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Inferior petrosal sinus sampling

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
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
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
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
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
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
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
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]
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 15, 2016: Journal of Neurointerventional Surgery
Kharis Burns, Darshika Christie-David, Jenny E Gunton
UNLABELLED: Ketoconazole was a first-line agent for suppressing steroidogenesis in Cushing's disease. It now has limited availability. Fluconazole, another azole antifungal, is an alternative, although its in vivo efficacy is unclear. A 61-year-old female presented with weight gain, abdominal striae and worsening depression. HbA1c increased to 76 mmol/mol despite increasing insulin. Investigations confirmed cortisol excess; afternoon serum cortisol was 552 nmol/l with an inappropriate ACTH of 9...
2016: Endocrinology, Diabetes & Metabolism Case Reports
Harish Venugopal, Katherine Griffin, Saima Amer
UNLABELLED: Resection of primary tumour is the management of choice in patients with ectopic ACTH syndrome. However, tumours may remain unidentified or occult in spite of extensive efforts at trying to locate them. This can, therefore, pose a major management issue as uncontrolled hypercortisolaemia can lead to life-threatening infections. We present the case of a 66-year-old gentleman with ectopic ACTH syndrome from an occult primary tumour with multiple significant complications from hypercortisolaemia...
2015: Endocrinology, Diabetes & Metabolism Case Reports
Sonam Tashi, Keng Sin Ng
Cushing's syndrome is known to have a wide spectrum of clinical presentation with debilitating consequences and morbidity if not diagnosed and treated in time. Sometimes the diagnosis of Cushing's syndrome can be challenging to the endocrinologist, especially when the usual battery of biochemical tests and advanced cross-sectional imaging is negative or inconclusive. We described a case in which the use of bilateral inferior petrosal sinus sampling (BIPSS) was conclusive albeit being technically challenging (due to a rare incidental finding of double superior vena cava) and invasive in nature...
August 2015: Journal of Radiology Case Reports
Sauradeep Sarkar, Simon Rajaratnam, Geeta Chacko, Sunithi Mani, Asha S Hesargatta, Ari George Chacko
BACKGROUND: This study was performed to examine patient outcomes following pure endoscopic transsphenoidal surgery (ETS) for Cushing's disease (CD). METHOD: We studied 64 consecutive patients who underwent 69 endoscopic transsphenoidal procedures. Radiological evaluation comprised detailed examination of preoperative magnetic resonance images (MRI), including positron emission tomography (PET) for select cases. Inferior petrosal sinus sampling (IPSS) was not performed for any patient...
January 2016: Acta Neurochirurgica
William F Chandler, Ariel L Barkan, Todd Hollon, Alla Sakharova, Jayson Sack, Barunashish Brahma, David E Schteingart
BACKGROUND: Transsphenoidal surgery is the standard approach for treating Cushing disease. Evidence is needed to document effectiveness. OBJECTIVE: To analyze results of transsphenoidal surgery in 276 consecutive patients, including 19 children. METHODS: Medical records were reviewed for patients treated initially with surgery for Cushing disease from 1980 to 2012. Radiographic features, pathology, remissions, recurrences, and complications were recorded...
February 2016: Neurosurgery
Yuichi Takashi, Yuka Kinoshita, Noriko Makita, Manabu Taguchi, Katsutoshi Takahashi, Masaomi Nangaku, Seiji Fukumoto
We describe a 30-year-old man with ectopic adrenocorticotropic hormone (ACTH) syndrome. Before the operation, there was no diurnal variation of ACTH, and ACTH did not respond to CRH or dexamethasone suppression tests. These abnormalities disappeared after the removal of a neuroendocrine tumor in the lung. In addition, plasma ACTH was measureable at as early as postoperative day 3 with ACTH levels increasing thereafter. Furthermore, an insulin tolerance test and inferior petrosal sinus sampling indicated that ACTH was secreted from the pituitary...
2015: Internal Medicine
Mirsala Solak, Ivana Kraljevic, Tina Dusek, Ante Melada, Marcel Marjanovic Kavanagh, Vjerislav Peterkovic, David Ozretic, Darko Kastelan
The purpose of this study was to review therapeutic outcomes and comorbidities of patients with Cushing's disease (CD) in a single center. We conducted a retrospective study of 33 patients with CD undergoing transsphenoidal surgery from January 2007 to February 2014 (27 females and 6 males, median age 38 years, range 18-71 years). The diagnosis of Cushing's syndrome was established on the basis of the patient's history, characteristic clinical features, and laboratory data including an elevated 24-h urinary free cortisol level, lack of serum cortisol suppression after dexamethasone suppression tests and an elevated midnight cortisol level...
March 2016: Endocrine
Divya Yogi-Morren, Mouhammed Amir Habra, Charles Faiman, James Bena, Betul Hatipoglu, Laurence Kennedy, Robert J Weil, Amir H Hamrahian
OBJECTIVE: Expert opinion and a consensus statement on Cushing syndrome (CS) indicate that in a patient with a clinical presentation and biochemical studies consistent with a pituitary etiology, the presence of a pituitary tumor ≥6 mm is highly suggestive of Cushing disease (CD). The purpose of the present study was to determine the optimal pituitary tumor size that can differentiate between patients with CD and ectopic adrenocorticotrophic hormone (ACTH) secretion (EAS) and obviate the need for inferior petrosal sinus sampling (IPSS)...
October 2015: Endocrine Practice
Chao-Hung Kuo, Yu-Shu Yen, Jau-Ching Wu, Yu-Chun Chen, Wen-Cheng Huang, Henrich Cheng
BACKGROUND: There are scant data of endoscopic transsphenoidal surgery (ETS) with adjuvant therapies of Cushing disease (CD). OBJECTIVE: To report the remission rate, secondary management, and outcomes of a series of CD patients. METHODS: Patients with CD with magnetic resonance imaging (MRI)-positive adenoma who underwent ETS as the first and primary treatment were included. The diagnostic criteria were a combination of 24-hour urine-free cortisol, elevated serum cortisol levels, or other tests (e...
September 2015: World Neurosurgery
Julien Ducry, Fulgencio Gomez, John O Prior, Ariane Boubaker, Maurice Matter, Matteo Monti, Yan Pu, Nelly Pitteloud, Luc Portmann
UNLABELLED: Ectopic ACTH Cushing's syndrome (EAS) is often caused by neuroendocrine tumors (NETs) of lungs, pancreas, thymus, and other less frequent locations. Localizing the source of ACTH can be challenging. A 64-year-old man presented with rapidly progressing fatigue, muscular weakness, and dyspnea. He was in poor condition and showed facial redness, proximal amyotrophy, and bruises. Laboratory disclosed hypokalemia, metabolic alkalosis, and markedly elevated ACTH and cortisol levels...
2015: Endocrinology, Diabetes & Metabolism Case Reports
Hershel Raff
Endogenous hypercortisolism (Cushing syndrome) is one of the most enigmatic diseases in clinical medicine. The diagnosis and differential diagnosis of Cushing syndrome depend on proper laboratory evaluation. In this review, an update is provided on selected critical issues in the diagnosis and differential diagnosis of Cushing syndrome: the use of late-night salivary cortisol in initial diagnosis and for postoperative surveillance, and the use of prolactin measurement to improve the performance of inferior petrosal sinus sampling to distinguish Cushing disease from ectopic adrenocorticotropic hormone (ACTH) syndrome during differential diagnosis of ACTH-dependent Cushing syndrome...
March 2015: Endocrinology and Metabolism Clinics of North America
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