Effect of intercavernous sinus drainage pattern on exactness of bilateral inferior petrosal sinus sampling results in foretell the area of Cushing’s disease tumors

Abstract

Abstract Background Cushing’s disease(CD) is originatedfromimmoderatedischarge of adrenocorticotropic hormone (ACTH) from tumor cells, which leads to adrenal cortical hyperplasia and excessive glucocorticoid secretion, resulting in disordered metabolism of various substances, and hypercortisolism. The purpose of this research was to assess the effect of the intercavernous sinus drainage pattern on ability of bilateral inferior petrosal sinus sampling (BIPSS) to predict tumor location in patients with CD. Methods The clinical data of 50 patients with CD who experienced BIPSS in the Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University between August 2018 and April 2022 were retrospectively analyzed. Data included the patients’ basic preoperative clinical data, preoperative dynamic contrast-enhanced MRI of the pituitary gland, BIPSS results, grading of the intercavernous sinus drainage pattern, and intraoperative determination of tumor location. A chi-square test was performed to evaluate the correlates with the actual tumor lateralization during transsphenoidal surgery in both symmetric and asymmetric intercavernous sinus drainage patterns. In the asymmetric drainage pattern, a chi-square goodness-of-fit test was conducted for two classified variables: whether the mean nondominant side/peripheral ACTH ratio was greater than 1, and whether the tumor was located on the nondominant side. The mean nondominant side/peripheral ACTH ratio was defined as a. Results BIPSS results showed that the right side of the intercavernous sinus drainage pattern was much more likely to be the dominant side [21 cases (42.0%)] than the left side [11 cases (22.0%)]. In symmetric drainage patterns, BIPSS prediction of tumor lateralization waslargelyrelatedto intraoperative tumor location (p < 0.001). In asymmetric drainage patterns, tumor lateralization was related to a (p = 0.034). The tumor was located on the nondominant side when a was greater than 1 and on the dominant side when a was less than 1. Conclusion The intercavernous sinus drainage pattern influences the accuracy of BIPSS for prediction of tumor location in Cushing’s disease. The combination of intercavernous sinus drainage pattern and the comparison of nondominant IPSS with the peripheral ACTH gradient can be used for accurate prediction of tumor location CD.