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Related Concept Videos

Cushing Syndrome I: Introduction01:26

Cushing Syndrome I: Introduction

13
Cushing syndrome refers to the collection of clinical manifestations that arise when tissues are exposed to excessive amounts of cortisol or cortisol-like medications over an extended period. Cortisol, a glucocorticoid produced by the adrenal cortex, regulates metabolism, immune responses, and the body’s adaptation to stress. When its concentration remains chronically elevated, these physiological pathways become dysregulated, resulting in the characteristic features of the...
13
Cushing Syndrome II: Pathophysiology01:19

Cushing Syndrome II: Pathophysiology

1
Cortisol production is normally governed by the hypothalamic–pituitary–adrenal (HPA) axis, which maintains hormonal balance through tightly regulated feedback mechanisms. Disruption of this regulatory system is central to the development of Cushing syndrome, whether the excess cortisol originates from external medications or internal pathology. Persistent cortisol elevation alters metabolism, immune function, and endocrine signaling, producing the characteristic clinical features...
1

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Related Experiment Video

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A Novel Method: Super-selective Adrenal Venous Sampling
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Cavernous sinus sampling in patients with Cushing's disease.

Till Burkhardt1, Jörg Flitsch, Philine van Leyen

  • 1Pituitary Unit, Department of Neurosurgery.

Neurosurgical Focus
|February 3, 2015
PubMed
Summary

Cavernous sinus sampling (CSS) aids in locating adenomas for Cushing's disease patients when MRI is unclear. This invasive method accurately predicted adenoma lateralization in 82% of surgical cases, proving useful for difficult diagnoses.

Keywords:
ACTH = adrenocorticotropic hormoneCSS = cavernous sinus samplingCushing's diseaseMRIc/p = central/peripheralcavernous sinus samplinginferior petrosal sinus sampling

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Area of Science:

  • Neurosurgery
  • Endocrinology
  • Radiology

Background:

  • Accurate diagnosis and adenoma localization are crucial for successful Cushing's disease treatment.
  • Transsphenoidal pituitary exploration can be unsuccessful without precise localization.
  • Cavernous sinus sampling (CSS) is an alternative to inferior petrosal sinus sampling for adenoma lateralization.

Purpose of the Study:

  • To evaluate the efficacy of preoperative cavernous sinus sampling (CSS) in predicting adenoma lateralization in Cushing's disease patients.
  • To assess the diagnostic accuracy of CSS when endocrine tests are equivocal or MRI results are negative.
  • To report the authors' experience with CSS in a consecutive series of patients.

Main Methods:

  • Retrospective analysis of 67 patients with Cushing's disease who underwent CSS between 1999 and 2014.
  • CSS performed using the Teramoto technique for patients with unclear endocrine test results or negative MRI.
  • Comparison of CSS-predicted lateralization with surgical findings in 51 patients.

Main Results:

  • A central/peripheral gradient was identified in 59 patients, with lateralization determined in 51.
  • CSS accurately predicted adenoma lateralization in 42 out of 51 (82%) patients who underwent surgery.
  • No severe complications associated with CSS were reported.

Conclusions:

  • While MRI has advanced, CSS remains a valuable tool for diagnosing and lateralizing minute adenomas in Cushing's disease.
  • CSS can improve surgical outcomes by providing precise localization when other diagnostic methods are inconclusive.
  • The study demonstrates the utility and safety of CSS in managing complex Cushing's disease cases.