100049, China.
⁵ Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
⁶ Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.

Abstract

Context: During bilateral inferior petrosal sinus sampling (BIPSS), the side-to-side adrenocorticotropic hormone (ACTH) ratio, referred to as sampling lateralization, was used to predict pituitary adenoma localization.

Objective: To investigate the potential different diagnostic accuracy of BIPSS for differentiating Cushing disease (CD) and ectopic ACTH secretory syndrome (EAS) patients with low lateralization (inferior petrosal sinus [IPS]:IPS ≤ 1.4) and high lateralization (IPS:IPS > 1.4).

Methods: This single-center retrospective study (2011-2021) included (all patients had BIPSS results and confirmed pathologic diagnoses) 220 consecutive CD patients (validation set), 30 EAS patients, and 40 of the CD patients who had digital subtraction angiography (DSA) videos (discovery set).

Results: In the discovery set, the low-lateralization CD group (n = 11) had a higher median plasma ACTH concentration (62.2, IQR 44.7-181.0 ng/L) than the high-lateralization CD group (n = 29) (33.0, IQR 18.5-59.5, P = .013). Lower IPS to peripheral ratios were observed in the low-lateralization group during BIPSS, both before and after stimulation (P = .013 and P = .028). The sensitivity of BIPSS before stimulation in differentiating CD from EAS was lower in the low-lateralization group than the high-lateralization group (54.6% vs 93.1%, P = .003), as validated in the validation set. DSA videos revealed higher vascular area difference visible in the 2 sides of the pituitary in low lateralization (median 1.2 × 10⁵ pixels, IQR 0.5-1.8) than the high-lateralization group (0.4 × 10⁵ pixels, IQR 0.1-0.7, P = .008). The vascular area ratio of the 2 sides was also significantly higher in low (1.55, IQR 1.31-2.20) than high lateralization (1.19, IQR 1.07-1.35, P = .010).

Conclusion: Our study suggested that low lateralization in CD patients may reduce the diagnostic sensitivity of BIPSS, which might be potentially associated with peripituitary vascular anatomy.

Keywords: Cushing disease; digital subtraction angiography; ectopic ACTH syndrome; inferior petrosal sinus sampling; pituitary.

Published by Oxford University Press on behalf of the Endocrine Society 2024.