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Direct sampling of the cavernous sinus in Cushing's disease
R A Vandorpe1, A J Fox, D M Pelz
1Department of Diagnostic Radiology, Victoria General Hospital, Halifax, NS.
Summary
Direct cavernous sinus sampling offers a safe and effective alternative for diagnosing Cushing's disease. This technique accurately identifies the source of excess adrenocorticotropin, aiding in microadenoma localization.
Area of Science:
- Endocrinology
- Neurosurgery
- Medical Imaging
Background:
- Inferior petrosal sinus sampling is a standard diagnostic method for Cushing's disease.
- Previous methods using soft catheters have been associated with rare but severe complications, including brainstem injury.
Observation:
- A novel technique involving simultaneous, direct sampling of the cavernous sinuses was employed in five patients.
- A Tracker microcatheter was utilized for this minimally invasive procedure.
Findings:
- This direct cavernous sinus sampling method proved to be safe and accurate for diagnosing Cushing's disease in the observed cohort.
- No complications were reported in the five patients undergoing this procedure.
Implications:
- Direct cavernous sinus sampling represents a potentially safer alternative to inferior petrosal sinus sampling for Cushing's disease diagnosis.
- The technique's utility extends to the precise localization of adrenocorticotropin-producing pituitary microadenomas.