Neurologic Complications of Inferior Petrosal Sinus Sampling

Gandhi, Chirag D.; Meyer, Scott A.; Patel, Aman B.; Johnson, D.M.; Post, Kalmon D.

doi:10.3174/ajnr.a0930

Cited by 53 publications

(25 citation statements)

References 18 publications

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“…This view is consistent with the studies of Doppman [43], Mamelak [41], and Lefournier [44]. In a recent study published by Gandhi et al [50], one serious complication of irreversible brain stem injury in a study of 44 patients who underwent BIPSS for evaluation of Cushing's disease was described. In this rare case, there was radiographic evidence of venous outflow variance that may have contributed to the injury.…”

Section: Discussionsupporting

confidence: 73%

Selective inferior petrosal sinus sampling without venous outflow diversion in the detection of a pituitary adenoma in Cushing’s syndrome

et al. 2011

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Section: Discussionsupporting

confidence: 73%

Selective inferior petrosal sinus sampling without venous outflow diversion in the detection of a pituitary adenoma in Cushing’s syndrome

et al. 2011

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“…To avoid this problem, proper placement of intravascular catheter tips can be routinely confirmed by retrograde venography of the cavernous sinuses and inferior petrosal sinuses. The consistency of success with bilateral sampling of the inferior petrosal sinuses is operator dependent and varies substantially from center to center, from nearly universal success at some centers 33,38,110 (including pediatric patients) to success rates of 67%-84% at others. 49,96 Most CD patients with a false-negative result can be identified by their relatively low peak ACTH levels in the inferior petrosal sinus blood (less than 200 pg/ml basal levels or less than 400 pg/ml after CRH stimulation).…”

Section: Diagnostic Evaluationmentioning

confidence: 99%

“…38,64 Thus, most centers of expertise in the evaluation and treatment of CS use IPSS only in patients with ACTH-dependent CD and conflicting results of noninvasive endocrine evaluation for the differential diagnosis of CS, discordant biochemical and radiological studies, or negative pituitary MR imaging (Fig. 3).…”

Section: Complications Of Ipssmentioning

confidence: 99%

Cushing's disease: pathobiology, diagnosis, and management

Lonser

Nieman

Oldfield

2017

JNS

147

114

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Cushing's syndrome (CS) is caused by prolonged supraphysiological levels of circulating cortisol. Cushing's disease (CD) is the most common etiology (70%-80% of CS cases) of endogenous CS. It is caused by a pituitary adenoma that secretes adrenocorticotropic hormone (ACTH), which stimulates secretion of cortisol by the adrenal glands. If not effectively treated, CD is associated with hypertension, diabetes, obesity, osteoporosis, vascular disease, and shortened life span. Successful resection of a CD-associated ACTH-secreting pituitary adenoma results in immediate biochemical remission and preservation of pituitary function. Early identification of CD by clinical findings, endocrinological evaluation, and imaging studies is critical for diagnosis and effective surgical management. endocrinological and Clinical Features endocrinological Features Normal PhysiologyInsight into the normal and pathophysiological mechanisms of control of the hypothalamic-anterior pituitaryadrenal axis is critical to understanding the pathologic, diagnostic, and therapeutic features of CD (Fig. 1). 52 Under normal physiological conditions (circadian rhythm, where cortisol levels peak in early morning and nadir late at night), systemic inflammation (cytokine), or stress (physiological or psychological), corticotropin-releasing hormone (CRH; a 41-amino acid peptide) is released from the paraventricular hypothalamic nucleus via the median eminence. From the median eminence, CRH is transported in the hypophyseal portal venous system to the pituitary gland, where it binds to the CRH receptor-1 (CRH-R1) on pituitary corticotroph cells. CRH binding to CRH-R1 receptors activates adenylate cyclase and stimulates proopiomelanocortin (POMC) gene expression in the corticotroph cells.17,66 Proopiomelanocortin preprohormone is processed into ACTH (a 39-amino acid peptide) and b-lipotropin (a 93-amino acid peptide). Products of b-lipotropin include b-endorphin and a-lipotropin. ACTH is secreted into the systemic circulation and binds to receptors in the adrenal cortex, where it stimulates production and secretion of glucocorticoids, including cortisol. 83 Under normal conditions, circulating cortisol provides physiological control of this endocrine axis by its negative feedback inhibition on hypothalamic CRH and pituitary ACTH secretion. Cushing's disease (CD) is the result of excess secretion of adrenocorticotropic hormone (ACTH) by a benign monoclonal pituitary adenoma. The excessive secretion of ACTH stimulates secretion of cortisol by the adrenal glands, resulting in supraphysiological levels of circulating cortisol. The pathophysiological levels of cortisol are associated with hypertension, diabetes, obesity, and early death. Successful resection of the CD-associated ACTH-secreting pituitary adenoma is the treatment of choice and results in immediate biochemical remission with preservation of pituitary function. Accurate and early identification of CD is critical for effective surgical management and optimal prognosis. The authors review the cu...

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“…Also, complications include brain stem infarction, cranial nerve paralysis, venous subarachnoid hemorrhage and obstructive hydrocephalus (Deda et al, 2005;Gandhi et al, 2008;Lee et al, 2008). These result primarily from the variants and maldevelopment of the IPS.…”

Section: Discussionmentioning

confidence: 99%

Imaging study of the long extracranial extension of the inferior petrosal sinus with MSCT

Zhang

Chen

et al. 2009

Clinical Anatomy

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The aim of this study was to explore the anatomic route of Long-Inferior Petrosal Sinuses (IPS) with multi-slice spiral computed tomography, and to provide referenced evidence for the interventional preoperative evaluation for the diagnosis and treatment of skull base and sellar lesions. The route of Long-IPS and its confluence with the internal jugular vein (IJV) and the connection level of 12 IPS were shown with multi-planar reconstruction and curved multi-planar reconstruction, and the IPS length was determined. Combining the results of continuous multi-slice scanning, the diameters of the IPS at the initial segment in the jugular foreman and middle segment and the confluence segment of the IPS-IJV junction level were determined. The mean length of the Long-IPS was 66.2 +/- 17.5 mm, and the length was over 60 mm on eight sides and its peak value 100 mm. The mean diameters of the IPS were 2.4 mm +/- 0.7 mm, 2.1 mm +/- 0.4 mm, and 2.1 mm +/- 0.5 mm at the initial, middle, and confluent segments, respectively. Their diameters were equal to or greater than 2 mm at the connection level on eight sides. Furthermore, the diameter was greater than 1.6 mm at the middle and initial segments. The Long-IPS might be used as a route to the intra-cranial IPS. MSCT is helpful for showing the route and variation of the IPS and could be an effective method for preoperative evaluation of the IPS.

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Neurologic Complications of Inferior Petrosal Sinus Sampling

Cited by 53 publications

References 18 publications

Selective inferior petrosal sinus sampling without venous outflow diversion in the detection of a pituitary adenoma in Cushing’s syndrome

Selective inferior petrosal sinus sampling without venous outflow diversion in the detection of a pituitary adenoma in Cushing’s syndrome

Cushing's disease: pathobiology, diagnosis, and management

Imaging study of the long extracranial extension of the inferior petrosal sinus with MSCT

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