Utility of bilateral inferior petrosal sinus sampling for diagnosis and lateralization of Cushing’s disease in the pediatric population: case series and review of the literature

2021 ◽  
Author(s):  
K. M. Kang ◽  
K. Muralidharan ◽  
H. Knowlton ◽  
K. I. A. Hassan ◽  
A. Yekula ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Pediatric Population ◽  
Case Series ◽  
Cushing's Disease ◽  
Inferior Petrosal Sinus ◽  
Review Of The Literature ◽  
Inferior Petrosal Sinus Sampling

scholarly journals The Effects of Sampling Lateralization on Bilateral Inferior Petrosal Sinus Sampling for Pediatric Cushing’s Disease—A Single Endocrinology Centre Experience and Review of the Literature

2021 ◽  
Vol 12 ◽  
Author(s):  
Elzbieta Moszczyńska ◽  
Elzbieta Marczak ◽  
Mieczysław Szalecki ◽  
Krzysztof Kądziołka ◽  
Marcin Roszkowski ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Cushing’S Disease ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Standard Test ◽  
Cushing's Disease ◽  
Inferior Petrosal Sinus ◽  
Inferior Petrosal Sinus Sampling ◽  
Gold Standard Test ◽  
Almost All

BackgroundThis study aims to analyze the diagnostic accuracy of bilateral inferior petrosal sinus sampling (BIPSS), the gold standard test for the differential diagnosis of ACTH-dependent Cushing’s syndrome (CS) in a group of pediatric patients with Cushing’s disease (CD).MethodsThis is a retrospective analysis which include 12 patients with hypercortisolemia and inconclusive pituitary MRI, who underwent bilateral inferior petrosal sinus sampling (BIPSS) and transsphenoidal surgery (TSS) from 2004 to 2020 in the Children’s Memorial Health Institute (CMHI) Warsaw, Poland. Pituitary origin of ACTH secretion was considered if baseline central to peripheral (C/P) ACTH level ratio was ≥ 2 or C/P ratio was ≥ 3 after human corticotropin-releasing hormone (hCRH) stimulation. The diagnosis was histologically confirmed in almost all cases after TSS.ResultsThe diagnostic accuracy of BIPSS reached 75% at baseline and 83.3% after CRH stimulation. The compatibility of localization of a microadenoma by BIPSS with the surgical location was 66.7%.ConclusionsOwing to its high diagnostic effectiveness, BIPSS remains the best test to differentiate CD from EAS. The indications for the procedure should be carefully considered, because EAS in the pediatric population, unlike in adults, is extremely rare. Moreover BIPSS has only limited value for indicating tumor localization.

scholarly journals Lateralization of inferior petrosal sinus sampling in Cushing's disease correlates with cavernous sinus venous drainage patterns, but not tumor lateralization

Heliyon ◽  
2020 ◽  
Vol 6 (10) ◽  
pp. e05299
Author(s):  
Mohammad Ghorbani ◽  
Hamideh Akbari ◽  
Christoph J. Griessenauer ◽  
Christoph Wipplinger ◽  
Alireza Dastmalchi ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Cushing’S Disease ◽  
Venous Drainage ◽  
Cushing's Disease ◽  
Inferior Petrosal Sinus ◽  
Inferior Petrosal Sinus Sampling ◽  
Drainage Patterns

Multiple pituitary hormone gradients from inferior petrosal sinus sampling in Cushing's disease

1988 ◽  
Vol 119 (1) ◽  
pp. 75-80 ◽  
Author(s):  
Patricia A. Crock ◽  
Richard G. Pestell ◽  
Anthony J. Calenti ◽  
Eric J. Gilford ◽  
J. Keith Henderson ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Anterior Pituitary ◽  
Close Association ◽  
Pituitary Hormones ◽  
Cushing's Disease ◽  
Pituitary Hormone ◽  
Inferior Petrosal Sinus ◽  
The Novel ◽  
Inferior Petrosal Sinus Sampling ◽  
Left And Right

Abstract. Pre-operative bilateral simultaneous inferior petrosal sinus sampling with assessment of ACTH levels in the left and right sinuses and the periphery was performed in 9 patients with pituitary dependent Cushing's disease who were subsequently found at surgery to have basophil microadenomata. The novel observation of this study was the pattern of secretion of other pituitary hormones so that significant inter-sinus gradients ≥ 1.4:1 were seen for β-endorphin (2.8 ± 1.3, mean ± sem), PRL (4.2 ± 1.3) and GH (6.9 ± 2.4) as well as for ACTH (5.1 ± 1.1). There was no inter-sinus gradient for LH, FSH and TSH. In these 9 patients with adenomata, the correlations between the inter-sinus gradients for ACTH and β-endorphin were r = 0.95 (P <0.01), ACTH and PRL r = 0.90 (P < 0.01) and for ACTH and GH r = 0.89 (P <0.05). This close association between the gradients for ACTH and other anterior pituitary hormones could be due either to cosecretion of β-endorphin, PRL and GH by the ACTH-producing pituitary adenomata or to a paracrine effect of β-endorphin from the tumours on adjacent pituitary tissue. By reflecting the central pituitary hormone milieu, petrosal sinus sampling can give information about pituitary function unobtainable from peripheral hormone levels.

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

2015 ◽  
Vol 38 (2) ◽  
pp. E7 ◽  
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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