[en] Multihormonal bilateral petrosal sinus sampling (BPSS) has been proposed to improve corticotroph microadenomas prediction of lateralisation. Few series have simultaneously compared data of pituitary MRI, surgical findings and multihormonal BPSS. Seven patients (6F/1M) with Cushing's disease, mean age at diagnosis of 35 years (range 24-55) were prospectively studied to compare radiological and multihormonal BPSS data with surgical and pathological findings. In untreated patients, simultaneous measures of ACTH, TSH and prolactine (PRL) were done at time 0, 7, 15, 22 minutes after CRH (500 mg) and TRH (200 mg) stimulation. An intersinus gradient of 1.4 was considered as a lateralisation.
All microadenomas were identified during surgery, diameters ranged from 2 to 7 mm. All patients were in long-term surgical remission. Pathological studies confirmed a tumoral tissue with ACTH immunostaining in 6/7 cases and PRL in 3/7 cases. Pituitary MRI correctly identified tumors in 4 cases, the remaining tumors were not seen. Basal and stimulated intersinus gradients of ACTH, TSH and PRL were homolateral in 6/7 cases and were coincident with surgical findings in 4/7 cases. The other three cases were contralateral to MRI and surgical data.
In conclusion, simultaneous gradient of ACTH, PRL and TSH did not improve lateralisation prediction in this series. Hormonal hypersecretion was homolateral in six cases whereas pathological studies demonstrated a mixed secretion in only three cases. A preferential pituitary draining could explain these discordances. Data from our series and from others (done with CRH stimulation and ACTH-PRL measures) strongly suggest a paracrine interaction between tumoral and normal pituitary tissue. [fr] Le cathétérisme sélectif des sinus pétreux avec dosages multihormonaux a été proposé pour améliorer la prédiction de la localisation des microadénomes corticotropes. Les apports prédictifs de la résonance magnétique hypophysaire, les données peropératoires et anatomopathologiques ont été rarement confrontées ensemble à ceux du cathétérisme multihormonal. Sept patients (6F/1M) présentant une maladie de Cushing, âge moyen : 35 ans (rang 24-55) ont été étudiés prospectivement afin de comparer les données radiologiques et du cathétérisme multihormonal avec celles des résultats peropé ratoires et anatomopathologiques. En absence d'anticortisoliques, les dosages simultanés de l'hormone adénocorticotrope (ACTH), thyrotropine (TSH), et prolactine (PRL) sont réalisés aux temps 0, 7, 15, 22 minutes après stimulation par CRF (500 mg) et de TRH (200 mg). Un gradient d'ACTH intersinus supérieur à 1,4 rend compte de la latéralisation.
Dans tous les cas, les microadénomes ont été identifiés par le chirurgien avec des diamètres compris entre 2 et 7 mm. Tous les patients ont eu une rémission après chirurgie. L'anatomopathologie confirme un tissu adénomateux immunomarquant ACTH dans 6/7 cas et PRL dans 3/7 cas. La RMN identifie 4 cas correctement, les autres ne sont pas détectés. Le cathétérisme prédit l'hypersécretion adénomateuse d'ACTH dans tous les cas. Les gradients intersinus basaux et stimulés de ACTH, TSH et PRL sont homolatéraux dans 6/7 cas et coïncident avec l'observation chirurgicale dans 4/7 cas, les 3 autres cas sont controlatéraux aux données de la RMN et celles du chirurgien.
En conclusion, les gradients simultanés de ACTH, PRL et TSH n'améliorent pas la localisation adénomateuse. L'hypersécrétion hormonale est homolatérale dans 6 cas, alors que par immunochimie une sécrétion mixte n'est retrouvée que dans 3 cas. Un drainage préférentiel de l'hypophyse pourrait rendre compte de ces sécrétions concordantes. Nos données ainsi que d'autres séries (réalisées seulement avec CRH, ACTH et PRL) soulèvent la possibilité également d'une interaction paracrine tumeur-hypophyse.
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