Bilateral inferior petrosal sinus sampling in the diagnosis of ACTH-dependent Cushing's syndrome: experience in a tertiary hospital.

Objectives: Bilateral inferior petrosal sinus sampling (BIPSS) is a useful test for differential diagnosis of central vs. ectopic adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (CS). We provide a description of the protocol used in our Center and an analysis of its diagnostic accuracy. Methods: A retrospective study was conducted of 28 patients who underwent BIPSS combined with corticotropin-releasing hormone (CRH) stimulation. The procedure is performed in an interventional neuroradiology suite, involving a multidisciplinary team of neuroradiologists, endocrinologists and laboratory professionals. The two petrosal sinuses are catheterized and a peripheral blood sample is obtained simultaneously, at baseline and at 3, 6 and 10 min following stimulation. ACTH and prolactin are determined by immunochemiluminescence. Results: A total of 19 cases of Cushing's disease (CD) and 1 case of ectopic CS were confirmed. In all cases, BIPSS provided accurate diagnostic guidance, with a sensitivity and specificity of 100%. In 8 patients, remission was not achieved after surgery. In 84% of catheterizations, ACTH ratio peaked at 3-6 min following stimulation. Patients with histologically-confirmed CD exhibited higher sinus ACTH ratios and values. Prolactin ratio helped us identify and exclude 28.6% of the samples with inconsistent results. Conclusions: In our series, BIPSS combined with CRH stimulation demonstrated to be a safe, effective procedure. Prolactin emerges as a useful marker of correct catheterization. The participation of a multidisciplinary team is essential.

Posterior fossa tumors in children with neurofibromatosis type 1 (NF1).

BACKGROUND: Tumours of the posterior fossa associated with neurofibromatosis type 1 (NF1) are very infrequent. Series studying this association are seldom reported. PERSONAL EXPERIENCE: In a series of 600 NF1 patients studied during 39 years (1965-2004) only five (0.83%) had posterior fossa tumours. They were studied clinically, radiologically by computerized tomography (CT) or magnetic resonance (MR) and histologically. Four of them had astrocytomas but only in one case was the tumour primarily cerebellar while the tumour was primarily of the brain stem with invasion of the adjacent regions of one or both cerebellar hemispheres in three patients. The fifth tumour was a medulloblastoma that had a survival of 3 years following treatment. The patient with primary cerebellar astrocytoma is apparently cured 7 years after the removal of the tumour. The patients with the brain stem tumours extending to the cerebellum, showed a chronic slowly progressive cerebellar disease, but remain alive at age of more than 20 years (one was lost to follow-up). DISCUSSION AND CONCLUSION: The aim of this study was to present five children (one male and four females) less than 16 years of age when they were initially seen in our service, who had NF1 associates with posterior fossa tumours. This location is very uncommon in patients with NF1, in contrast with those located in other regions, such as pathway optic tumours and brain stem tumours. Most of these tumours are histologically benign (low grade astrocytomas). Only one patient in this series had a medulloblastoma, an exceptionally rare tumour seldom reported in patients with NF1.

Fractura vertebral aguda y técnicas de refuerzo vertebral / Acute vertebral fracture and vertebral reinforcement techniques

La alta incidencia de las fracturas por fragilidad y especialmente de las fracturas vertebrales (FV) en mujeres con osteoporosis posmenopáusica obliga a abordar este tema una y otra vez. En este manuscrito se actualizan los datos epidemiológicos que indican la magnitud del problema y se revisan alternativas de tratamiento farmacológico, tanto para disminuir el dolor producido por la FV como para prevenir la presentación de nuevas fracturas osteoporóticas de cualquier tipo, indicando los agentes antirresortivos y osteoformadores disponibles actualmente. En los casos de FV por compresión, en las que el tratamiento farmacológico habitual no produce mejoría del dolor y siempre que no existan contraindicaciones, puede ser muy apropiado realizar vertebroplastia o cifoplastia (AU)

The high incidence of fractures by fragility and, especially of the vertebral fractures in osteoporotic postmenopausal women, forces us to approach this subject once more. In this manuscript epidemiological data that indicates the magnitude of the problem will be updated. Treatment alternatives to decrease back pain produced by vertebral fracture are will be reviewed, and the prevention of the occurrence of new osteoporotic fractures of any type, through the administration of suitable antiresorptive and bone-forming pharmacological agents to increase bone mineral density will also be addressed. In some patients with painful vertebral compression fractures it is possible obtain an analgesic effect by percutaneous vertebroplasty or by kiphoplasty using polymethylmetacrilate cement or calcium- phosphate cement, injected into vertebral bodies (AU)

[Acute vertebral fracture and vertebral reinforcement techniques]. / Fractura vertebral aguda y técnicas de refuerzo vertebral.

The high incidence of fractures by fragility and, especially of the vertebral fractures in osteoporotic postmenopausal women, forces us to approach this subject once more. In this manuscript epidemiological data that indicates the magnitude of the problem will be updated. Treatment alternatives to decrease back pain produced by vertebral fracture are will be reviewed, and the prevention of the occurrence of new osteoporotic fractures of any type, through the administration of suitable antiresorptive and bone-forming pharmacological agents to increase bone mineral density will also be addressed. In some patients with painful vertebral compression fractures it is possible obtain an analgesic effect by percutaneous vertebroplasty or by kiphoplasty using polymethylmetacrilate cement or calcium- phosphate cement, injected into vertebral bodies.