ACTH Determination in a Petrosal Sinus Venous Specimen after Corticotrophin Releasing Factor Provides the Best Clue on the Laterality of Microadenoma in Cushing's Disease.

Yamada, Shozo; Shishiba, Yoshimasa; Sawano, Shinzi; Aiba, Tadashi

doi:10.1507/endocrj1954.36.269

Cited by 3 publications

(1 citation statement)

References 19 publications

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“…Nevertheless, all achieved remission. Several studies have shown that using BSimIPSS with CRH stimulation, lateralisation of the adenoma within the pituitary gland may be achieved (1, 14, 16,35) in some or all patients, and hemihypophysectomy of the suspected side has been advised if an adenoma cannot be identified during surgical exploration. Others, however, have found lateralisation by inferior petrosal sinus sampling to be misleading (17,21), and in one report the intraoperative measurement of ACTH in the peri-pituitary blood was used to correct the misleading results from inferior petrosal sinus sampling (36).…”

Section: Journal Of Endocrinology (1998) 139mentioning

confidence: 99%

Bilateral sequential inferior petrosal sinus sampling with corticotrophin-releasing hormone stimulation in the diagnosis of Cushing's disease

Padayatty

Orme²,

Nelson³

et al. 1998

European Journal of Endocrinology

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Objective: The demonstration of a central to peripheral ACTH gradient in a hypercortisolaemic patient is diagnostic of Cushing's disease. We tried to determine whether single blood samples for ACTH obtained sequentially from each of the inferior petrosal sinuses following human corticotrophin-releasing hormone (hCRH) stimulation can reliably establish such a gradient. Design: Prospective study. Patients: Seventeen patients with clinical and biochemical features of Cushing's syndrome. Methods: After the administration of hCRH, the patients underwent bilateral sequential inferior petrosal sinus sampling, with a single blood sample obtained from each of the inferior petrosal sinuses sequentially, along with a peripheral venous sample. The petrosal sinus catheter was withdrawn immediately after obtaining a blood sample. Patients did not require indwelling catheters in the petrosal sinuses, nor heparinisation. Results: Bilateral sequential inferior petrosal sinus sampling correctly identified a pituitary source of ACTH, as shown by a central to peripheral ACTH ratio >2, in all patients in whom the procedure was successfully carried out. All patients underwent transsphenoidal pituitary surgery resulting in remission. Conclusions: The simplified method of inferior petrosal sinus sampling, using a single sequential sample from each of the inferior petrosal sinuses, following initial hCRH stimulation, is as accurate as the more complex test using multiple bilateral simultaneous inferior petrosal sinus samples. It avoids the use of indwelling cerebral venous catheters and is therefore unlikely to cause brain stem damage.

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