The role of inferior petrosal sinus sampling in the diagnostic. This procedure is included in the diagnostic algorithm for cs in current guidelines 32. Ipss is a method that compares the blood level of acth collected from peripheral vessels and both sides of the inferior petrosal sinus after stimulation of acth secretion with crh. Ectopic cushings syndrome in a patient with inferior. Lateralization of inferior petrosal sinus sampling in cushing. The role of bilateral inferior petrosal sinus sampling in the diagnosis of cushings syndrome. Bilateral inferior petrosal sinus sampling bipss is the gold standard in diagnosing cushing disease and distinguishing a central source of adrenocorticotropic hormone acth secretion ie, a pituitary adenoma from an ectopic source. Petrosal sinuses are a group of veins on both sides of the head. Use of magnetic resonance venography for inferior petrosal. Although bilateral catheterization of the inferior petrosal sinuses was successful in 496 patients 99%, 5 patients 1% had sampling performed in the more proximal venous system, including the jugular vein just inferior to the petrosal sinus, when a very small petrosal sinus did not accommodate a catheter or plexiform venous anatomy could not. The limited ability of inferior petrosal sinus sampling with. Urine free cortisol in the highdose dexamethasone suppression test for the. Cyclic cushings disease with misleading inferior petrosal.
A0930 original neurologic complications of inferior petrosal research sinus sampling c. Bilateral inferior petrosal sinus sampling provide a useful tool to the physician in solving this complex riddle. Notably, this study used a highstrength 3t mri magnet in 10% of cases. Pitfalls in performing and interpreting inferior petrosal.
Inferior petrosal sinus sampling, however, is highly accurate and safe when. During naloxone from the left inferior petrosal sinus a, right inferior testing, acth levels rose to 863 left and 501 pmoll petrosal sinus vand a peripheral forearm vein 0basal. A pitfall of bilateral inferior petrosal sinus sampling in cyclic. The effects of sampling lateralization on bilateral inferior. Patients who are suspected of having a pituitary tumor resulting in cushings syndrome may be referred for inferior petrosal sinus sampling if findings on mri examination of the pituitary did not reveal a tumor or are inconclusive. Bilateral inferior petrosal sinus sampling neurosurgery. This handout explains a procedure called inferior petrosal sinus sampling. Lab studies can often differentiate ectopic from pituitary acthdriven cushings syndrome, but it is clear that the levels, even on dynamic testing, may have some overlap. Inferior petrosal sinus sampling ipss is a useful diagnostic technique in adrenocorticotropic hormone acthdependent hypercortisolism with normal or equivocal mr imaging. Inferior petrosal sinus sampling is an infrequently used method of confirming the presence of a hormonally active pituitary microadenoma when imaging alone has been insufficient. A cause of cs is cushing disease cd, which is hypercortisolemia due to excess pituitary secretion of adrenocorticotropic hormone acth, which stimulates adrenal cortical secretion of cortisol. The lateralization accuracy of inferior petrosal sinus. Overall, the inferior petrosal sinus sampling procedure involves minimal discomfort. Petrosal sinus article about petrosal sinus by the free.
Pdf the role of bilateral inferior petrosal sinus sampling. Inferior petrosal definition of inferior petrosal by. Manual searches were also used, and relevant references included in the extracted papers were also searched. Context it is often difficult to find an adenoma in patients with cushings disease cd whose preoperative magnetic resonance imaging mri is normal. Intermittent acth secretion from pituitary adenomas may result in insignificant differences between petrosal and peripheral acth levels at.
Inferior petrosal sinus sampling ipss is a useful diagnostic technique in adrenocorticotropic hormone acthdependent hypercortisolism with normal or equivocal mr. Pdf the lateralization accuracy of inferior petrosal. A number of other techniques are discussed including sampling. Bipss involves catheterization of both the inferior petrosal sinuses, which constitute the proximal venous.
Lateralization of inferior petrosal sinus sampling in. To determine whether petrosal sinus sampling is useful to distinguish patients with mild or intermittent cushings disease from normal subjects and individuals with pseudocushing states, we performed bilateral inferior petrosal sinus sampling for acth before and after the administration of crh in 7 eucortisolemic volunteers, 8. Inferior petrosal sinus article about inferior petrosal. Differential diagnostic value of bilateral inferior. Bilateral inferior petrosal sinus sampling bipss is gold standard test for. This is an interventional procedure in which acth levels obtained from venous drainage very near the pituitary gland are compared to peripheral blood. Objective the aim of this study was to determine the accuracy of inferior petrosal sinus sampling ipss in predicting adenoma lateralization. All the blood samples were immediately delivered to the laboratory for acth assay. A patient with cushing disease lateralizing a pituitary. Ten of the patients subsequently had transsphenoidal pituitary microsurgery. The role of inferior petrosal sinus sampling in the. The most sensitive method for differentiating between pituitary and ectopic. This process is experimental and the keywords may be updated as the learning algorithm improves.
Bilateral simultaneous inferior petrosal sinus sampling ipss is used. Venous angiography is needed to interpret inferior petrosal sinus and cavernous sinus sampling data for lateralizing adrenocorticotropinsecreting adenomas. Beginning at the cavernous sinus bilaterally, the left and right ipss course along a narrow groove between the petrous part of the temporal bone and the basilar region of the occipital bone until it. Usefulness of the corticotropinreleasing hormone test. Full text bilateral inferior petrosal sinus sampling in. Bilateral inferior petrosal sinus sampling in the diagnosis of cushing disease amy r deipolyi,1 rahmi oklu21vascular and interventional radiology, nyu langone medical center, new york, ny, usa. Bilateral inferior petrosal sinus sampling by unilateral. Preoperative lateralization modalities for cushing disease. Plasma acth values during simultaneous bilateral inferior petrosal sinus sampling, performed before and after corticotropinreleasing hormone administration. Inferior petrosal sinus blood sampling for acth measurement ipss is used for the differential diagnosis of acthdependent cushings syndrome and for the preoperative location of pituitary microadenomas. Using a previously described classification system, we prospectively classified venous anatomy bilaterally in 5 of 6 persons consecutively undergoing inferior petrosal sinus sampling. Original research neurologic complications of inferior petrosal sinus sampling c. Bilateral inferior petrosal sinus sampling bipss is useful for differential diagnosis of adult cushings disease cd but may not be so reliable in pediatric cases. Petrosal sinus sampling in the diagnosis of cushings syndrome bilateral simultaneous sampling of the inferior petrosal sinus ips is an accurate test with a high degree of sensitivity and specificity and provides the most direct method of diagnosing cd and distinguishing it from ectopic acth syndrome 1,14.
A corticotropin gradient sample via bipss is required to confirm diagnosis when pituitary mri imaging and biochemical diagnostic tests have been inconclusive. The ipss results revealed a petrosal sinus samples after corticotropin. The authors present an overview of ipssboth the technique and its interpretationas well as a summary of recent studies. Inferior petrosal sinus sampling an overview sciencedirect topics. Selective inferior petrosal sinus sampling without venous. Inferior petrosal sinus sampling ipss is considered to be the gold standard for. Inferior petrosal sinus sampling ipss is used for the evaluation of patients with cushings disease and the ectopic adrenocorticotropic hormone acth syndrome. Ipss inferior petrosal sinus sampling or bipss bilateral ipss is a more accurate but invasive test used to differentiate pituitary from ectopic or adrenal cushings syndrome. Aug 21, 2019 inferior petrosal sinus sampling ipss is an invasive procedure in which adrenocorticotropic hormone acth levels are sampled from the veins that drain the pituitary gland.
Pdf simultaneous bilateral inferior petrosal sinus sampling bipss is an essential part of the diagnostic work up of cushings syndrome. Bilateral inferior petrosal sinus sampling bipss is performed to assess the degree of pituitary. Ab in this technical note, the use of desmopressin to stimulate pituitary adrenocorticotropic hormone secretion in place of the commercially available corticotropin releasing hormone crh in bilateral inferior petrosal sinus sampling is described. Identification of patients with cushings disease with negative. Bilateral inferior petrosal sinus sampling bipss with crh. This dural venous sinus emerges from the cavernous sinus within the middle cranial fossa and drains into the internal jugular vein. Testing to aid in the diagnosis can be extensive, time consuming, and can take months to complete. Full text bilateral inferior petrosal sinus sampling in the. Large pituitary adenomas produce elevated acth levels in the petrosal sinuses bilaterally. Inferior petrosal sinus sampling definition of inferior. Full text bilateral inferior petrosal sinus sampling in the diagnosis of.
Pdf neurologic complications of inferior petrosal sinus. Inferior petrosal sinus sampling ipss is considered to be the gold standard for confirming the origin of acth secretion in patients with cushings syndrome. Bilateral inferior petrosal sinus sampling with desmopressin. The purpose of this study was to evaluate the sensitivity of bipss before and after desmopressin stimulation in pediatric cd, and to explore related factors of false. The role of bilateral inferior petrosal sinus sampling in. Some patients might have an unexpected allergic reaction to. Oct 01, 2020 inferior petrosal sinus sampling ipss is known as the gold standard to distinguish whether excessive adrenocorticotropin hormone acth production origins from the pituitary gland or an ectopic source. The aim of this paper is to describe the technique used in inferior petrosal sinus catheterization in our service, emphasizing the solution found for frequent difficulties, and verify the success rate achieved. Inferior petrosal sinus sampling is a procedure that may be required to confirm the source of acthdependent cushings syndrome.
Pdf complications of inferior petrosel sinus sampling. However, due to a number of factors, the value of ipss for adenoma lateralization may be limited. Initially, hypercortisolemia overproduction of cortisol in the. Bilateral inferior petrosal sinus sampling was successfully performed in 12 of consecutive patients with acth. Inferior petrosal sinus sampling ipss plays a vital role in the diagnosis and treatment of cushings disease. By continuing to use our website, you are agreeing to our use of cookies. Oct 29, 2020 inferior petrosal sinus sinus petrosus inferior the inferior petrosal sinus is a paired cranial venous channel that drains the cavernous sinus, midbrain, cerebellum and inner ear. Mar 11, 2014 inferior petrosal sinus corticotroph adenoma pituitary lesion inferior petrosal sinus sampling selective venous sampling these keywords were added by machine and not by the authors. Usefulness of the corticotropinreleasing hormone test during. Inferior petrosal sinus sampling ipss helps differentiate the source of acthdependent hypercortisolism in patients with inconclusive biochemical testing and imaging, and is considered the gold standard for distinguishing cushing disease cd from ectopic acth syndrome eac. Cd was diagnosed if inferior petrosal sinus ips to peripheral adrenocorticotropic hormone acth ratio was 2 at baseline or 3 after desmopressin stimulation. The role of inferior petrosal sinus sampling in the diagnostic localization of cushings disease.
Cortisol is produced by the adrenal glands which sit above the kidneys. Oct 22, 2019 pituitary mri did not identify a pituitary adenoma, while a bilateral inferior petrosal sinus sampling bipss performed in the offphase was indicative of central acth production because of a strong acth increase after corticotrophin release hormone crh injection 100. External jugular venous sampling for cushings disease in. Inferior petrosal sinus blood sampling for acth measurement ipss is used for the differential diagnosis of acthdependent cushings syndrome and for we use cookies to enhance your experience on our website. Bilateral inferior petrosal sinus sampling in the differential diagnosis of adrenocorticotropindependent.
However, if plain radiographs or ct scans provide unequivocally positive findings in cushing syndrome less than 20%, inferior petrosal sinus sampling is not indicated. Wiggam mi, heaney ap, mcilrath em, mccance dr, sheridan b, hadden dr, et al. Simultaneous bilateral inferior petrosal sinus sampling bipss plays a crucial role in the diagnostic workup of cushings syndrome. To evaluate the anatomy of the junction of the inferior petrosal sinus and the internal jugular vein. Whether bipss is capable to localize the correct side of the pituitary. Acth is being produced by the pituitary and may also help in lateralizing the microadenoma although the later is more contentious.
Aug 10, 2018 inferior petrosal sinus sampling ipss is an invasive procedure in which adrenocorticotropic hormone acth levels are sampled from the veins that drain the pituitary gland. Assessment of the inferior petrosal sinus on t1weighted. In addition, variations in size and anatomy are often present between the two inferior petrosal sinuses in a patient. Neurologic complications of inferior petrosal sinus sampling c. Bilateral inferior petrosal sinus sampling ncbi nih. We present a comprehensive approach to interpreting ipss results by examining several real cases. Petrosal sinus sampling in the diagnosis of cushings. Bilateral inferior petrosal sinus sampling bipss is a minimally. Inferior petrosal sinus sampling for acth differentiates pi. Inferior petrosal sinus sampling ipss is a useful diagnostic technique s. Inferior petrosal sinus sampling in the diagnosis of cushing.
Bilateral inferior petrosal sinus sampling bipss is a minimally invasive test performed by interventional radiologists to evaluate challenging cases of cushing syndrome cs. Baseline 0 minute plasma acth value pmoll at post corticotropinreleasing hormone administration 5 minutes 10 15 right inferior petrosal sinus 118. Sampling lateralization was yielded if interpetrosal sinus gradient was 1. Neurologic complications of inferior petrosal sinus sampling. The noninvasive assays used in the workup of cushing syndrome are often misleading or ambiguous, yielding sensitivities of up to only 80%. Inferior petrosal sinus sampling ipss as a diagnostic tool in the differential. Hirsch j, oklu r 2012 the role of bilateral inferior petrosal sinus sampling in the diagnostic evaluation of cushing syndrome. Overall the study concluded that dmri was more accurate than css at localization of adenomas. The anatomy of the anastomoses between the inferior petrosal sinus, the internal jugular vein, and the venous plexuses at the base of the skull varies, but it is almost always possible to catheterize the inferior petrosal sinus.
Inferior petrosal sinus sampling combined with crh is useful in both. Improved diagnostic accuracy of inferior petrosal sinus sampling. Bilateral inferior petrosal sinus sampling is the gold standard diagnostic assay in identifying the pituitary source of adrenocorticotropic hormone secretion in cushing syndrome. A pitfall of bilateral inferior petrosal sinus sampling in. Bilateral inferior petrosal sinus sampling bipss, currently, is the gold standard test for the differential diagnosis of cushings syndrome cs, but few data are available on the efficacy and accuracy of bipss in the qualitative. The effects of sampling lateralization on bilateral. Feb 28, 2021 background inferior petrosal sinus ips sampling ipss is a transvenous interventional procedure performed to diagnose cushings disease. The reported ipss failure rate is approximately 10%. This technique is able to confirm that excess hormone e. The inferior petrosal sinuses connect the cavernous sinuses with the ipsilateral internal jugular veins. Contrast extravasation after bilateral inferior petrosal. The ipsp acth ratio is used to distinguish between cd and eas. Inferior petrosal sinus sa mpling ipss is a procedure that checks. 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 88100% and 67100%, respectively.
Assessment of bilateral inferior petrosal syndrome. Cushings diseasecushings syndrome is one of the most challenging diagnosis in all of endocrinology. A bilateral inferior petrosal sinus sampling bipss performed during a trough phase was false positive for pituitary acth overproduction resulting in unnecessary transsphenoidal surgery while a second bipss performed during an active phase was indicative for ectopic cs. Therefore, inferior petrosal sinus sampling ipss is considered the gold standard for identifying both the origin of tumors and the site of a pituitary adenoma4. Purpose inferior petrosal sinus catheterization and sampling for corticotropin dosage helps to differentiate hypophisary and ectopic forms of cushing syndrome. Anatomy of the junction of the inferior petrosal sinus and. As the goal of bipss is to sample venous outflow from the pituitary gland in. It is our practice to collect a 24h urinary sample for cortisol determination the day. Desmopressin stimulation test in the procedure of bipss, desmopressin stimulation test was conducted after successful catheterization and sampling at 0min. Doppman jl, chang r, oldfield eh, chrousos g, stratakis ca, nieman lk 1999 the hypoplastic inferior petrosal sinus. The inferior petrosal sinus is situated in the inferior petrosal sulcus, formed by the junction of the petrous part of the temporal bone with the basilar part of the occipital bone. Inferior petrosal sinus sampling radiology reference. Infection is controlled by using sterile technique.
Bilateral inferior petrosal sinus sampling bipss is a. Xrays are used but the radiation doses are minimized. During searching, keywords and free words were used simultaneously. 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 acthproducing pituitary adenomas. Subsequent bilateral inferior petrosal sinus sample bipss was performed for the localization diagnosis figure 1d, which demonstrated adrenocorticotrophic hormone acth level of inferior petrosal sinus and femoral vein at 0 min were 691. The inferior petrosal sinus sampling procedure is performed in the radiology department. Differential diagnostic value of bilateral inferior petrosal.
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