Petrosal sinus sampling an overview sciencedirect topics. Inferior petrosal sinus sampling is recommended in cases of cushings syndrome in which clinical, biochemical, or imaging studies have not clearly identified either a pituitary or an ectopic origin of the acth production. Bilateral inferior petrosal sinus sampling with desmopressin. Inferior petrosal sinus sampling radiology reference.
Home csrf forums public inferior petrosal sinus sampling ipss what to expect. Inferior petrosal sinus sampling in the diagnosis of. Ten of the patients subsequently had transsphenoidal pituitary microsurgery. Catheters are inserted through the femoral veins and threaded to the petrosal sinuses. Large pituitary adenomas produce elevated acth levels in the petrosal sinuses bilaterally. Cushings diseasecushings syndrome is one of the most challenging diagnosis in all of endocrinology. Inferior petrosal sinus sampling ucla interventional. However, if plain radiographs or ct scans provide unequivocally positive findings in cushing syndrome less than 20%, inferior petrosal sinus sampling is not indicated. Bilateral inferior petrosal sinus sampling ipss a procedure that uses desmopressin to determine levels of acth hormone from veins that drain from the pituitary gland, is a sensitive way to diagnose patients with cushings disease and find tumors, a chinese study shows. Newer techniques improving diagnostic accuracy and reducing complications. Bilateral inferior petrosal sinus sampling is the most reliable test to differentiate cushings disease from ectopic adrenocorticotropic hormone acth production.
Jul 01, 2016 simultaneous bilateral inferior petrosal sinus sampling bipss plays a crucial role in the diagnostic workup of cushings syndrome. Inferior petrosal sinus sampling ipss plays a vital role in the diagnosis and treatment of cushings disease. Inferior petrosal sinus sampling ipss is used for localization andor lateralization in patients when the lesion in the pituitary gland cannot be observed using radiological imaging techniques. Ipss involves simultaneous blood sampling for acth from the right inferior petrosal sinus ips, left ips, and a peripheral vein both before and after corticotropinreleasing hormone crh stimulation. Infection is controlled by using sterile technique. Sampling is then repeated from both sinuses and a peripheral vein, at 2, 5 and 10 minutes after crh infusion. Cortisol is produced by the adrenal glands which sit above the kidneys. 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. Doppman jl, chang r, oldfield eh, chrousos g, stratakis ca, nieman lk 1999 the hypoplastic inferior petrosal sinus. The authors present an overview of ipssboth the technique and its interpretationas well as a summary of recent studies. The role of bilateral inferior petrosal sinus sampling in the diagnosis. Inferior petrosal sinus sampling in the diagnosis of cushing. To investigate the value of prolactin as an independent marker of catheter placement to improve the diagnostic accuracy of inferior petrosal sinus sampling ipss in patients with corticotropindependent cushing syndrome. Determining the cause of cushings syndrome can be dif.
Bilateral inferior petrosal sinus sampling bipss is performed to. The procedure is believed to be safe, with mostly minor complications. Inferior petrosal sinus sampling in the differential. Acth is being produced by the pituitary and may also help in lateralizing the microadenoma although the. Bekci t, belet u, soylu ai, uzunkaya f, ozturk m, atmaca a. Inferior petrosal sinus sampling ipss is used for localization andor latcite this article as. Testing to aid in the diagnosis can be extensive, time consuming, and can take months to complete. Request pdf bilateral inferior petrosal sinus sampling bilateral inferior petrosal sinus sampling, the gold standard assay in diagnosing pituitary secretion of adrenocorticotropic hormone in. When this occurs, bilateral inferior petrosal sinus sampling is needed to determine whether the case is caused by a pituitary adenoma or an ectopic adrenocorticotropic hormoneproducing tumor. We assessed the efficacy of this technique in 43 patients and defined a cutoff value for highest sensitivity and specificity. Initially, hypercortisolemia overproduction of cortisol in the. Neurologic complications of inferior petrosal sinus sampling.
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. Pdf bilateral inferior petrosal sinus sampling researchgate. Bilateral inferior petrosal sinus sampling bipss is a. Objective to describe findings and outcomes of 331 bilateral inferior petrosal sinus sampling bipss procedures performed in 327 patients evaluated for cushing disease cd. Full text bilateral inferior petrosal sinus sampling in the. Bilateral inferior petrosal sinus sampling bipss is sensitive and specific, and is therefore the gold standard assay for diagnosing cd.
Picture of contrast injection of the inferior petrosal sinuses. Diagnosing cushings disease when standard tests are. Reduction of falsenegative results in inferior petrosal. Petrosal sinuses are a group of veins on both sides of the head.
However, there are rare, but severe, neurologic complications that need to be considered. Inferior petrosal sinus sampling in the differential diagnosis of cushings syndrome. The aim of our study was to evaluate this procedure as a diagnostic tool in the diagnosis of cd and eas. Bilateral inferior petrosal sinuses sampling in the. Catheters, whether preshaped polyethylene or coaxial tracker systems, are supple and atraumatic. Bilateral inferior petrosal sinus sampling request pdf. Inferior petrosal sinus sampling ucla interventional neuroradiology. Inferior petrosal sinus sampling ipss is planned for the patient with an initial diagnosis of cushings disease, and a lesion with a diameter of 4 mm in the right half of pituitary gland is detected in the magnetic resonance imaging. Therefore, if the patient has pituitary cushings, the acth levels in the ips are. 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. A pitfall of bilateral inferior petrosal sinus sampling in. 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.
Electronic medical records were used to identify demographics, laboratory, procedural. Bipss technique the most important recent advance in the diagnostic evaluation of patients with cushings syndrome has been the use of bilateral inferior petrosal sinus sampling bipss for acth the inferior petrosal sinuses receive drainage from the pituitary gland without mixture of blood from other sources. Efficiency of inferior petrosal sinus sampling in the. It begins below and behind the cavernous sinus and, passing through the anterior part of the jugular foramen, ends in the superior bulb of the internal jugular vein. Viewing 10 posts 1 through 10 of 10 total author posts may 11, 2016 at 11. Bilateral inferior petrosal sinuses sampling bipss is an invasive and elaborate but established procedure in distinguishing cushings disease cd from ectopic adrenocorticotropic hormone acth syndrome. Major variations in the inferior petrosal sinus are extremely rare. Some patients might have an unexpected allergic reaction to the dye used during the study. Inferior petrosal sinus sampling ipss is a useful diagnostic technique in adrenocorticotropic hormone acthdependent hypercortisolism with normal or equivocal mr imaging. Petrosal sinus sampling imaging glossary patients ur. Agree a date for the procedure with the patient, the mu charge nurse and. Background bilateral inferior petrosal sinus sampling bipss following corticotropicreleasing hormone crh stimulation is the current gold standard technique in the diagnosis of cushing disease. Inferior petrosal sinus sampling ipss as a diagnostic tool in the.
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 is considered the criterion standard for localizing adrenocorticotropic hormone. Inferior petrosal sinus sampling vanderbilt health. Inferior petrosal sinus sampling ipss as a diagnostic tool in the differential diagnosis between pituitarydependent and ectopic acth syndrome was established in the 1970s 1, 23, 24, 25. Inferior petrosal sinus sampling ipss what to expect. Hirsch j, oklu r 2012 the role of bilateral inferior petrosal sinus sampling in the diagnostic evaluation of cushing syndrome. Bilateral inferior petrosal sinus sampling was successfully performed in 12 of consecutive patients with acth. Background peripheral venous sampling for the diagnosis and localization of.
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. Prolactin measurement during inferior petrosal sinus. Bilateral inferior petrosal sinus ips sampling after ovine corticotropinreleasing hor. Bilateral inferior petrosal sinus sampling ncbi nih. This is an outpatient procedure where the patient is awake throughout the test. However, as a result of crh shortage, desmopressin ddavp has been used instead for bipss. Despite the fact that bipss is an invasive procedure, the occurrence of. Petrosal sinus sampling in diagnostic evaluation of acth. Pdf neurologic complications of inferior petrosal sinus.
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. Inferior petrosal sinus sampling an overview sciencedirect topics. To analyze results of the technique and meaning in each of the processes. Using a previously described classification system, we prospectively classified venous anatomy bilaterally in 5 of 6 persons consecutively undergoing inferior petrosal sinus sampling. Pituitary computed tomography ct shows poor specificity and sensitivity about 47%, whereas the sensitivity is about 5060% in magnetic resonance. Because magnetic resonance imaging mri fails to detect many adrenocorticotropic hormone acthsecreting pituitary adenomas, inferior petrosal sinus sampling ipss is considered the gold standard to differentiate cushing disease cd from ectopic acth secretion syndrome eas. Inferior petrosal sinus sampling definition of inferior. Pdf simultaneous bilateral inferior petrosal sinus sampling bipss is an essential. Type a venous drainage into the internal jugular vein is via a single inferior petrosal sinus anterior condylar vein may or may not be in communication.
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. We present the experience of a single tertiary care center using the modified bipss protocol and. The value of inferior petrosal sinus sampling in diagnosis. 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. Inferior petrosal sinus an overview sciencedirect topics.
Full text bilateral inferior petrosal sinus sampling in. Inferior petrosal sinus sampling is a procedure that may be required to confirm the source of acthdependent cushings syndrome. Acth testing for cushings syndrome and cushings disease. Direct inferior petrosal sinus sampling ipss for acth is considered by many to be the most accurate test for this differential diagnosis. Type c ips drains into the vertebral venous plexus via the anterior. Desmopressin is promising alternative in diagnosing. Bipss is an interventional radiology procedure in which acth levels obtained from venous drainage very near the pituitary gland are compared to peripheral. Materials and methods the radiology departments electronic database was searched to identify all bipss procedures 199020. The procedure must be undertaken in the presence of.
Bilateral inferior petrosal sinuses sampling in the routine. All samples are taken into edta tubes, for immediate centriguation, to be assayed for acth only. Inferior petrosal sinus sampling ipss is considered to be the gold standard for confirming the origin of acth secretion in patients with cushings syndrome. The role of inferior petrosal sinus sampling in the.
Inferior petrosal sinus sampling ipss is a useful diagnostic. The diagnostic efficiency of ipss in the differentiation of pituitary. Inferior petrosal venous sinus sampling springerlink. Selective venous sampling from the cavernous sinuses is not a more reliable technique than sampling from the inferior petrosal sampling in cushings 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 88100% and 67100%, respectively. 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 in healthy human subjects. Bilateral inferior petrosal sinus sampling is the gold standard diagnostic assay in identifying the pituitary source of adrenocorticotropic hormone secretion in cushing syndrome. Tips of the catheters in the inferior petrosal sinuses. Inferior petrosal sinus sa mpling ipss is a procedure that checks. Mar 20, 2016 anatomical variants of the inferior petrosal sinus ips.
In addition, variations in size and anatomy are often present between the two inferior petrosal sinuses in a patient. Acth is being produced by the pituitary and may also help in lateralizing the microadenoma although the later is more contentious. Aug 07, 2018 inferior petrosal sinus sampling ipss is used for localization andor lateralization in patients when the lesion in the pituitary gland cannot be observed using radiological imaging techniques. There is no simple answer to a rare complication of inferior. Inferior petrosal sinus sampling endocrinology diagnosis. The petrosal sinuses are the veins at the base of the skull that drain the pituitary. The most robust test to distinguish cushings disease from the ectopic acth syndrome is inferior petrosal sinus sampling ipss. Inferior petrosal venous sinus sampling request pdf. The inferior petrosal sinus sampling procedure is performed in the radiology department. Overall, the inferior petrosal sinus sampling procedure involves minimal discomfort. Diagnostic errors after inferior petrosal sinus sampling. Results of inferior petrosal sinus sampling using ddavp as stimulus stimulus ddavp acth pgml 0 min acth 3 min acth 5 min acth 10 min acth 15 min acth 30 min right inferior petrosal 77 60 59 54 58 66 left inferior petrosal 53 56 59 54 59 52 peripheral 43 48 51 52 53 48.
Simultaneous, bilateral sampling of the inferior petrosal sinuses is extremely sensitive, specific, safe, and accurate. Its principal use is for the differential diagnosis of. Bilateral inferior petrosal sinus sampling in the diagnosis. A corticotropin gradient sample via bipss is required to confirm diagnosis when pituitary mri imaging and biochemical diagnostic tests have been inconclusive. 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. A catheter is placed into a vein in each leg like for an angiogram of the heart and threaded up into the jugular vein on either side of the neck. To evaluate the anatomy of the junction of the inferior petrosal sinus and the internal jugular vein.
The full text of this article hosted at is unavailable due to technical difficulties. 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. Some authors have suggested internal jugular vein sampling ijvs as an alternative to ipss. This technique is able to confirm that excess hormone e. Ips sampling ipss was devised in an attempt to improve. Adrenocorticotropic hormonedependent cushings syndrome. Theile described drainage of this sinus into the superior thyroid vein. Bilateral inferior petrosal sinuses sampling bipss is an invasive and elaborate but established procedure in distinguishing cushings disease cd from. Full text bilateral inferior petrosal sinus sampling in the diagnosis of. Catheterization and sampling of the inferior petrosal sinuses was performed as previously described 32. Bilateral inferior petrosal sinus sampling bipss is a minimally. This example shows elevation of acth in the right inferior petrosal sinus, likely indicating a tumor in the right side of the pituitary gland causing cushings disease.
Inferior petrosal sinus sampling in the diagnostic evaluation. 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. The detailed protocol for inferior petrosal sinus sampling is beyond the scope of this guide. Check venograms performed prior to inferior petrosal sinus sampling, immediately prior to stimulation crf 100ug iv and after the procedure. Xrays are used but the radiation doses are minimized. Inferior petrosal sinus sampling ipss distinguishes pituitary.
This handout explains a procedure called inferior petrosal sinus sampling. Neurologic complications of inferior petrosal sinus sampling ajnr. Jul 01, 2016 this video covers the anatomy of the petrosal sinuses superior and inferior petrosal sinus, their location, drainage and function. Since 1995, we substituted crh by desmopressin in bilateral inferior petrosal sinus sampling ipss. Anatomy of the junction of the inferior petrosal sinus and. This process is experimental and the keywords may be updated as the learning algorithm improves. Inferior petrosal sinus sampling ipss test you are being tested for cushings syndrome, a condition whereby your body produces excessive amounts of cortisol hormone. Thromboembolic complications after inferior petrosal sinus sampling in patients with cushings syndrome. A tiny catheter is then threaded through each of these catheters into the petrosal sinus on both sides of the pituitary gland. Simultaneous bilateral inferior petrosal sinus sampling bipss plays a crucial role in the diagnostic workup of cushings syndrome. 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. Patients are typically given a mild sedative and a local anesthetic. In a small fraction of cushings disease cases, the results of all standard tests are nondiagnostic.
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