Inferior petrosal sinus sampling in Cushing’s syndrome: usefulness and pitfalls

Adrenocorticotropin hormone (ACTH)-dependent Cushing's syndrome is most often due to a pituitary corticotroph adenoma, with ectopic ACTH-secreting tumors representing approximately 15% of cases. Biochemical and radiological techniques have been established to help distinguish between these two entities, and thus aid in the localization of the neoplastic lesion for surgical resection. The test that offers the highest sensitivity and specificity is bilateral inferior petrosal sinus sampling (BIPSS). BIPSS is an interventional radiology procedure in which ACTH levels obtained from venous drainage very near the pituitary gland are compared to peripheral blood levels before and after corticotropin hormone (CRH) stimulation. A gradient between these two locations indicates pituitary Cushing's, whereas the absence of a gradient suggests ectopic Cushing's. Accurate BIPSS results require hypercortisolemia to suppress normal corticotroph ACTH production and hypercortisolemia at the time of the BIPSS to assure excessive ACTH secretion. In some cases, intrapituitary gradients from side-to-side can be helpful to localize small corticotroph adenomas within the sella. BIPSS has rare complications and is considered safe when performed at centers with experience in this specialized technique.

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Dexmedetomidine for Conscious Sedation in Bilateral Inferior Petrosal Sinus Sampling

Research & Innovation in Anesthesia ◽

10.5005/jp-journals-10049-0015 ◽

2016 ◽

Vol 1 (2) ◽

pp. 61-62

Author(s):

Neeraj Barnwal ◽

Raylene Dias ◽

Rahul Mamde

Keyword(s):

General Anesthesia ◽

Cushing’S Syndrome ◽

Conscious Sedation ◽

Cushing's Syndrome ◽

Inferior Petrosal Sinus ◽

The Novel ◽

Rare Presentation ◽

Inferior Petrosal Sinus Sampling ◽

Ectopic Adrenocorticotropic Hormone ◽

Acth Secreting

ABSTRACT Cushing's syndrome in an acromegalic patient is a very rare presentation. To differentiate a Cushing's disease from Cushing's syndrome due to ectopic adrenocorticotropic hormone (ACTH) secreting tumors, inferior petrosal sinus sampling (IPSS) is required. Acromegaly patients have associated airway abnormalities posing a challenge to administration of anesthesia. Traditionally, most IPSS was done under general anesthesia. But now it is being recognized that general anesthesia for this procedure has its own implications and hence conscious sedation is being used for this purpose. We describe our experience with the novel agent dexmedetomidine for conscious sedation in this procedure. How to cite this article Barnwal N, Dias R, Mamde R. Dexmedetomidine for Conscious Sedation in Bilateral Inferior Petrosal Sinus Sampling. Res Inno in Anesth 2016;1(2):61-62.

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Usefulness of prolactin measurement in inferior petrosal sinus sampling with desmopressin for Cushing’s syndrome

British Journal of Neurosurgery ◽

10.1080/02688697.2020.1736263 ◽

2020 ◽

Vol 34 (3) ◽

pp. 253-257

Author(s):

Hamideh Akbari ◽

Mohammad Ghorbani ◽

Maryam Kabootari ◽

Ali Zare Mehrjardi ◽

Mohammad Reza Mohajeri Tehrani ◽

...

Keyword(s):

Cushing’S Syndrome ◽

Cushing's Syndrome ◽

Inferior Petrosal Sinus ◽

Inferior Petrosal Sinus Sampling

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Cyclic Cushing's disease with misleading inferior petrosal sinus sampling results during a trough phase

Neurosurgical FOCUS ◽

10.3171/2014.12.focus14780 ◽

2015 ◽

Vol 38 (2) ◽

pp. E7 ◽

Cited By ~ 9

Author(s):

Vivien Bonert ◽

Namrata Bose ◽

John D. Carmichael

Keyword(s):

Cushing’S Syndrome ◽

Cushing’S Disease ◽

Adrenocorticotropic Hormone ◽

Diagnostic Testing ◽

Cushing's Syndrome ◽

Cushing's Disease ◽

Inferior Petrosal Sinus ◽

Inferior Petrosal Sinus Sampling ◽

Acth Secreting ◽

Transsphenoidal Resection

Diagnosing Cushing's syndrome is challenging and is further hampered when investigations are performed in a patient with cyclic Cushing's syndrome. A subset of patients with Cushing's syndrome exhibit periods of abnormal cortisol secretion with interspersed normal secretion. Patients can have periods of clinical improvement during these quiescent phases or remain symptomatic. Initial diagnostic testing can be challenging because of the unpredictable durations of the peak and trough phases, and it is especially challenging when the diagnosis of cyclic Cushing's syndrome has not yet been determined. Here, the authors present the case of a patient with Cushing's disease with a pathology-proven adrenocorticotropic hormone (ACTH)–secreting pituitary adenoma and whose initial inferior petrosal sinus sampling (IPSS) results were deemed indeterminate; further studies elucidated the diagnosis of cyclic Cushing's syndrome. Repeat IPSS was diagnostic of a central source for ACTH secretion, and the patient was treated successfully with transsphenoidal resection. Literature concerning the diagnosis and management of cyclic Cushing's syndrome is also reviewed.

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The role of inferior petrosal sinus sampling in ACTH-dependent Cushing's syndrome: review and joint opinion statement by members of the Italian Society for Endocrinology, Italian Society for Neurosurgery, and Italian Society for Neuroradiology

Neurosurgical FOCUS ◽

10.3171/2014.11.focus14766 ◽

2015 ◽

Vol 38 (2) ◽

pp. E5 ◽

Cited By ~ 31

Author(s):

Francesca Pecori Giraldi ◽

Luigi Maria Cavallo ◽

Fabio Tortora ◽

Rosario Pivonello ◽

Annamaria Colao ◽

...

Keyword(s):

Cushing’S Syndrome ◽

Adrenocorticotropic Hormone ◽

Dynamic Testing ◽

Cushing's Syndrome ◽

Italian Society ◽

The Other ◽

Inferior Petrosal Sinus ◽

Etiological Diagnosis ◽

Inferior Petrosal Sinus Sampling

In the management of adrenocorticotropic hormone (ACTH)–dependent Cushing's syndrome, inferior petrosal sinus sampling (IPSS) provides information for the endocrinologist, the neurosurgeon, and the neuroradiologist. To the endocrinologist who performs the etiological diagnosis, results of IPSS confirm or exclude the diagnosis of Cushing's disease with 80%–100% sensitivity and over 95% specificity. Baseline central-peripheral gradients have suboptimal accuracy, and stimulation with corticotropin-releasing hormone (CRH), possibly desmopressin, has to be performed. The rationale for the use of IPSS in this context depends on other diagnostic means, taking availability of CRH and reliability of dynamic testing and pituitary imaging into account. As regards the other specialists, the neuroradiologist may collate results of IPSS with findings at imaging, while IPSS may prove useful to the neurosurgeon to chart a surgical course. The present review illustrates the current standpoint of these 3 specialists on the role of IPSS.

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