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Inferior petrosal sinus sampling

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https://www.readbyqxmd.com/read/28910955/-the-localization-diagnosis-of-patients-with-adrenocorticotropic-hormone-dependent-cushing-s-syndrome-in-adolescence
#1
S Chen, Z X Pan, L Lu, A L Tong, H Pan, H J Zhu, Y Yao, M Feng, R Z Wang, Z L Lu
Objective: To elucidate the clinical characteristics and localization diagnosis of patients with adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (CS) in adolescence. Methods: The clinical data, laboratory examination and localization diagnosis from 35 patients aged less than 18 years old with adolescent CS who were treated at Peking Union Medical College Hospital between January 1990 and March 2012 were analyzed. Results: There were 29 cases of Cushing's disease (CD) and 6 cases of ectopic ACTH syndrome (EAS)...
September 12, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28705797/cyclical-cushing-s-how-best-to-catch-the-ups-and-downs
#2
Malik Asif Humayun, Tanya Hart, Tristan Richardson
A 68-year-old man with a background of hypertension and type 2 diabetes presented with fluctuating symptoms of muscle aches and pains and tiredness. His initial work-up for the possibility of hypercortisolaemia showed a completely variable pattern, with 24-hour cortisol excretion and serum cortisol post 1 mg dexamethasone suppression test ranging from normal to significantly elevated. A series of salivary cortisol with symptom diary confirmed the cyclical nature of hypercortisolaemia, and his concomitant adrenocorticotropic hormone (ACTH) levels were elevated...
July 13, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28680643/a-rare-case-of-an-acth-crh-co-secreting-midgut-neuroendocrine-tumor-mimicking-cushing-s-disease
#3
Regina Streuli, Ina Krull, Michael Brändle, Walter Kolb, Günter Stalla, Marily Theodoropoulou, Annette Enzler-Tschudy, Stefan Bilz
Ectopic ACTH/CRH co-secreting tumors are a very rare cause of Cushing's syndrome and only a few cases have been reported in the literature. Differentiating between Cushing's disease and ectopic Cushing's syndrome may be particularly difficult if predominant ectopic CRH secretion leads to pituitary corticotroph hyperplasia that may mimic Cushing's disease during dynamic testing with both dexamethasone and CRH as well as bilateral inferior petrosal sinus sampling (BIPSS). We present the case of a 24-year-old man diagnosed with ACTH-dependent Cushing's syndrome caused by an ACTH/CRH co-secreting midgut NET...
2017: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/28639924/cushing-syndrome-diagnostic-workup-and-imaging-features-with-clinical-and-pathologic-correlation
#4
REVIEW
Nicolaus A Wagner-Bartak, Ali Baiomy, Mouhammed Amir Habra, Shalini V Mukhi, Ajaykumar C Morani, Brinda R Korivi, Steven G Waguespack, Khaled M Elsayes
OBJECTIVE: Cushing syndrome (CS) is a constellation of clinical signs and symptoms resulting from chronic exposure to excess cortisol, either exogenous or endogenous. Exogenous CS is most commonly caused by administration of glucocorticoids. Endogenous CS is subdivided into two types: adrenocorticotropic hormone (ACTH) dependent and ACTH independent. CONCLUSION: Cushing disease, which is caused by a pituitary adenoma, is the most common cause of ACTH-dependent CS for which pituitary MRI can be diagnostic, with bilateral inferior petrosal sinus sampling useful in equivocal cases...
July 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28626863/prolactin-correction-for-adequacy-of-petrosal-sinus-cannulation-may-diminish-diagnostic-accuracy-in-cushing-s-disease
#5
Sunita M C De Sousa, Ann I McCormack, Shaun McGrath, David J Torpy
OBJECTIVE: Petrosal venous prolactin concentrations have been promoted to improve the diagnostic accuracy of inferior petrosal sinus sampling (IPSS), beyond that achieved with ACTH measurement alone, in diagnosing a pituitary ACTH source and determining corticotrophinoma side (L/R). Our objective was to assess the effect of using prolactin to confirm adequacy of petrosal cannulation in a cohort of patients with ACTH-dependent Cushing's syndrome. DESIGN: Retrospective cohort study...
June 19, 2017: Clinical Endocrinology
https://www.readbyqxmd.com/read/28614036/an-individualized-approach-to-the-evaluation-of-cushing-syndrome
#6
REVIEW
Susmeeta T Sharma
Cushing syndrome (CS) is caused by chronic exposure to excess glucocorticoids. Early recognition and treatment of hypercortisolemia can lead to decreased morbidity and mortality. The diagnosis of CS and thereafter, establishing the cause can often be difficult, especially in patients with mild and cyclic hypercortisolism. Surgical excision of the cause of excess glucocorticoids is the optimal treatment for CS. Medical therapy (steroidogenesis inhibitors, medications that decrease adrenocorticotropic hormone [ACTH] levels or glucocorticoid antagonists) and pituitary radiotherapy may be needed as adjunctive treatment modalities in patients with residual, recurrent or metastatic disease, in preparation for surgery, or when surgery is contraindicated...
June 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28356253/adrenocortical-carcinoma-masquerading-as-cushing-s-disease
#7
Kush Dev Jarial, Rama Walia, Santosh Kumar, Anil Bhansali
Cushing's syndrome (CS) can be classified as adrenocorticotropic hormone (ACTH)-dependent or ACTH-independent depending on the ACTH levels. However, 30% of the patients with CS have ACTH levels in the 'grey zone' (5-20 pg/mL), thereby posing a challenge in establishing the aetiological diagnosis. In a patient with full-blown features of Cushing's syndrome with equivocal ACTH levels, and a pituitary microadenoma on contrast-enhanced MRI sella, can falsely lead to a diagnosis of Cushing's disease. Pituitary microadenoma, if <6 mm in size, may be an incidental finding (incidentaloma) in this scenario and can be present in ∼3-27% of the healthy population...
March 29, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28242132/abducens-nerve-palsy-due-to-inferior-petrosal-sinus-thrombosis
#8
Shivam Om Mittal, Junaid Siddiqui, Bashar Katirji
Isolated unilateral abducens nerve palsy is usually due to ischemia, trauma or neoplasm. Dorello's canal is the space between the petrous apex and superolateral portion of the clivus, bound superiorly by Gruber's ligament. The abducens nerve travels with inferior petrosal sinus (IPS) though the Dorello's canal before entering the cavernous sinus. A 31-year-old man presented with neck pain, and binocular horizontal diplopia, worse looking towards left and at distance. He had a history of intravenous drug abuse but no history of hypertension or diabetes...
February 24, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28225994/a-rare-case-of-ectopic-acth-syndrome-originating-from-malignant-renal-paraganglioma
#9
Esra Tutal, Demet Yılmazer, Taner Demirci, Evrim Cakır, Salih Sinan Gültekin, Bahadır Celep, Oya Topaloğlu, Erman Çakal
Ectopic adrenocorticotropic hormone (ACTH) syndrome is characterized by hypercortisolism due to the hypersecretion of a non-pituitary ACTH-secreting tumor leading to Cushing's syndrome. Only a few cases have been reported previously as causing ectopic ACTH related to paraganglioma. Herein, we present a case of Cushing's syndrome, in who was proved to be attributable to an ACTH-secreting renal malignant paraganglioma. A 40-year-old woman presented with a five-month history of newly diagnosed hypertension and diabetes, weakness, hyperpigmentation, oligomenorrhea, hirsutism, and acneiform lesions...
February 13, 2017: Archives of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28069628/cushing-s-syndrome-a-practical-approach-to-diagnosis-and-differential-diagnoses
#10
REVIEW
Joseph M Pappachan, Christian Hariman, Mahamood Edavalath, Julian Waldron, Fahmy W Hanna
Diagnosis of Cushing's syndrome (CS) and identification of the aetiology of hypercortisolism can be challenging. The Endocrine Society clinical practice guidelines recommends one of the four tests for initial screening of CS, namely, urinary-free cortisol, late night salivary cortisol, overnight dexamethasone suppression test or a longer low-dose dexamethasone suppression test, for 48 hours. Confirmation and localisation of CS requires additional biochemical and radiological tests. Radiological evaluation involves different imaging modalities including MRI with or without different radio-nuclear imaging techniques...
April 2017: Journal of Clinical Pathology
https://www.readbyqxmd.com/read/28003168/endoscopic-endonasal-surgery-for-remission-of-cushing-disease-caused-by-ectopic-intracavernous-macroadenoma-case-report-and-literature-review
#11
Maria Koutourousiou, Welby I Winstead
BACKGROUND: Complete surgical resection of an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma is the gold standard of treatment of Cushing disease. Ectopic location of these adenomas is an extremely rare condition that may compromise the diagnosis and surgical success. We present the first case of an ectopic intracavernous ACTH-secreting macroadenoma totally resected with endoscopic endonasal surgery (EES). CASE DESCRIPTION: A 36-year-old woman presented with Cushing syndrome...
February 2017: World Neurosurgery
https://www.readbyqxmd.com/read/27430447/neuroendocrine-disorders-pituitary-imaging
#12
REVIEW
Alexander Faje, Nicholas A Tritos, Brooke Swearingen, Anne Klibanski
Significant advances in pituitary imaging have taken place in the past several decades, including the introduction of magnetic resonance imaging (MRI). This imaging modality has vastly improved our ability to detect and characterize sellar masses and more accurately characterize the extent and spread of lesions in and around the sella. Intraoperative MRI may help improve the completeness of resection of sellar masses. Other imaging modalities, including magnetic resonance angiography, computed tomography (CT), and CT angiography, have an important role in specific cases...
2016: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/27375832/unmasking-sarcoidosis-following-surgery-for-cushing-disease
#13
Jon E F Diernaes, Anette Bygum, Per L Poulsen
We present a patient with Cushing disease apparently suppressing sarcoidosis, which was unmasked following surgical resection of a pituitary adrenocorticotropin (ACTH)-producing microadenoma. Case report and a short review of the literature published in this area. A 46-year-old Caucasian woman presented with symptoms of hypercortisolism such as progressive weight gain, Cushingoid appearance, proximal myopathy, easy bruising, and amenorrhea. Blood testing including inferior petrosal sinus sampling uncovered an ACTH-producing microadenoma in the right aspect of the anterior pituitary gland for which the patient underwent transphenoidal resection...
January 2016: Dermato-endocrinology
https://www.readbyqxmd.com/read/27352844/bilateral-inferior-petrosal-sinus-sampling
#14
REVIEW
Benedetta Zampetti, Erika Grossrubatscher, Paolo Dalino Ciaramella, Edoardo Boccardi, Paola Loli
Simultaneous bilateral inferior petrosal sinus sampling (BIPSS) plays a crucial role in the diagnostic work-up of Cushing's 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 88-100% and 67-100%, respectively. In the setting of hypercortisolemia, ACTH levels obtained from venous drainage of the pituitary are expected to be higher than the levels of peripheral blood, thus suggesting pituitary ACTH excess as the cause of hypercortisolism...
July 2016: Endocrine Connections
https://www.readbyqxmd.com/read/27214296/venous-sampling-for-cushing-disease-comparison-of-internal-jugular-vein-and-inferior-petrosal-sinus-sampling
#15
COMPARATIVE STUDY
Martin G Radvany, Alfredo Quinones-Hinojosa, Gary L Gallia, Gary S Wand, Roberto Salvatori
OBJECTIVE: Because magnetic resonance imaging (MRI) fails to detect many adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas, inferior petrosal sinus sampling (IPSS) is considered the gold standard to differentiate Cushing disease (CD) from ectopic ACTH secretion syndrome (EAS). Some authors have suggested internal jugular vein sampling (IJVS) as an alternative to IPSS. METHODS: We simultaneously compared IJVS to IPSS in 30 consecutive patients referred for ACTH-dependent Cushing syndrome and equivocal MRI exams...
September 2016: Endocrine Practice
https://www.readbyqxmd.com/read/27186561/bilateral-inferior-petrosal-sinus-sampling-using-vasopressin
#16
Narendra Kotwal, Yogesh Kumar, Vimal Upreti, Amandeep Singh, M K Garg
CONTEXT: Anatomical localization of pituitary adenoma can be challenging in adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome, and bilateral inferior petrosal sinus sampling (BIPSS) is considered gold standard in this regard. Stimulation using corticotrophin-releasing hormone (CRH) improves the sensitivity of BIPSS, however, same is not easily available in India. Therefore, we undertook this study of BIPPS using vasopressin as agent for stimulation owing to its ability to stimulate V3 receptors present on corticotrophs...
May 2016: Indian Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/27169546/management-of-cushing-syndrome-in-children-and-adolescents-experience-of-a-single-tertiary-centre
#17
Maria Güemes, Philip G Murray, Caroline E Brain, Helen A Spoudeas, Catherine J Peters, Peter C Hindmarsh, Mehul T Dattani
UNLABELLED: The diagnosis and management of paediatric Cushing syndrome (CS) is highly challenging. This study aims to characterise its presentation, diagnosis, management and outcome by a retrospective case review of 30 patients (14 females) followed at a single tertiary paediatric endocrinology centre over a 30-year period. At presentation, median age was 8.9 years (0.2-15.5) and the commonest manifestations were weight gain (23/30), hirsutism (17/30), acne (15/30) and hypertension (15/30)...
July 2016: European Journal of Pediatrics
https://www.readbyqxmd.com/read/27104179/a-patient-with-cushing-disease-lateralizing-a-pituitary-adenoma-by-inferior-petrosal-sinus-sampling-using-desmopressin-a-case-report
#18
Joo Hee Lim, Soo Jung Kim, Mo Kyung Jung, Ki Eun Kim, Ah Reum Kwon, Hyun Wook Chae, Duk Hee Kim, Ho-Seong Kim
A 14-year-old girl was referred for evaluation of the etiology of Cushing syndrome. During the previous 2 years, she had experienced weight gain, secondary amenorrhea, growth retardation, and back pain. Random serum cortisol level, 24-hour urinary free cortisol excretion, and overnight and low-dose dexamethasone suppression tests suggested Cushing syndrome. Midnight adrenocorticotropic hormone (ACTH) level and high-dose dexamethasone suppression test confirmed Cushing disease. Pituitary magnetic resonance imaging was suspicious for microadenoma...
March 2016: Annals of Pediatric Endocrinology & Metabolism
https://www.readbyqxmd.com/read/27045643/-use-of-inferior-petrosal-sinus-sampling-during-the-perioperative-periodtreatment-of-cushing-s-disease-with-negative-magnetic-resonance-imaging
#19
Ming Feng, Lin Lu, Xiaohai Liu, Congxin Dai, Xinjie Bao, Kan Deng, Bing Xing, Feng Feng, Huijuan Zhu, Yong Yao, Renzhi Wang
OBJECTIVE: To analyze inferior petrosal sinus sampling (IPSS) in diagnosis and treatment of Cushing's disease with negative magnetic resonance imaging (MRI). METHODS: We retrospectively reviewed 79 cases of Cushing's disease with negative MRI in the Department of Neurosurgery of Peking Union Medical College Hospital from August 2012 to August 2014. Of the 79 patients, 58 underwent IPSS. There were 16 males and 42 females in this study, with age 12 to 65 years old...
March 22, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/26880723/bilateral-inferior-petrosal-sinus-sampling-experience-in-327-patients
#20
Amy Deipolyi, Alexander Bailin, Joshua A Hirsch, T Gregory Walker, Rahmi Oklu
OBJECTIVE: To describe findings and outcomes of 331 bilateral inferior petrosal sinus sampling (BIPSS) procedures performed in 327 patients evaluated for Cushing disease (CD). MATERIALS AND METHODS: The radiology department's electronic database was searched to identify all BIPSS procedures (1990-2013). Electronic medical records were used to identify demographics, laboratory, procedural, surgical and pathologic findings. RESULTS: A total of 331 BIPSS procedures were performed in 327 patients (254 F, 73 M), mean age 41 (range 7-81) years...
February 2017: Journal of Neurointerventional Surgery
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