scholarly journals Bilateral inferior petrosal sinus sampling in the diagnosis of Cushing disease

2015 ◽  
pp. 1
Author(s):  
Rahmi Rahmi Oklu ◽  
Amy Deipolyi
Keyword(s):  
Inferior Petrosal Sinus ◽  
Cushing Disease ◽  
Inferior Petrosal Sinus Sampling

VENOUS SAMPLING FOR CUSHING DISEASE: COMPARISON OF INTERNAL JUGULAR VEIN AND INFERIOR PETROSAL SINUS SAMPLING

2016 ◽  
Vol 22 (9) ◽  
pp. 1057-1061 ◽  
Author(s):  
Martin G. Radvany ◽  
Alfredo Quinones-Hinojosa ◽  
Gary L. Gallia ◽  
Gary S. Wand ◽  
Roberto Salvatori
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Inferior Petrosal Sinus ◽  
Venous Sampling ◽  
Cushing Disease ◽  
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 Transsphenoidal Surgery for Cushing Disease After Nondiagnostic Inferior Petrosal Sinus Sampling

Neurosurgery ◽  
2012 ◽  
Vol 71 (1) ◽  
pp. 14-22 ◽  
Author(s):  
Sameer A. Sheth ◽  
Matthew K. Mian ◽  
Jonathan Neal ◽  
Nicholas A. Tritos ◽  
Lisa Nachtigall ◽  
...  
Keyword(s):  
Predictive Value ◽  
Transsphenoidal Surgery ◽  
Adrenocorticotropic Hormone ◽  
Remission Rate ◽  
Inferior Petrosal Sinus ◽  
Cushing Disease ◽  
Inferior Petrosal Sinus Sampling ◽  
Course Of Action ◽  
Anatomic Variants ◽  
Sensitivity Specificity

Abstract BACKGROUND: Inferior petrosal sinus sampling (IPSS) is a useful technique for confirming a pituitary source of adrenocorticotropic hormone (ACTH) overproduction in Cushing disease. Uncertainty remains regarding the appropriate course of therapy when an ectopic tumor is predicted by IPSS but none can be found and in circumstances when the procedure cannot be successfully completed owing to technical or anatomic limitations. OBJECTIVE: To determine an appropriate course of action after nondiagnostic IPSS. METHODS: We reviewed 288 IPSS procedures in 283 patients between 1986 and 2010 at our center. An IPS:peripheral ACTH ratio ≥ 2 at baseline or ≥ 3 after corticotrophin-releasing hormone was considered predictive of a pituitary source of ACTH. A procedure was considered nondiagnostic if the procedure was successfully performed and the results predicted an ectopic source but none could be found despite extensive imaging or if the IPS could not be bilaterally cannulated because of technical difficulties or anatomic variants. RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive value of IPSS for detecting a pituitary source in Cushing disease were 94%, 50%, 98%, and 29%, respectively. We identified 3 categories of nondiagnostic IPSS comprising 44 of the total procedures. These patients underwent exploratory transsphenoidal surgery, and in 42 of these patients (95%), a pituitary source was surgically proven, with a remission rate of 83%. CONCLUSION: Transsphenoidal surgery should be considered in cases of ACTH-dependent Cushing disease and noncentralized or technically unsuccessful IPSS without evidence of ectopic tumor.

Bilateral inferior petrosal sinus sampling: experience in 327 patients

2016 ◽  
Vol 9 (2) ◽  
pp. 196-199 ◽  
Author(s):  
Amy Deipolyi ◽  
Alexander Bailin ◽  
Joshua A Hirsch ◽  
T Gregory Walker ◽  
Rahmi Oklu
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Inferior Petrosal Sinus ◽  
Technical Success ◽  
Cushing Disease ◽  
Inferior Petrosal Sinus Sampling ◽  
Technical Success Rate ◽  
Technical Failures ◽  
Groin Hematoma

ObjectiveTo describe findings and outcomes of 331 bilateral inferior petrosal sinus sampling (BIPSS) procedures performed in 327 patients evaluated for Cushing disease (CD).Materials and methodsThe radiology department's electronic database was searched to identify all BIPSS procedures (1990–2013). Electronic medical records were used to identify demographics, laboratory, procedural, surgical and pathologic findings.ResultsA total of 331 BIPSS procedures were performed in 327 patients (254 F, 73 M), mean age 41 (range 7–81) years. The overall technical success rate was 88% for bilateral cannulation, though nearly two-thirds of the technical failures had unilateral sampling that diagnosed CD. Of the 331 BIPSS procedures, 40 were performed without, and 291 with stimulation by Acthrel or desmopressin. Sensitivity was 89–94% for unstimulated BIPSS, 96% for stimulated BIPSS, and 77% for MRI. BIPSS lateralization was accurate in about half of patients, compared with 75% accuracy for MRI. Mean inferior petrosal sinus (IPS):peripheral adrenocorticotropic hormone ratio was 17.3 (SE 1.8) at baseline, and 99.2 (SE 14.8) at 3 min, with decreasing values over time. All patients with follow-up after surgical resection for centralizing BIPSS were reported to be cured, with cortisol levels significantly decreased from 19 to 4 μg/dL (p<0.0001). Complications from BIPSS were rare, including groin hematoma (2.5%), but no thromboembolic complications were seen.ConclusionsBIPSS remains the ‘gold standard’ for diagnosing CD. Stimulation with Acthrel or desmopressin is key to increasing specificity. When only one IPS can be successfully cannulated, results may still be diagnostic. BIPSS findings cannot be used to accurately lateralize lesions within the pituitary.

scholarly journals Why We Should Still Treat by Neurosurgery Patients With Cushing Disease and a Normal or Inconclusive Pituitary MRI

2019 ◽  
Vol 104 (9) ◽  
pp. 4101-4113 ◽  
Author(s):  
Justine Cristante ◽  
Virginie Lefournier ◽  
Nathalie Sturm ◽  
Jean Guy Passagia ◽  
Anne Sophie Gauchez ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Implicit Assumption ◽  
Inferior Petrosal Sinus ◽  
Cushing Disease ◽  
Inferior Petrosal Sinus Sampling ◽  
Single Center Study ◽  
Remission Rates ◽  
Transnasal Endoscopic Approach ◽  
Evolution With Time ◽  
Center Study

Abstract Context In patients with Cushing disease (CD) and a typical image of adenoma at MRI, transsphenoidal surgery is consensual. However, when MRI is inconclusive or normal, some authors now advocate medical treatment instead. The implicit assumption is that modern MRI should miss only very small microadenomas that are too difficult to visualize at surgery. Objective To analyze the evolution with time of the performances of MRI and the outcomes of surgery in patients with CD with a typical image of adenoma vs an inconclusive or normal MRI. Design and Patients Retrospective single center study of 195 patients with CD treated by transsphenoidal surgery between 1992 and 2018, using first a translabial microscopic and then a transnasal endoscopic approach. Patients with inconclusive or normal MRI were explored by bilateral inferior petrosal sinus sampling. Four MRI groups were defined: microadenomas (n = 89), macroadenomas (n = 18), or MRI either inconclusive (n = 44) or normal (n = 44). Results The proportion of inconclusive/normal MRI decreased with time, from 60% (21/35) in 1992 to 1996 to 27% (14/51) in 2012 to 2018 (P = 0.037). In the four MRI groups, the per-operatory adenoma visualization rate was only slightly lower when MRI was normal (95%, 100%, 86%, 79%; P = 0.012) and postoperative remission rates were not different (85%, 94%, 73%, 75%; P = 0.11). Conclusion The diagnostic performances of MRI have improved but remain inferior to the eye of an expert neurosurgeon, best assisted by endoscopy. We propose that patients with CD and an inconclusive/normal MRI be addressed by an expert neurosurgeon for transsphenoidal surgery rather than being treated medically.

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.

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