Reduction of False-Negative Results in Inferior Petrosal Sinus Sampling with Simultaneous Prolactin and Corticotropin Measurement

Mulligan, Guy B.; Eray, Esin; Faiman, Charles; Gupta, Manjula K.; Pineyro, Maria M.; Makdissi, Antoine; Suh, John H.; Masaryk, Thomas J.; Prayson, Richard A.; Weil, Robert J.; Hamrahian, Amir H.

doi:10.4158/ep10067.or

Cited by 45 publications

(44 citation statements)

References 33 publications

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“…При этом впервые максимальное отношение АКТГ для расчетного индекса получено на фоне стимуляции десмопрессином. Исследование про-лактина для контроля положения катетера было предложено сравнительно давно [14][15][16]. Однако необходимость рутинного определения пролактина по-прежнему вызывает споры из-за высокой часто-ты ложноотрицательных результатов, что отмечено и в настоящей работе.…”

Section: Discussionunclassified

“…Для контроля положения катетера было предло-жено, наряду с АКТГ, исследовать содержание дру-гих гормонов гипофиза, в частности: гормона роста, тиреотропного гормона (ТТГ), альфа-субъединицы и пролактина [12][13][14][15][16]. Пролактин секретируется передней долей гипофиза в наиболее высоких кон-центрациях по сравнению с другими гормонами.…”

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“…Более того, концентрации ТТГ, гормона роста и альфа-субъединицы могут быть подавлены у пациентов с ЭГ [13]. В связи с этим современные исследования в основном ориентированы именно на пролактин как маркер успешной катетеризации нижних камени-стых синусов [15,16,18]. Дополнительное значение определения уровня пролактина и расчет его гради-ента приобрело после предложения использовать АKTГ/пролактин нормализованное отношение, ко-торое, согласно пилотному исследованию [15], по-зволяет повысить чувствительность селективного забора крови из нижних каменистых синусов на фоне стимуляции кортиколиберином.…”

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The role of prolactin gradient and normalized ACTH/prolactin ratio in the improvement of sensitivity and specificity of selective blood sampling from inferior petrosal sinuses for differential diagnostics of ACTH-dependent hypercorticism

Белая¹,

Рожинская²,

Melnichenko³

et al. 2013

Probl Endokrinol (Mosk)

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The present study included patients with confirmed diagnosis of ACTH-dependent hypercorticism admitted to the Department of Neuroendocrinology and Osteopathies, Endocrinological Research Centre, between 2008 and 2012. Selective blood sampling from the inferior petrosal sinuses was performed with the stimulation by decompressin administered intravenously at a dose of 8 mcg. The normalized ACTH/prolactin ratio was calculated by dividing the maximum ACTH gradient following decompressin stimulation by the ipsilateral prolactin gradient. The cut off values were calculated from the operating characteristic curves as follows: 1.5 for the prolactin gradient (sensitivity 92.5%, specificity 100%) and 1.18 for the normalized ACTH/prolactin ratio (sensitivity 85.9%; 95% CI 76.8-93.4, specificity 100%; 95% CI 60.9-100). In the study cohort (n=70), the normalized ACTH/prolactin ratio proved to be a more specific but less sensitive parameter than the routine analysis of the ACTH gradient (sensitivity 98.4%, specificity 83.3%). Areas under the operating characteristic curves were on the whole identical. However, comparison of the diagnostic value of selective blood sampling from the inferior petrosal sinuses in combination of the determination of the prolactin gradient and normalized ACTH/prolactin ratio with the results obtained in the patients in whom the catheter position was not controlled (n=47) revealed the advantages of the former approach in terms of both the number of unverified causes of hypercorticism (1 versus 6) and the area under the operating characteristic curves 0.964 (95% CI 0.897-1.032) among 70 patients and 0.910 (95% CI 0.821-0.998) among the first 47 patients (included in the analysis confined to the confirmed cases). It is concluded that the determination of the prolactin gradient and calculation of the normalized ACTH/prolactin ratio allow to increase the diagnostic value of selective blood sampling from the inferior petrosal sinuses under decompressin stimulation. This inference is especially true of doubtful cases.

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The role of prolactin gradient and normalized ACTH/prolactin ratio in the improvement of sensitivity and specificity of selective blood sampling from inferior petrosal sinuses for differential diagnostics of ACTH-dependent hypercorticism

Белая¹,

Рожинская²,

Melnichenko³

et al. 2013

Probl Endokrinol (Mosk)

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“…In addition, confirmation of accurate venous sampling in only one IPS may not rule out a pituitary source in the contralateral side of the pituitary gland due to variable venous drainage [4].…”

Section: Caveatsmentioning

confidence: 99%

Inferior Petrosal Sinus Sampling

Ergin

Hamrahian

Kennedy

et al. 2015

The Cleveland Clinic Manual of Dynamic Endocrine Testing

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“…Such samples can then be assessed for prolactin to confirm the adequacy of sampling and prevent false negative outcomes. [37][38][39] The primary technological advance enabling correct catheter positioning and reducing complications is the incorporation of microcatheters, which became more commonly used in the 1990s. 40 Such devices allow for more central catheterization of the IPS, and likely have lower rates of venous thrombosis.…”

Section: Newer Techniques Improving Diagnostic Accuracy and Reducing mentioning

confidence: 99%

Bilateral inferior petrosal sinus sampling in the diagnosis of Cushing disease

Deipolyi¹,

Öklü²

2015

JVD

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Reduction of False-Negative Results in Inferior Petrosal Sinus Sampling with Simultaneous Prolactin and Corticotropin Measurement

Cited by 45 publications

References 33 publications

The role of prolactin gradient and normalized ACTH/prolactin ratio in the improvement of sensitivity and specificity of selective blood sampling from inferior petrosal sinuses for differential diagnostics of ACTH-dependent hypercorticism

The role of prolactin gradient and normalized ACTH/prolactin ratio in the improvement of sensitivity and specificity of selective blood sampling from inferior petrosal sinuses for differential diagnostics of ACTH-dependent hypercorticism

Inferior Petrosal Sinus Sampling

Bilateral inferior petrosal sinus sampling in the diagnosis of Cushing disease

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