Cateterismo de senos petrosos en el diagnóstico etiológico de síndrome de Cushing: Primera experiencia en Uruguay

Mariana Pintado; Paula Montiglia; Marcelo Langleib; Fernanda Sánchez; Flavia Varela; Ramiro Lima; Margarita Vaz; María Mercedes Piñeyro

doi:10.29193/RMU.37.2.10

Authors

Mariana Pintado Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Clínica de Endocrinología y Metabolismo
Paula Montiglia Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Clínica de Endocrinología y Metabolismo
Marcelo Langleib Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Departamento Clínico de Imagenología
Fernanda Sánchez Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Departamento de Laboratorio Clínico
Flavia Varela Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Departamento de Laboratorio Clínico
Ramiro Lima Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Neurocirugía
Margarita Vaz Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Clínica de Endocrinología y Metabolismo
María Mercedes Piñeyro Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Clínica de Endocrinología y Metabolismo

DOI:

https://doi.org/10.29193/RMU.37.2.10

Keywords:

CUSHING SYNDROME, PETROSAL SINUS SAMPLING, DESMOPRESSIN, CATHETERIZATION

Abstract

Identifying the cause of adrenocorticotropin (ACTH)-dependent Cushing’s syndrome is key to define the appropriate treatment. Hypersecretion of the adrenocorticotropic hormone (ACTH) is mainly caused by a pituitary tumor (Cushing’s syndrome) or, in 10% to 20% of cases, by tumors with ectopic production of this hormone. Differentiation between these two etiologies may not be easy due to the low sensitivity and specificity of non- invasive tests. Bilateral sampling of the lower petrosal sinus is the gold standard to differentiate between a pituitary and an ectopic origin, showing the pituitary ACHT hypersecretion and recording the central-to-peripheral ACTH gradient in the tumor’s drainage.
Despite it being highly recommended for all cases of ACTH-dependent Cushing’s syndrome, it is reserved for patients with a diagnosis of hypercortisolism and negative or misleading findings in the MRI of the sellar region. The study presents the first case of petrosal sinus sampling for diagnostic purposes in Uruguay, in a 55-year-old woman with ACHT-dependent hypercortisolism showing an adenohypophysis image < 6 mm. The petrosal-peripheral gradient confirmed the diagnosis of Cushing’s syndrome and no complications arose during the procedure. Afterwards a transsphenoidal surgery was performed for resection of the adenoma. Evolution was good and immunochemistry confirmed the tumor’s etiology.

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