Table 2.
Details of pituitary imaging, BSIPSS, pituitary histology, definitive treatment and outcome
| Pt no. | BSIPSS | MRI/CT | Adenoma position at TSS | Pituitary histology | 09.00 h Cortisol nmol/L post-TSS (day) | Definitive treatment | Interval (yrs) to post-RT remission | Time of recovery of pituitary-adrenal axis (yr) post-TSS or RT | Time of recurrence (yrs) post- definitive treatment | Long-term outcome |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | ML | R | R | N | 719 (7) | TSSa + TSS + BA | – | – | No | Nelson’s syndrome (0.6 years post BA) |
| 2 | – | ML | N (biopsy) | N | 269 (10) | TSS + RT | 0.9 | 1.2 | No | Remission |
| 3 | – | ML | R | Adenoma | 630 (4) | TSS + RT | 0.3 | 1.1 | No | Remission |
| 4 | L | N | R | N | 600 (5) | TSS + RT | 0.1 | 0.4 | Yes (7.6) | Abnormal cortisol circadian rhythm—no treatment |
| 5 | ML | L | L | N | 612 (6) | TSS + RT | 0.4 | 0.6 | No | Remission |
| 6 | L | N | L | N | 382 (8) | TSS + RT | 2.2 | – | No | BA for ACTH-independent cortisol secretion (3.9 years post-RT)—remission |
| 7 | L | ML/R | ML | N | 43 (5) | TSS | – | – | Yes (2.0) | TSS—no remission, RT—remission (1.4 years post RT) |
| 8 | R | N | R | Adenoma | <50 (4) | TSS | – | No recovery | No | Remission |
| 9 | L | R | L | Adenoma | <50 (3) | TSS | – | 12.0 | No | Remission |
| 10 | R | N | R | Adenoma | <50 (6) | TSS | – | – | No | Remission |
| 11 | R | N | R | N | <50 (5) | TSS | – | Yes | No | Remission |
| 12 | L | R | L | N | <50 (5) | TSSa + TSS | – | 1.8 | No | Remission |
| 13 | ML | L | ML/R | N | <50 (6) | TSS | – | 0.7 | No | Remission |
| 14 | R | N | R | Adenoma | <50 (2) | TSS | – | 2.3 | No | Remission |
| 15 | L | ML | ML | Adenoma | <50 (2) | TSS | – | – | Yes (6.0) | RT—no remission, metyrapone—no remission, pasireotide-remission (3.0 years post RT) |
| 16 | Lb | N | L | Adenoma | 36 (8) | TSS | – | 1.7 | No | Remission |
| 17 | Rb | N | R | Adenoma | 22 (5) | TSS | – | – | No | Remission |
| 18 | R | N | R | Adenoma | 44 (5) | TSS | – | 2.1 | No | Remission |
| 19 | ML | N | ML | Adenoma | <50 (7) | TSS | – | 4.0 | No | Remission |
| 20 | R | N | R | Adenoma | 20 (4) | TSS | – | 1.45 | No | Remission |
| 21 | ML | N | Diffuse adenoma | Adenoma | 21 (5) | TSS | – | No recovery | No | Remission |
BSIPSS bilateral simultaneous inferior petrosal sinus sampling, IPS/P interpetrosal sinus ACTH gradient (≥1.4 suggests lateralisation) (2), L left-sided lateralisation/adenoma position, R right-sided lateralisation/adenoma position (bperformed under general anesthesia); ML no lateralisation/midline position, N normal, TSS transsphenoidal surgery (aperformed at another centre), RT external beam pituitary radiotherapy, BA bilateral adrenalectomy