Inferior petrosal sinus sampling and stimulation with CRH: 15 years of experience in a tertiary hospital

Fernández, Laura González; Ramos, Roberto José Añez; Montenegro, Alejandra Maricel Rivas; Torrecilla, Noemí Brox; González, María Miguélez; Moreno, Diego Muñoz; Goñi, Jose Atencia; Weber, Bernhard; Guerra, Aurelio López; Ishishi, Yoko Lucía Olmedilla; Hualpa, Juan Carlos Pércovich; Albarrán, Olga González; Centeno, Rogelio García

doi:10.1016/j.endien.2021.10.006

Cited by 2 publications

(1 citation statement)

References 37 publications

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“…Regarding the diagnostic performance data, accuracy rates between 90 % and 100 % can be found in the literature [18]. Previous studies and meta-analyses demonstrated improved diagnostic accuracy when CRH stimulation is performed [19,20]. We found basal accuracy rates of 89 %, which could be further increased to 98 % by utilizing CRH stimulation in our cohort.…”

Section: Discussionsupporting

confidence: 50%

Bilateral inferior petrosal sinus sampling: Procedural data from a German single-center study

Augustin

Detomas

Hartung

et al. 2023

Rofo

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Purpose To assess radiation exposure and diagnostic performance of bilateral inferior petrosal sinus sampling for the distinction of pituitary and ectopic adrenocorticotropin-dependent Cushingʼs syndrome. Materials and Methods Procedural data of bilateral inferior petrosal sinus procedures were retrospectively evaluated. The analysis included the patients’ clinical and demographic data, procedural radiation exposure, and complication rates, sampling results, clinical course of the patients, and calculation of diagnostic performance data. Results The cases of 46 patients diagnosed with adrenocorticotropin-dependent Cushingʼs syndrome were evaluated. Bilateral inferior petrosal sinus sampling was successfully performed in 97.8 % of the cases. The overall median procedure-related fluoroscopy time was 7.8 min. (range 3.2–36.2 min.), and the median procedural dose area product was 11.9 Gy*cm2 (range 2.1–73.7 Gy*cm2). Radiation doses due to digital subtraction angiography series for visualization of the inferior petrosal sinus were 3.6 Gy*cm2 (range 1.0–18.1 Gy*cm2). Radiation doses due to fluoroscopy had a higher impact on the overall radiation exposure and were significantly influenced by the patients’ habitus. The sensitivity, specificity, and positive and negative predictive values were 84 %, 100 %, 100 %, and 72 % before stimulation with corticotropin-releasing hormone, and 97 %, 100 %, 100 %, and 93 % after stimulation. Concordance between magnetic resonance imaging studies and bilateral inferior petrosal sinus sampling results was only found in 35.6 % of the cases. The periprocedural complication rate was 2.2 %, with one patient experiencing vasovagal syncope during catheterization. Conclusion Bilateral inferior petrosal sinus sampling is a safe procedure with high technical success rates und excellent diagnostic performance. The procedure-related radiation exposure shows large variations and depends on the complexity of cannulation as well as the patients’ habitus. Fluoroscopy accounted for the largest proportion of radiation exposure. Acquisition of digital subtraction angiography series for the verification of correct catheter placement appears justified. Key Points: Citation Format

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Section: Discussionsupporting

confidence: 50%

Bilateral inferior petrosal sinus sampling: Procedural data from a German single-center study

Augustin

Detomas

Hartung

et al. 2023

Rofo

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Relevance of inferior petrosal sinus sampling in the diagnosis of Cushing’s syndrome: a case report

García

Sirera

Quesada

et al. 2022

Advances in Laboratory Medicine / Avances en Medicina De Laboratorio

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Objectives Non-specific signs and symptoms of Cushing’s syndrome (CS) can pose a diagnostic challenge. Case presentation We report the case of a man referred to the service of endocrinology for suspected CS. Hypercortisolism was confirmed on CS screening tests, whereas diagnostic tests confirmed the presence of adrenocorticotropin (ACTH) -dependent CS. The corticotropin-releasing hormone stimulation (CRH) test was performed to determine whether CS had an endogenous or ectopic origin. Since the CRH and the magnetic resonance imaging (MRI) test were negative, IPSS was performed and suggested that CS was originated in the pituitary glands. Transsphenoidal pituitary resection was carried out. Histopathological analysis confirmed the cortitotrope origin of the tumor. Conclusions The etiological study and differential diagnosis of CS are complex processes that involve a variety of biochemical and imaging tests. It is important that a sequence of biochemical screening and diagnostic tests is performed, along with studies for establishing the location of the lesion, to determine whether CS has an adrenal, pituitary or ectopic origin. Despite its good diagnostic performance, the results of biochemical tests may not be conclusive, especially in ACTH-dependent CS. In the case reported, the inconclusive results obtained in the CRH test rendered an invasive procedure (IPSS) necessary, which ultimately confirmed diagnosis.

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Inferior petrosal sinus sampling and stimulation with CRH: 15 years of experience in a tertiary hospital

Cited by 2 publications

References 37 publications

Bilateral inferior petrosal sinus sampling: Procedural data from a German single-center study

Bilateral inferior petrosal sinus sampling: Procedural data from a German single-center study

Relevance of inferior petrosal sinus sampling in the diagnosis of Cushing’s syndrome: a case report

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