gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Localization of pituitary adenomas in patients with Cushing disease (CD) with negative or inconclusive MRI findings using cavernous sinus sampling (CSS)

Meeting Abstract

  • H. Kränzlein - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
  • P. van Leyen - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
  • T. Ries - Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Hamburg
  • J. Flitsch - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
  • D. Lüdecke - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.06.10

doi: 10.3205/11dgnc143, urn:nbn:de:0183-11dgnc1435

Published: April 28, 2011

© 2011 Kränzlein et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Cushing disease (CD) shows a non-suppressed plasma ACTH in hypercortisolism, sufficient suppression of cortisol in dexamethasone tests and stimulation of ACTH or cortisol in the CRH test. If ACTH-secreting adenomas are not seen in high standard MRI (recently 3-Tesla), cavernous sinus sampling (CSS) has been used as an additional diagnostic tool. Ten years of experience in transnasal microsurgery of CD allow us to validate the usefulness of CSS.

Methods: 66 patients (9 children) underwent CSS between 1/1999 and 2010 because of inconclusive endocrine testing, recurrent disease, and/or negative MRI findings according to the method of A.Teramoto et al. (1993).

Results: Due to anatomical reasons the catheterization of the cavernous sinus failed in 2 patients (3%), actual hypercortisolism was not confirmed in 6 patients (9%). In 7 patients CSS excluded pituitary dependent Cushing disease with confirmed hypercortisolism. Therefore, these patients did not undergo pituitary exploration. So far, 2 ectopic ACTH-secreting tumors have been histologically confirmed in these patients. In the remaining 50 patients with a central-peripheral gradient, 41 CSS procedures lateralized the ACTH-adenoma of the pituitary correctly (82%), as proven by surgery. Despite a central-peripheral gradient there was no lateralization gradient in 6 cases. Of these, four patients had either a midline tumor/stalk tumor or a tumor extension into both sides of the pituitary. Therefore, the correct gradient was found in a total 90%. There was no procedure-related severe morbidity.

Conclusions: In cases with unclear endocrine tests and for localizing minute ACTH-secreting adenomas in the pituitary, CSS prior to transsphenoidal surgery is a very useful tool. Ideally, a discussion between the endocrinologist and the pituitary surgeon is advisable in cases with complex findings before invasive techniques are performed.