Prolactin measurement during inferior petrosal sinus sampling improves the localization of pituitary adenomas in Cushing's disease

Mulligan, Guy B.; Faiman, Charles; Gupta, Manjula K.; Kennedy, Laurence; Hatipoğlu, Betül; Hui, Ferdinand; Weil, Robert J.; Hamrahian, Amir H.

doi:10.1111/j.1365-2265.2012.04339.x

Cited by 38 publications

(29 citation statements)

References 27 publications

(82 reference statements)

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“…In our study, the determination of lateralization was directly from plasma ACTH levels. However, previous studies have shown that by simultaneously measuring prolactin levels, a correction can be carried out to validate the integrity of pituitary venous effluent, helping to validate the presence or absence of an ACTH‐secreting pituitary tumour . Prolactin measurement can even reveal false‐negative lateralization .…”

Section: Discussionmentioning

confidence: 99%

Tumour lateralization in Cushing's disease by inferior petrosal sinus sampling with desmopressin

Feng

Liu

et al. 2017

Clinical Endocrinology

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Section: Discussionmentioning

confidence: 99%

Tumour lateralization in Cushing's disease by inferior petrosal sinus sampling with desmopressin

Feng

Liu

et al. 2017

Clinical Endocrinology

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“…75,110 The relative concentration of prolactin in the inferior petrosal sinus blood compared with the peripheral blood can be used to normalize the concentration of the ACTH from the inferior petrosal sinuses in relation to the peripheral blood to yield a calculated ACTH in the inferior petrosal sinus-to-peripheral blood ratio that can enhance the diagnostic accuracy of the test. 33,65,93 For this reason, many centers save blood samples from the procedure and measure the prolactin concentrations if the results of the IPSS need further analysis. To avoid false-positive results, IPSS must be performed while the patient is hypercortisolemic.…”

Section: Diagnostic Evaluationmentioning

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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“…This hypothesis, based on the assumption that the hormones measured drained symmetrically in the two sides of the pituitary, was not consistently confirmed and conversely an intersinus, and central/peripheral gradient also for these hormones was repeatedly documented (96, 97, 98, 99). More recent reports on the use of PRL in addition to ACTH to correctly localize the pituitary adenoma site in CD have given conflicting result (100, 101). …”

Section: Bipss and Corticotroph Microadenoma Lateralizationmentioning

confidence: 99%

Bilateral inferior petrosal sinus sampling

Zampetti

Grossrubatscher

Ciaramella

et al. 2016

Endocrine Connections

106

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Simultaneous bilateral inferior petrosal sinus sampling (BIPSS) plays a crucial role in the diagnostic work-up of Cushing’s syndrome. It is the most accurate procedure in the differential diagnosis of hypercortisolism of pituitary or ectopic origin, as compared with clinical, biochemical and imaging analyses, with a sensitivity and specificity of 88–100% and 67–100%, respectively. In the setting of hypercortisolemia, ACTH levels obtained from venous drainage of the pituitary are expected to be higher than the levels of peripheral blood, thus suggesting pituitary ACTH excess as the cause of hypercortisolism. Direct stimulation of the pituitary corticotroph with corticotrophin-releasing hormone enhances the sensitivity of the procedure. The procedure must be undertaken in the presence of hypercortisolemia, which suppresses both the basal and stimulated secretory activity of normal corticotrophic cells: ACTH measured in the sinus is, therefore, the result of the secretory activity of the tumor tissue. The poor accuracy in lateralization of BIPSS (positive predictive value of 50–70%) makes interpetrosal ACTH gradient alone not sufficient for the localization of the tumor. An accurate exploration of the gland is recommended if a tumor is not found in the predicted area. Despite the fact that BIPSS is an invasive procedure, the occurrence of adverse events is extremely rare, particularly if it is performed by experienced operators in referral centres.

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Prolactin measurement during inferior petrosal sinus sampling improves the localization of pituitary adenomas in Cushing's disease

Abstract: Prolactin measurement, during IPSS, improves our ability to correctly localize the pituitary adenoma site in CD.

Cited by 38 publications

References 27 publications

Tumour lateralization in Cushing's disease by inferior petrosal sinus sampling with desmopressin

Tumour lateralization in Cushing's disease by inferior petrosal sinus sampling with desmopressin

Cushing's disease: pathobiology, diagnosis, and management

Bilateral inferior petrosal sinus sampling

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