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Context <p>Bilateral 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&#xa0;mm detected on MRI.</p> Purpose <p>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&#xa0;mm).</p> Methods <p>This single-centre retrospective study (2011–2019) included 25 EAS and 179 CD (microadenoma ≤ 6&#xa0;mm) patients whose diagnoses were confirmed by pathology. All CD patients received two to ten years of follow-up.</p> Results <p>According 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; <i>P</i> &lt; 0.001). CD patients were divided into a low-lateralization group (lateralization ratio ≤ 1.4) and a high-lateralization group (&gt; 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 (<i>n</i> = 40), which was lower than the sensitivity of 93.5% (95% CI 88.2%-96.6%) for the high-lateralization group (<i>n</i> = 139) (<i>P</i> &lt; 0.001).</p> Conclusion <p>Lower 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.</p> Clinical trial number <p>Not applicable.</p>

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Revamped perspective on conventional interpretation: the foreboding prognostic significance of low-lateralization in inferior petrosal sinus sampling for diagnosis of Cushing’s disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月27日

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  • Xiaohong Lyu,
  • Jiaxuan Liu,
  • Dingyue Zhang,
  • Xiaobo Zhang,
  • Huijuan Zhu,
  • Shi Chen,
  • Lin Lu,
  • Hui Pan

摘要

Context

Bilateral 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).

Methods

This 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.

Results

According 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).

Conclusion

Lower 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.