Diagnostic Value of Bilateral Petrosal Sinus Sampling in Children with Cushing's Disease: A Multi-Center Study.

Aim Although the sensitivity and specificity of bilateral inferior petrosal sinus sampling (BIPSS) were shown to be quite high in adult patients, studies in children are limited in number and have conflicting results since it is much less common in this population. Our study aims to assess the role of BIPSS in the detection and accuracy of lateralization of pituitary adenomas in patients with Cushing’s disease (CD) and its advantage over the other diagnostic methods. Methods This is a multicenter, nationwide, web-based study. The diagnostic value of BIPSS in 16 patients whose CD diagnosis was confirmed was evaluated retrospectively. The sensitivity and specificity of BIPSS and MRI were calculated, and Kruskal-Wallis and Mann Whitney U tests were performed to compare their diagnostic values. Results We found that standard tests, except for morning cortisol level, were effective in proving the presence of Cushing syndrome. While MRI findings were consistent with microadenoma in 8 cases(50%), CD presence and lateralization was successfully predicted in 14 of 16 patients with BIPSS. When compared MRI examination, a statistical significance was obtained both in pre-stimulation and post-stimulation results (p=0.047 and 0.041, respectively). BIPSS showed a significantly higher sensitivity of 92.8% than MRI in detecting the pituitary source of ACTH secretion. Conclusions Our study supports that BIPSS is a superior diagnostic work-up than MRI to confirm the diagnosis of CD. Moreover, in line with the previous studies, BIPSS was shown to provide better information about adenoma localization, which is vital for possible surgical intervention.