ĐẶC ĐIỂM LÂM SÀNG, XÉT NGHIỆM VÀ HÌNH ẢNH CỘNG HƯỞNG TỪ TUYẾN YÊN TRÊN BỆNH NHÂN MẮC HỘI CHỨNG CUSHING PHỤ THUỘC ACTH

Abstract

Objective: To investigate pituitary images on MRI in patients with ACTH-dependent Cushing's syndrome. Subject and method: Cross-sectional descriptive study of 15 patients (12 women, 3 men) diagnosed with ACTH-dependent Cushing's syndrome and underwent magnetic resonance imaging of the pituitary gland from October 2022 to October 2023. Results: Male/female ratio = 1/4. The verage age is 38.47 ± 10.78 (the age range from 27 to 62). All patients had plasma ACTH levels >10pg/ml which is consistent with the clinical diagnosis of ACTH-dependent Cushing's syndrome. Patients with pituitary adenomas observed on MRI account for 80%. The average tumor size is 4.59 ± 1.77mm, 100% of tumors are microadenoma at grade I, stage 0 according to the Hardy-Wilson classification. The group of tumors with isointense signals are highest on both T1W and T2W pulse sequences, at 83.34% and 58.33%, respectively. On the kinetic injection pulse sequence, all tumors appeared as poorly enhancing nodules. Conclusion: Pituitary magnetic resonance imaging is a good method in diagnosing and evaluating the invasion's level and stage of pituitary adenomas in patients with ACTH-dependent Cushing's syndrome. Assessing tumor morphology combined with kinetic injection pulse sequence is valuable in defining diagnosis, especially in cases which tumors are difficult to see on basic pulse sequences. However, there are several pituitary adenomas that are not observed on MRI, even when incorporating a dynamic drug injection pulse sequence. In these cases, invasive and specialized techniques such as bilateral inferior petrosal sinus sampling (BIPSS) should be considered to quantify ACTH level.