[Role of perioperative biological tests during the performance and follow-up of corticotroph adenoma exeresis].
ACTH assay in cavernous sinus samples during resection of pituitary adrenocorticotroph adenomas is a simple and safe technique providing an intraoperative assessment of adrenocorticotroph hormone gradients. Bilateral puncture of the cavernous sinus can be achieved vial the standard transsphenoidal approach to the sella turcica. ACTH is determined with IRMA at 37;C with an incubation time of less than one hour. Among 71 cases in our experience, the ACTH gradient accurately predicted the position of the adenoma in 93% of the cases. This rate is higher than the 61% accuracy reported for inferior petrosal sinus sampling. The technique reported is more precise than MRI which correctly identifies adenomas in only 50% of the cases. The remaining cases are either false positives or false negatives. We report an 82% cure rate either via direct resection of the microadenoma or via partial hypophysectomy guided by the ACTH gradient. In our series, 20 cases of Cushing's disease had a normal MRI and no surgically identifiable adenoma. In 10 of these cases however, cure was achieved by performing ACTH gradient guided partial hypophysectomy. This method produces no morbidity and is most helpful for the neurosurgeon allowing confirmation of the position of an MRI-visible adenoma or an adenoma identified intraoperatively. It does not however replace neurosurgical experience which remains the most important predictive factor for outcome in surgical treatment of Cushing's disease.
Passagia
J G
JG
Service de Neurochirurgie, CHU de Grenoble, BP 217, 38043 Grenoble Cedex, France. JGPassagia@chu-grenoble.fr
Gay
E
E
Chabre
O
O
Martinie
M
M
Labat-Moleur
F
F
Bachelot
I
I
D000236:Adenoma / Q000150:complications / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D000324:Adrenocorticotropic Hormone / Q000097:blood* / Q000378:metabolism; D003480:Cushing Syndrome / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007016:Hypophysectomy / Q000379:methods; D007430:Intraoperative Care / Q000379:methods*; D008279:Magnetic Resonance Imaging; D017591:Petrosal Sinus Sampling; D010911:Pituitary Neoplasms / Q000150:complications / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D011863:Radioimmunoassay; D012189:Retrospective Studies; D016896:Treatment Outcome
D000324:Adrenocorticotropic Hormone
Place des examens biologiques peropératoires dans la réalisation et le contrôle de l'exérèse des adénomes corticotropes.