Bilateral inferior petrosal sinus sampling reliably differentiates pituitary from ectopic Cushing's, but frequently fails to predict pituitary tumour location, especially when lateralizing to the right

2015 ◽  
Author(s):  
Olympia Koulouri ◽  
Nishita Nigam ◽  
Andrew Powlson ◽  
Neil Donnelly ◽  
Richard Mannion ◽  
...  
Keyword(s):  
Pituitary Tumour ◽  
Inferior Petrosal Sinus ◽  
Inferior Petrosal Sinus Sampling ◽  
Tumour Location ◽  
The Right

scholarly journals Central ghrelin production does not substantially contribute to systemic ghrelin concentrations: a study in two subjects with active acromegaly

2002 ◽  
pp. 195-199 ◽  
Author(s):  
FM van der Toorn ◽  
JA Janssen ◽  
WW de Herder ◽  
F Broglio ◽  
E Ghigo ◽  
...  
Keyword(s):  
Significant Rise ◽  
Inferior Petrosal Sinus ◽  
Normal Range ◽  
Systemic Blood ◽  
Blood Samples ◽  
Inferior Petrosal Sinus Sampling ◽  
Petrosal Vein ◽  
Obese Subjects ◽  
Active Acromegaly ◽  
The Right

INTRODUCTION: In an animal model of acromegaly (PEPCK-hGH transgenic mice), low systemic levels of ghrelin have been observed compared with normal mice. We hypothesized that systemic circulating ghrelin levels are also decreased in humans with active acromegaly and that the contribution of central ghrelin production to systemic ghrelin levels is minimal. OBJECTIVES: The aim of the present study was to investigate, in two subjects with active acromegaly, whether there are differences between systemic ghrelin levels and ghrelin concentrations in the petrosal sinus. DESIGN: We measured systemic and central ghrelin levels in these two acromegalic patients by bilateral simultaneous inferior petrosal sinus sampling. Central and systemic blood samples were drawn before and 1, 5, 10, 15 and 20 min after stimulation with GH-releasing hormone (GHRH). Ghrelin was measured with a commercially available radioimmunoassay. RESULTS: In one acromegalic subject, the baseline systemic and central ghrelin levels were within the same range as in two non-acromegalic obese subjects. No gradient could be observed between central and systemic ghrelin concentrations. Stimulation with GHRH did not change the ghrelin concentrations in this patient. In the other acromegalic subject, the systemic ghrelin levels were also in the same range as in two non-acromegalic obese subjects. However, in this subject, baseline ghrelin concentrations in the right inferior petrosal vein were considerably lower than the systemic ghrelin concentrations, indicating a peripheral over central gradient. Administration of GHRH induced a significant rise in central ghrelin concentrations in the right inferior petrosal vein. Ghrelin levels in the left inferior petrosal vein and systemic ghrelin levels were in the normal range and GHRH stimulation did not change these concentrations. CONCLUSIONS: The absence of a central over peripheral ghrelin gradient in these two acromegalics indicated that circulating ghrelin is mainly produced peripherally. Circulating systemic ghrelin levels were not decreased in these two subjects with active acromegaly.

Combined cavernous and inferior petrosal sinus sampling in the differential diagnostic of ACTH-dependent Cushing's syndrome

2018 ◽  
Author(s):  
Natalia Gussaova ◽  
Uliana Tsoy ◽  
Alexander Savello ◽  
Natalia Plotnikova ◽  
Vladislav Cherebillo ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Inferior Petrosal Sinus ◽  
Inferior Petrosal Sinus Sampling

Inferior petrosal sinus sampling – 16 years of experience from a single tertiary center in Israel

2020 ◽  
Author(s):  
Matan Fischer ◽  
Avivit Cahn ◽  
Benjamin Glaser ◽  
Gil Leibowitz ◽  
Joshua Stokar ◽  
...  
Keyword(s):  
Inferior Petrosal Sinus ◽  
Years Of Experience ◽  
Inferior Petrosal Sinus Sampling ◽  
Tertiary Center

Bilateral inferior petrosal sinus sampling in a cohort of patients with acth dependent cushing´s syndrome in a tertiary hospital

2020 ◽  
Author(s):  
García Moreno Rosa María ◽  
Parro Isabel Moreno ◽  
Sánchez David Ortiz ◽  
Remedios Frutos ◽  
Rioja Rubén Gómez ◽  
...  
Keyword(s):  
Tertiary Hospital ◽  
Inferior Petrosal Sinus ◽  
Inferior Petrosal Sinus Sampling

scholarly journals The role of bilateral inferior petrosal sinus sampling in the diagnosis of Cushing's syndrome

2007 ◽  
Vol 51 (8) ◽  
pp. 1329-1338 ◽  
Author(s):  
Andrea Utz ◽  
Beverly M.K. Biller
Keyword(s):  
Cushing’S Syndrome ◽  
Venous Drainage ◽  
Cushing's Syndrome ◽  
Blood Levels ◽  
Inferior Petrosal Sinus ◽  
Ectopic Acth ◽  
Inferior Petrosal Sinus Sampling ◽  
Neoplastic Lesion ◽  
Before And After ◽  
Acth Secreting

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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