BILATERAL SIMULTANEOUS CAVERNOUS SINUS SAMPLING USING CORTICOTROPIN-RELEASING HORMONE IN THE EVALUATION OF CUSHING DISEASE

PURPOSE: To determine whether bilateral, simultaneous, cavernous sinus sampling after corticotropin-releasing hormone (CRH) stimulation offe rs as accurate detection and lateralization of Gushing disease as infe rior petrosal sinus sampling does, METHODS: Seventeen consecutive pati ents with hypercortisolism and with high-dose dexamethasone suppressio n test results suggesting Gushing disease underwent bilateral cavernou s sinus sampling with GRH stimulation, The diagnosis of Gushing diseas e was established in all patients by histologic examination or, if no tumor was found at surgery, by subtotal resection of the gland or radi ation therapy resulting in eventual hypocortisolism or normal adrenal function and clinical remission. RESULTS: The sensitivity of cavernous sinus sampling with and without GRH in detecting Gushing disease was 94% and 71%, respectively. The abnormal side of the pituitary was corr ectly identified in all patients who had criteria for lateralization, yielding a positive predictive value of 100%. CONCLUSIONS: This small series suggests that cavernous sinus sampling with GRH is as accurate as inferior petrosal sinus sampling in detecting Gushing disease and p erhaps more accurate in lateralizing the abnormality within the pituit ary gland.