Effectiveness of bilataral inferior petrosal sinus sampling in diagnosis of ACTH dependent cushing syndrome

2021 ◽  
Author(s):  
Selvinaz Erol ◽  
Ozturk Feyza Yener ◽  
sen esra cil ◽  
Canat M.Masum ◽  
Cakir Sezin Dogan ◽  
...  
Keyword(s):  
Cushing Syndrome ◽  
Inferior Petrosal Sinus ◽  
Inferior Petrosal Sinus Sampling

To determine the efficacy of bilateral inferior petrosal sinus sampling in differentiating Cushing disease from ectopic Cushing syndrome

2020 ◽  
pp. 1-11
Author(s):  
Muhammad Azeemuddin ◽  
Tanveer Ul Haq ◽  
Shahmeer Khan ◽  
Raza Sayani ◽  
Ayesha Shoukat Hussain ◽  
...  
Keyword(s):  
Cushing Syndrome ◽  
Case Series ◽  
Invasive Procedure ◽  
University Hospital ◽  
Inferior Petrosal Sinus ◽  
Cushing Disease ◽  
Post Contrast ◽  
Inferior Petrosal Sinus Sampling ◽  
Positive Results

Abstract Management of endogenous Cushing syndrome is based on its aetiology. Increased Adrenocorticotropic Hormone (ACTH) levels are the most common cause of this disorder and, therefore, it is critical to determine the source of ACTH before further management. Dynamic post contrast MRI is currently the most common investigation implied to diagnose pituitary adenoma; however, it comes with the drawback of low specificity and high false positive results. Inferior petrosal sinus sampling (IPSS) is an established invasive procedure performed to differentiate central versus peripheral source of ACTH which, in turn, results in hypercortesolaemia. This is a series of 14 patients who underwent IPSS at the Department of Radiology, Aga Khan University Hospital, Karachi, from January 2006 to December 2018. The case series emphasises the role of IPSS in the management of ACTH-dependent Cushing syndrome and combined efficacy of Dynamic post-contrast MRI and the procedure under focus. Continuous....

scholarly journals Differential Diagnostic Value of Bilateral Inferior Petrosal Sinus Sampling (BIPSS) in ACTH-Dependent Cushing Syndrome: a Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Hao Wang ◽  
Ying Ba ◽  
Qian Xing ◽  
Run-Ce Cai
Keyword(s):  
Differential Diagnosis ◽  
Likelihood Ratio ◽  
Cushing Syndrome ◽  
Meta Analysis ◽  
Diagnostic Value ◽  
Cochrane Library ◽  
Published Data ◽  
Inferior Petrosal Sinus ◽  
Inferior Petrosal Sinus Sampling ◽  
Sensitivity Specificity

Abstract Background: Previous studies have shown inconsistent results in the differential diagnosis obtained from bilateral inferior petrosal sinus sampling (BIPSS) in adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome. This meta-analysis evaluated the diagnostic value of BIPSS via the published literature. Methods: This study searched PubMed, Embase, Web of Science, the Cochrane library, and the Wanfang database for published data on the differential diagnosis obtained using BIPSS in Cushing syndrome as of October 2019. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and receiver operating characteristic (ROC) curves were calculated based on the relevant data. Results: This meta-analysis included a total of 23 studies with 1,617 patients. The calculated sensitivity, specificity, PLR, and NLR were 0.94 (95% confidence interval, CI: 0.91–0.96), 0.89 (95% CI: 0.79–0.95), 8.8 (95% CI: 4.3–17.9), and 0.07 (95% CI: 0.04–0.11), respectively. The pooled DOR and area under the ROC curve were 129 (95% CI: 48–345) and 0.97 (95% CI: 0.95–0.98), respectively. Conclusion: This meta-analysis indicated that BIPSS had a highly diagnostic value for ACTH originally in patients with ACTH-dependent Cushing syndrome, and BIPSS should be used as a routine method to identify ACTH sources. Keywords: Bilateral inferior petrosal sinus sampling, ACTH-dependent Cushing syndrome, Differential diagnosis , Diagnostic meta-analysis

scholarly journals Differential diagnostic value of bilateral inferior Petrosal sinus sampling (BIPSS) in ACTH-dependent Cushing syndrome: a systematic review and Meta-analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hao Wang ◽  
Ying Ba ◽  
Qian Xing ◽  
Run-Ce Cai
Keyword(s):  
Differential Diagnosis ◽  
Likelihood Ratio ◽  
Cushing Syndrome ◽  
Meta Analysis ◽  
Diagnostic Value ◽  
Cochrane Library ◽  
Published Data ◽  
Inferior Petrosal Sinus ◽  
Inferior Petrosal Sinus Sampling ◽  
Sensitivity Specificity

Abstract Background Previous studies have shown inconsistent results about the usefulness of bilateral inferior petrosal sinus sampling (BIPSS) in differential diagnosis of adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome. This meta-analysis evaluated the diagnostic value of BIPSS via the published literature. Methods This study searched PubMed, Embase, Web of Science, Cochrane library, and Wanfang database for published data on the use of BIPSS in Cushing syndrome differential diagnosis as of October 2019. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and receiver operating characteristic (ROC) curves were calculated based on the relevant data. Results This meta-analysis included a total of 23 studies with 1642 patients. The calculated sensitivity, specificity, PLR, and NLR were 0.94 (95% confidence interval, CI: 0.91–0.96), 0.89 (95% CI: 0.79–0.95), 8.8 (95% CI: 4.3–17.9), and 0.07 (95% CI: 0.04–0.11), respectively. The pooled DOR and area under the ROC curve were 129 (95% CI: 48–345) and 0.97 (95% CI: 0.95–0.98), respectively. Conclusion This meta-analysis indicated that BIPSS had high diagnostic value for detecting ACTH in patients with ACTH-dependent Cushing syndrome, and BIPSS should be used as an effective method to identify ACTH-secretion sources.

scholarly journals Pitfalls in Performing and Interpreting Inferior Petrosal Sinus Sampling: Personal Experience and Literature Review

2021 ◽  
Author(s):  
Jordan E Perlman ◽  
Philip C Johnston ◽  
Ferdinand Hui ◽  
Guy Mulligan ◽  
Robert J Weil ◽  
...  
Keyword(s):  
Personal Experience ◽  
Cushing Syndrome ◽  
Evidence Synthesis ◽  
Ectopic Acth Syndrome ◽  
Inferior Petrosal Sinus ◽  
Cushing Disease ◽  
Ectopic Acth ◽  
Inferior Petrosal Sinus Sampling ◽  
Operator Experience ◽  
Biochemical Testing

Abstract Context Inferior petrosal sinus sampling (IPSS) helps differentiate the source of ACTH-dependent hypercortisolism in patients with inconclusive biochemical testing and imaging, and is considered the gold standard for distinguishing Cushing disease (CD) from ectopic ACTH syndrome. We present a comprehensive approach to interpreting IPSS results by examining several real cases. Evidence Acquisition We performed a comprehensive review of the IPSS literature using PubMed since IPSS was first described in 1977. Evidence Synthesis IPSS cannot be used to confirm the diagnosis of ACTH-dependent Cushing syndrome (CS). It is essential to establish ACTH-dependent hypercortisolism before the procedure. IPSS must be performed by an experienced interventional or neuroradiologist because successful sinus cannulation relies on operator experience. In patients with suspected cyclical CS, it is important to demonstrate the presence of hypercortisolism before IPSS. Concurrent measurement of IPS prolactin levels is useful to confirm adequate IPS venous efflux. This is essential in patients who lack an IPS-to-peripheral (IPS:P) ACTH gradient, suggesting an ectopic source. The prolactin-adjusted IPS:P ACTH ratio can improve differentiation between CD and ectopic ACTH syndrome when there is a lack of proper IPS venous efflux. In patients who have unilateral successful IPS cannulation, a contralateral source cannot be excluded. The value of the intersinus ACTH ratio to predict tumor lateralization may be improved using a prolactin-adjusted ACTH ratio, but this requires further evaluation. Conclusion A stepwise approach in performing and interpreting IPSS will provide clinicians with the best information from this important but delicate procedure.

scholarly journals Differential Diagnostic Value of Bilateral Inferior Petrosal Sinus Sampling (BIPSS) in ACTH-Dependent Cushing Syndrome: a Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Hao Wang ◽  
Ying Ba ◽  
Qian Xing ◽  
Run-Ce Cai
Keyword(s):  
Differential Diagnosis ◽  
Likelihood Ratio ◽  
Cushing Syndrome ◽  
Meta Analysis ◽  
Diagnostic Value ◽  
Cochrane Library ◽  
Published Data ◽  
Inferior Petrosal Sinus ◽  
Inferior Petrosal Sinus Sampling ◽  
Sensitivity Specificity

Abstract Background: Previous studies have shown inconsistent results about the usefulness of bilateral inferior petrosal sinus sampling (BIPSS) in differential diagnosis of adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome. This meta-analysis evaluated the diagnostic value of BIPSS via the published literature.Methods: This study searched PubMed, Embase, Web of Science, Cochrane library, and Wanfang database for published data on the use of BIPSS in Cushing syndrome differential diagnosis as of October 2019. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and receiver operating characteristic (ROC) curves were calculated based on the relevant data.Results: This meta-analysis included a total of 23 studies with 1,617 patients. The calculated sensitivity, specificity, PLR, and NLR were 0.94 (95% confidence interval, CI: 0.91–0.96), 0.89 (95% CI: 0.79–0.95), 8.8 (95% CI: 4.3–17.9), and 0.07 (95% CI: 0.04–0.11), respectively. The pooled DOR and area under the ROC curve were 129 (95% CI: 48–345) and 0.97 (95% CI: 0.95–0.98), respectively.Conclusion: This meta-analysis indicated that BIPSS had high diagnostic value for detecting ACTH in patients with ACTH-dependent Cushing syndrome, and BIPSS should be used as an effective method to identify ACTH-secretion sources.

scholarly journals Differential Diagnostic Value of Bilateral Inferior Petrosal Sinus Sampling (BIPSS) in ACTH-Dependent Cushing Syndrome: a Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Hao Wang ◽  
Ying Ba ◽  
Qian Xing ◽  
Run-Ce Cai
Keyword(s):  
Differential Diagnosis ◽  
Likelihood Ratio ◽  
Cushing Syndrome ◽  
Meta Analysis ◽  
Diagnostic Value ◽  
Cochrane Library ◽  
Published Data ◽  
Inferior Petrosal Sinus ◽  
Inferior Petrosal Sinus Sampling ◽  
Sensitivity Specificity

Abstract Background: Previous studies have shown inconsistent results about the usefulness of bilateral inferior petrosal sinus sampling (BIPSS) in differential diagnosis of adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome. This meta-analysis evaluated the diagnostic value of BIPSS via the published literature.Methods: This study searched PubMed, Embase, Web of Science, Cochrane library, and Wanfang database for published data on the use of BIPSS in Cushing syndrome differential diagnosis as of October 2019. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and receiver operating characteristic (ROC) curves were calculated based on the relevant data.Results: This meta-analysis included a total of 23 studies with 1,617 patients. The calculated sensitivity, specificity, PLR, and NLR were 0.94 (95% confidence interval, CI: 0.91–0.96), 0.89 (95% CI: 0.79–0.95), 8.8 (95% CI: 4.3–17.9), and 0.07 (95% CI: 0.04–0.11), respectively. The pooled DOR and area under the ROC curve were 129 (95% CI: 48–345) and 0.97 (95% CI: 0.95–0.98), respectively.Conclusion: This meta-analysis indicated that BIPSS had high diagnostic value for detecting ACTH in patients with ACTH-dependent Cushing syndrome, and BIPSS should be used as a routine method to identify ACTH-secretion sources.

Effectiveness of bilataral inferior petrosal sinus sampling in diagnosis of ACTH dependent cushing syndrome

2021 ◽  
Author(s):  
Selvinaz Erol ◽  
Ozturk Feyza Yener ◽  
sen esra cil ◽  
Canat M.Masum ◽  
Cakir Sezin Dogan ◽  
...  
Keyword(s):  
Cushing Syndrome ◽  
Inferior Petrosal Sinus ◽  
Inferior Petrosal Sinus Sampling
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