Objective to describe findings and outcomes of 331 bilateral inferior petrosal sinus sampling bipss procedures performed in 327 patients evaluated for cushing disease. The occult ectopic acth syndrome is a common form of acthdependent hypercortisolism that cannot be distinguished from cushings disease with routine clinical studies. 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. Full text bilateral inferior petrosal sinus sampling in the diagnosis of. Cortisol is produced by the adrenal glands which sit above the kidneys. Inferior petrosal sinus radiology reference article. Ectopic cushings syndrome in a patient with inferior. Full text bilateral inferior petrosal sinus sampling in the. Ipss involves simultaneous blood sampling for acth from the right inferior petrosal sinus. Jul 01, 2016 this video covers the anatomy of the petrosal sinuses superior and inferior petrosal sinus, their location, drainage and function. However, if plain radiographs or ct scans provide unequivocally positive findings in cushing syndrome less than 20%, inferior petrosal sinus sampling. Initially hypercortisolism is confirmed urinary free cortisol, latenight salivary. The trust provides free monthly health talks on a variety of medical conditions and treatments. Petrosal definition of petrosal by the free dictionary.
Selective use of bilateral inferior petrosal sinus sampling in patients with. The aim of our study was to evaluate this procedure as a diagnostic tool in the diagnosis of cd and eas. Simultaneous bilateral inferior petrosal sinus sampling bipss is an essential part of the diagnostic work up of 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. Some of the biochemical diagnostic tests used include salivary and blood serum cortisol testing, 24hour urinary free cortisol ufc testing, the dexamethasone suppression test dst, and bilateral inferior petrosal sinus sampling.
Inferior petrosal sinus sampling radiology reference. 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. A pitfall of bilateral inferior petrosal sinus sampling in. Bilateral inferior petrosal sinus sampling provide a useful tool to the physician in solving this complex riddle. Inferior petrosal sinus sampling in healthy subjects reveals a unilateral corticotropinreleasing hormoneinduced arginine vasopressin. Background bilateral inferior petrosal sinus sampling bipss following corticotropicreleasing hormone crh stimulation is the current gold standard technique in. Bilateral inferior petrosal sinus sampling bipss is sensitive and specific, and is therefore the gold standard assay for diagnosing cd.
Catheters are inserted through the femoral veins and threaded to the 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. 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. 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. Picture of contrast injection of the inferior petrosal sinuses. Inferior petrosal sinus sampling is a procedure that may be required to confirm the source of acthdependent cushings syndrome.
It is often a plexus of venous channels rather than a true sinus and drains blood from the cavernous sinus to the jugular bulb. Inferior petrosal sinus sampling ipss is a useful diagnostic technique in adrenocorticotropic hormone acthdependent hypercortisolism with normal or equivocal mr imaging. Catheters are inserted through the femoral veins and threaded to the petrosal sinuses. Bilateral inferior petrosal sinus sampling bipss with simultaneous.
Patient information sheet bilateral inferior petrosal sinus. In the management of adrenocorticotropic hormone acthdependent cushings syndrome, inferior petrosal sinus sampling ipss provides information for the endocrinologist, the. Pdf simultaneous bilateral inferior petrosal sinus sampling bipss is an. Since 1995, we substituted crh by desmopressin in bilateral inferior petrosal sinus sampling ipss. Direct inferior petrosal sinus sampling ipss for acth is considered by many to be the most accurate test for this differential diagnosis. Inferior petrosal sinus sampling vanderbilt health.
Inferior petrosal sinus sampling is the best test to distinguish between a. Cushings diseasecushings syndrome is one of the most challenging diagnosis in all of endocrinology. Inferior petrosal sinus sampling in healthy subjects reveals a unilateral corticotropinreleasing hormoneinduced arginine vasopressin release associated with ipsilateral adrenocorticotropin secretion. Large pituitary adenomas produce elevated acth levels in the petrosal sinuses bilaterally. Inferior petrosal sinus sampling ipss what to expect. Inferior petrosal sinuses definition of inferior petrosal. Bilateral inferior petrosal sinus sampling bipss is the best test for distinguishing acthdependent forms of cushings syndrome, as long as the patient has active hypercortisolemia, which should be confirmed at the time of the procedure. Inferior petrosal sinus definition of inferior petrosal. Urinefree cortisol in the highdose dexamethasone suppression test for the. Bilateral inferior petrosal sinus sampling is the gold standard diagnostic assay in identifying the pituitary source of adrenocorticotropic hormone secretion in cushing syndrome. 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. However, there are rare, but severe, neurologic complications that need to be considered. Synonyms for inferior petrosal sinus in free thesaurus.
All samples are taken into edta tubes, for immediate centriguation, to be assayed for acth only. The detailed protocol for inferior petrosal sinus sampling. Routine inferior petrosal sinus sampling in the differential. Cyclic cushing syndrome due to an ectopic pituitary. In a small fraction of cushings disease cases, the results of all standard tests are nondiagnostic. Lateralization accuracy of inferior petrosal sinus. Inferior petrosal sinus sampling ipss as a diagnostic tool in the differential. Bilateral inferior petrosal sinus sampling how is bilateral. Petrosal sinuses are a group of veins on both sides of the head. Part of the techniques in interventional radiology book series techrad. Petrosal sinus definition of petrosal sinus by the free. Home csrf forums public inferior petrosal sinus sampling ipss what to expect. 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.
Inferior petrosal venous sinus sampling springerlink. Inferior petrosal sinus sampling ipss plays a vital role in the diagnosis and treatment of cushings disease. Diagnostic errors after inferior petrosal sinus sampling. Bilateral inferior petrosal sinus sampling using desmopressin. Basal plasma acth, serum cortisol and urinary free. Initially, hypercortisolemia overproduction of cortisol in the.
With the patient on the angiography table both groin regions are partially shaved, sterilized, and a local anesthetic is injected into the skin to provide pain relief. The inferior petrosal sinus sampling procedure is performed in the radiology department. Inferior petrosal sinus sampling is an infrequently used method of confirming the presence of a hormonally. Pdf neurologic complications of inferior petrosal sinus. Inferior petrosal sinus sampling in healthy human subjects. Petrosal sinus article about petrosal sinus by the free. 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. Bilateral inferior petrosal sinus sampling in the diagnosis of cushing disease. The lateralization accuracy of inferior petrosal sinus. Each inferior petrosal sinus drains the cavernous sinus. Inferior petrosal venous sinus sampling request pdf. Inferior petrosal sinus sampling radiology reference article.
Inferior petrosal sinus sampling definition of inferior. This video covers the anatomy of the petrosal sinuses superior and inferior petrosal sinus, their location, drainage and function. Inferior petrosal definition of inferior petrosal by. Anatomical variations may interfere with bilateral inferior petrosal sinus sampling resultsanatomik varyasyonlar bilateral petrozal sinus orneklemesi sonuclarini etkileyebilir the superior and inferior petrosal sinuses are also drained into cavernous sinus. 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.
However, as a result of crh shortage, desmopressin ddavp has been used instead for bipss. Inferior petrosal sinus sampling an overview sciencedirect topics. This is an outpatient procedure where the patient is awake throughout the test. Inferior petrosal sinus sampling ipss is a useful diagnostic technique in adrenocorticotropic hormone acthdependent hypercortisolism with. Jul 01, 2016 simultaneous bilateral inferior petrosal sinus sampling bipss plays a crucial role in the diagnostic workup of cushings syndrome. The detailed protocol for inferior petrosal sinus sampling is beyond the scope of this guide.
Inferior petrosal sinus article about inferior petrosal. This technique is able to confirm that excess hormone e. 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. Inferior petrosal sinus synonyms, inferior petrosal sinus. Anatomical variations may interfere with bilateral inferior petrosal sinus sampling resultsanatomik varyasyonlar bilateral petrozal sinus orneklemesi sonuclarini etkileyebilir. Inferior petrosal sinus sampling in the differential. Bilateral simultaneous inferior petrosal sinus sampling ipss is used.
A corticotropin gradient sample via bipss is required to confirm diagnosis when pituitary mri imaging and biochemical diagnostic tests have been inconclusive. Bilateral inferior petrosal sinus sampling introduction you have been diagnosed with cushings syndrome, a condition where there is excessive production of cortisol by your adrenal glands in your case, your adrenal glands are being stimulated by excessive production of. The inferior petrosal sinuses are two small sinuses situated on the inferior border of the petrous part of the temporal bone, one on each side. Each inferior petrosal sinus drains the cavernous sinus into the internal jugular vein. Diagnosing cushings disease when standard tests are. When this occurs, bilateral inferior petrosal sinus sampling is needed to. The inferior petrosal sinus is situated in the inferior petrosal sulcus, formed by the. Challenges in diagnosis of disease reported 100 years back.
Original research bilateral inferior petrosal sinus sampling. Overall, the inferior petrosal sinus sampling procedure involves minimal discomfort. Jci inferior petrosal sinus sampling in healthy subjects. Simultaneous, bilateral sampling of the inferior petrosal sinuses is extremely sensitive, specific, safe, and accurate. Inferior petrosal sinus sampling is considered the criterion standard for localizing adrenocorticotropic hormone. Inferior petrosal sinus sampling ucla interventional. We assessed the efficacy of this technique in 43 patients and defined a cutoff value for highest sensitivity and specificity. The procedure is believed to be safe, with mostly minor complications. Pdf bilateral inferior petrosal sinus sampling researchgate.
Neurologic complications of inferior petrosal sinus sampling. A depression or cavity formed by a bending or curving. In addition, variations in size and anatomy are often present between the two inferior petrosal sinuses in a patient. Bilateral inferior petrosal sinus sampling bipss is a minimally invasive test performed by interventional radiologists to evaluate challenging cases of cushing syndrome cs. The aim of our study was to evaluate this procedure as a diagnostic. Inferior petrosal sinus sampling endocrinology diagnosis.
As the goal of bipss is to sample venous outflow from the pituitary gland in. Testing to aid in the diagnosis can be extensive, time consuming, and can take months to complete. Using a previously described classification system, we prospectively classified venous anatomy bilaterally in 5 of 6 persons consecutively undergoing inferior petrosal sinus sampling. Xrays are used but the radiation doses are minimized. Assessment of bilateral 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. 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. Full text bilateral inferior petrosal sinus sampling in. In addition, variations in size and anatomy are often present between the two inferior petrosal. Inferior petrosal sinus sampling ipss was performed only in one patient and confirmed the diagnosis of cd.
The inferior petrosal sinus is one of the dural venous sinuses. To evaluate the anatomy of the junction of the inferior petrosal sinus and the internal jugular vein. Bilateral inferior petrosal sinus sampling ncbi nih. A cause of cs is cushing disease cd, which is hypercortisolemia due to excess pituitary secretion of adrenocorticotropic hormone acth, which stimulates adrenal cor. 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. Patients are typically given a mild sedative and a local anesthetic. A critical analysis of the value of simultaneous inferior petrosal sinus sampling in cushings disease and the occult ectopic adrenocorticotropin syndrome. Viewing 10 posts 1 through 10 of 10 total author posts may 11, 2016 at 11.
Petrosal sinus sampling in diagnostic evaluation of acth. Reported 90% sensitivity, 67% specificity, 99% ppv, 20% npv using inferior petrosal sinus sampling. We present the experience of a single tertiary care center using the modified bipss protocol and compare. It is often a plexus of venous channels rather than a true sinus and drains blood from the cavernous sinus to the jugular bulb through the jugular foramen pars nervosa or sometimes via a vein which passes through the hypoglossal canal to the suboccipital venous plexus. Acth is being produced by the pituitary and may also help in lateralizing the microadenoma although the. Inferior petrosal sinus sampling ipss test you are being tested for cushings syndrome, a condition whereby your body produces excessive amounts of cortisol hormone. Petrosal sinus sampling an overview sciencedirect topics. Direct sampling from the cavernous sinus might possibly compensate for the problems due to an atrophic or plexiform inferior petrosal sinus. Inferior petrosal sinus sampling in the diagnosis of cushing. Bilateral inferior petrosal sinus sampling bipss is a minimally. Inferior petrosal sinus sa mpling ipss is a procedure that checks. The accurate differential diagnosis of acthdependent cushings syndrome requires bilateral inferior petrosal sinus acth sampling with ocrh stimulation. Pdf the role of inferior petrosal sinus sampling in acth.
Inferior petrosal sinus sampling in the diagnosis of. Background bilateral inferior petrosal sinus sampling bipss following corticotropicreleasing hormone crh stimulation is the current gold standard technique in the diagnosis of cushing disease. This handout explains a procedure called inferior petrosal sinus sampling. Inferior petrosal sinus sampling ipss is an invasive procedure in which. Inferior petrosal sinus sampling is an invasive test in which the venous channels draining pituitary gland are sampled for acth levels. Bilateral inferior petrosal sinus sampling bipss is a. Acth is being produced by the pituitary and may also help in lateralizing. Assessment of bilateral inferior petrosal sinus sampling bipss in the diagnosis of cushings disease liangyu lin1, michael muhuo teng 2,4, chuni huang3,4, wenya ma5, kangling. Anatomy of the junction of the inferior petrosal sinus and. 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. Sampling is then repeated from both sinuses and a peripheral vein, at 2, 5 and 10 minutes after crh infusion. Management the cyclic nature of cushing syndrome was suggested by the absence of hypercortisolemia during inferior petrosal sinus sampling, and was confirmed by multiple 24 h urine free. It is our practice to collect a 24h urinary sample for cortisol.