Value of pituitary gland MRI at 7 T in Cushing’s disease and relationship to inferior petrosal sinus sampling: Case report

Meng Law, Regina Wang, Chia Shang J. Liu, Mark S. Shiroishi, John D. Carmichael, William J. Mack, Martin Weiss, Danny J.J. Wang, Arthur W. Toga, Gabriel Zada

Research output: Contribution to journalArticleOtherpeer-review

4 Citations (Scopus)

Abstract

Cushing’s disease is caused by adrenocorticotrophic hormone (ACTH)–secreting pituitary adenomas, which are often difficult to identify on standard 1.5-T or 3-T MRI, including dynamic contrast imaging. Inferior petrosal and cavernous sinus sampling remains the gold standard for MRI-negative Cushing’s disease. The authors report on a 27-year-old woman with Cushing’s disease in whom the results of standard 1.5-T and 3-T MRI, including 1.5-T dynamic contrast imaging, were negative. Inferior petrosal sinus sampling showed a high central-to-peripheral ACTH ratio (148:1) as well as a right-to-left ACTH gradient (19:1), suggesting a right-sided pituitary microadenoma. The patient underwent 7-T MRI, which showed evidence of a right-sided pituitary lesion with focal hypoenhancement not visualized on 1.5-T or 3-T MRI. The patient underwent an endoscopic endonasal transsphenoidal operation, with resection of a right-sided pituitary mass. Postoperatively, she developed clinical symptoms suggestive of adrenal insufficiency and a nadir cortisol level of 1.6 μg/dl on postoperative day 3, and hydrocortisone therapy was initiated. Permanent histo-pathology specimens showed Crooke’s hyaline change and ACTH-positive cells suggestive of an adenoma. MRI at 7 T may be beneficial in identifying pituitary microadenoma location in cases of standard 1.5-T and 3-T MRI-negative Cushing’s disease. In the future, 7-T MRI may preempt inferior petrosal sinus sampling and help in cases of standard and dynamic contrast 1.5-T and 3-T MRI-negative Cushing’s disease.

Original languageEnglish
Pages (from-to)347-351
Number of pages5
JournalJournal of Neurosurgery
Volume130
Issue number2
DOIs
Publication statusPublished - 1 Feb 2019
Externally publishedYes

Keywords

  • 7-T MRI
  • Cushing’s disease
  • Pituitary surgery

Cite this

Law, M., Wang, R., Liu, C. S. J., Shiroishi, M. S., Carmichael, J. D., Mack, W. J., Weiss, M., Wang, D. J. J., Toga, A. W., & Zada, G. (2019). Value of pituitary gland MRI at 7 T in Cushing’s disease and relationship to inferior petrosal sinus sampling: Case report. Journal of Neurosurgery, 130(2), 347-351. https://doi.org/10.3171/2017.9.JNS171969