Bilaterale und simultane Katheterisierung des Sinus petrosus inferior beim Cushing-Syndrom: Bestimmung nach ACTH zur Diagnostik und zur Seitenlokalisation eines hypophysären Mikroadenoms vor und nach Gabe von Corticotropin-Releasing-Hormon^*

Abstract

ACTH concentration was measured in simultaneously drawn blood samples from the left and right inferior petrosal sinuses before and after administration of corticotropin-releasing hormone (CRH). Such samples were successfully obtained in 20 of 21 patients with ACTH-dependent Cushing's syndrome on whom it was attempted. In 11 of the 20 patients there was no concentration difference between petrosal sinus and peripheral blood. But 13 of 19 patients had a unilateral central to peripheral concentration gradient greater than 1.4 after CRH administration. In the other six patients no ipsi- to contralateral gradient was demonstrable. Two of these patients had a proven ectopic ACTH-producing tumor; no adenoma was found at operation in three; on patient is awaiting operation. In 10 of 13 patients with unilateral gradient a microadenoma was found on the same side at operation. One patient had a hemi-hypophysectomy on the side of the higher gradient: hypocortisolemia developed in her postoperatively. Two other patients are awaiting operation. The results indicate that simultaneous bilateral catheterization of the inferior petrosal sinus with CRH stimulation is a highly informative examination with few side-effects and will contribute to better diagnosis and treatment of Cushing's syndrome.

Bilateral inferior petrosal sinus sampling

“…Later, Oldfield and coworkers in 1985 confirmed the usefulness of bilateral simultaneous sampling of inferior petrosal sinuses (BIPSS) in localizing the ACTH-secreting microadenoma in one side of pituitary gland, and showed the effectiveness of hemihypophysectomy on the side with the highest ACTH concentrations in three patients without pathological evidence of microadenoma (35). The procedure has been subsequently further improved by direct stimulation of the pituitary corticotroph with corticotropin-releasing hormone (CRH), which was initially used during BIPSS to improve the lateralization of ACTH-secreting pituitary microadenomas (36, 37, 38). …”

Adipocytes play an etiological role in the podocytopathy of high-fat diet-fed rats

“…Adiponectin has a protective effect against the development of albuminuria in a recent animal study (Christou & Kiortsis 2014). Moreover, the serum adiponectin concentration is independently associated with albuminuria in CKD patients (Kim et al 2016, Ortega Moreno et al 2015. Increased leptin concentrations correlate with renal injury and proteinuria, and also with damaged cultured renal proximal tubule cells in in vitro experiments (Briffa et al 2015, Thieme & Oliveira-Souza 2015.…”

Bilateral inferior petrosal sinus sampling in the differential diagnosis of ACTH‐dependent Cushing's syndrome: A reappraisal

“…Oldfield et al later found that BIPSS could be used to localize ACTH-secreting microadenomas on one side of the pituitary gland, and that three patients who did not have a clear microadenoma on imaging benefited from hemi-hypophysectomy on the side with the highest ACTH concentration [28]. Later, direct stimulation of the pituitary corticotroph with CRH, originally used to improve the lateralization of ACTH-secreting pituitary microadenomas during BIPSS, enhanced the accuracy of the procedure to confirm CD [29,30]. A comprehensive review of the NIH experience demonstrated that the use of CRH with BIPSS was able to enhance the sensitivity of the procedure in distinguishing eutopic CS from ectopic CS [16].…”