The significance of lateralization gradients as predictors of corticotropinoma localization

SUMMARY: Pituitary MRI with contrast enhancement is a standard method of neuroimaging, but, unfortunately, it can be uninformative in 30–50 % of cases when clarifying not only the presence, but also the localization of corticotropinoma. Inferior petrosal sinus sampling is the method of choice in the differential diagnosis of Cushing’s disease, and in addition, it can be used for the purpose of lateralization of pituitary adenoma. However, the lateralization sensitivity according to the latest data ranges from 54 % to 100 %, and these data may well serve as a starting point in choosing the side of intervention by a neurosurgeon, especially in cases where corticotropinoma is not visualized by MRI.

PURPOSE OF THE STUDY: to evaluate the diagnostic accuracy of lateralization gradients.

MATERIALS AND METHODS: cohort single–center retro/prospective study of 53 patients with Cushing’s disease. In order to assess the localization of corticotropinoma, a number of indicators were calculated (lateralization and prolactinadjusted ACTH intersinus gradient). Catheterization results were evaluated in comparison with contrast-enhanced pituitary MRI data and intraoperative data.

RESULTS: the study of the lateralization and prolactin-adjusted ACTH intersinus gradient showed their low diagnostic accuracy. The correct lateralization of corticotropinoma in our study when assessing gradients did not exceed 56.9 %, which in essence does not differ from random guessing. At the same time, an MRI of the pituitary with contrast enhancement allowed to correctly establish localization in 77.4 % of cases.

CONCLUSIONS: lateralization cannot be used as independent predictors of tumor node localization and choice of intervention side.

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