The role of inferior petrosal sinus sampling in the diagnostic localization of Cushing's disease

Abstract

<jats:p>✓ Cushing's syndrome can present a complex problem of differential diagnosis. Of cases in which hypercortisolemia results from an adrenocorticotropic hormone (ACTH)–dependent process, approximately 80% are due to a pituitary adenoma (Cushing's disease [CD]), 10% are due to adrenal lesions, and the remaining 10% are secondary to ectopic ACTH secretion. For patients with CD, surgical removal of the pituitary adenoma is the treatment of choice. Thus, localization of the source of ACTH secretion is critical in guiding timely treatment decisions.</jats:p> <jats:p>Inferior petrosal sinus sampling (IPSS) is considered to be the gold standard for confirming the origin of ACTH secretion in patients with Cushing's syndrome.</jats:p> <jats:p>The authors present an overview of IPSS—both the technique and its interpretation—as well as a summary of recent studies. A number of other techniques are discussed including sampling from the cavernous sinus, the jugular vein, and multiple sites to aid the diagnosis and lateralization of ACTH-producing pituitary adenomas. Management is best undertaken by a comprehensive multidisciplinary team taking into account the results of all the biochemical and imaging studies available, to provide the best advice in patient treatment decisions.</jats:p>

IPSS in Cyclical Cushing’s Syndrome Due to Ectopic ACTH Production: Proof of Principle and Potential Diagnostic Pitfall

“…Once the diagnosis of ACTH dependent Cushing's syndrome has been established, bilateral inferior petrosal sinus sampling can be performed to try differentiating central (pituitary) from ectopic sources of ACTH production [8]. However, this procedure can be unreliable in CCS unless performed when the syndrome is active.…”

Inferior petrosal sinus sampling: Final solution to a riddle called “Cushing's syndrome”

“…BIPSS is considered as gold standard in differentiating pituitary dependant Cushing's syndrome from ectopic Cushing's syndrome. 1 Basal IPS/PV ratio of ACTH more than 2, and post stimulation IPS/PV if more than 3 is considered to be diagnostic of Cushing's disease. Also lateralization of pituitary adenoma can be predicted if interpetrosal ratio of ACTH is more than 1.5.…”

“…1 Initial reports on selective petrosal sinus sampling to differentiate pituitary and ectopic source of adrenocorticotropic hormone (ACTH) were performed by Corrigan published in 1977. 2 Earlier, ratio of unilateral IPSS with peripheral venous ACTH levels was assessed but later on it was realized that pituitary venous drainage can be asymmetric either because of adenoma location or anatomical variation.…”

Cushing’s disease: the clinical features, diagnostics, differential diagnostics, and methods of treatment

“…устанавливается диагноз болезнь Ицен-ко-Кушинга, но около 10-20% пациентов имеют опухоли другой локазизации (АКТГ-эктопирован-ный синдром) [54][55][56][57].…”