SO SÁNH KẾT QUẢ CỦA KỸ THUẬT LẤY MÁU TĨNH MẠCH XOANG ĐÁ DƯỚI VỚI HÌNH ẢNH CỘNG HƯỞNG TỪ TUYẾN YÊN TRONG CHẨN ĐOÁN BỆNH CUSHING

Abstract

Objective: To compare the results of bilateral inferior petrosal sinus sampling with pituitary MRI in diagnosing Cushing's disease. 

Subject and method: This cross-sectional descriptive study involved 15 patients (12 females, 3 males) diagnosed with ACTH-dependent Cushing's syndrome and those with Cushing's disease suspected of recurrence after surgical treatment. These patients underwent MRI of the pituitary gland and bilateral inferior petrosal sinus sampling under DSA from October 2022 to October 2023. 

Results: Male/female ratio = 1/4. The average 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. Bilateral inferior petrosal sinus sampling yielded positive results in 14 out of 15 patients and helped predict the location of the pituitary tumor in 12 of these patients. Among these 12, 7 patients had predicted tumor locations that matched the findings observed on MRI (4 on the right side, 3 on the left). Complications, such as headache and pain at the femoral artery puncture site, occurred in 3 out of 15 patients but were mild and transient. 

Conclusion: Bilateral inferior petrosal sinus sampling is a valuable technique for confirming central ACTH secretion and distinguishing Cushing's disease from ectopic ACTH syndrome. However, to predict the location of the pituitary tumor accurately, it is essential to closely coordinate with MRI findings. Although the procedure is invasive, when performed correctly, the risk of severe complications during and after the intervention is very low.