Inferior petrosal sinus sampling

INTRODUCTION: Alcohol-induced hypercortisolism (AIH) is underrecognized and may masquerade as neoplastic hypercortisolism [Cushing syndrome (CS)] obscuring its diagnosis. OBJECTIVE AND METHODS: In order to characterize AIH, we performed a chart review of eight patients (4 males and 4 females; 2014-2022) referred for evaluation and treatment of neoplastic hypercortisolism - six for inferior petrosal sinus sampling, one due to persistent CS after unilateral adrenalectomy, and one for pituitary surgery for Cushing disease (CD)...

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...

OBJECTIVES: Bilateral inferior petrosal sinus sampling (BIPSS) is a useful test for differential diagnosis of central vs. ectopic adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (CS). We provide a description of the protocol used in our Center and an analysis of its diagnostic accuracy. METHODS: A retrospective study was conducted of 28 patients who underwent BIPSS combined with corticotropin-releasing hormone (CRH) stimulation. The procedure is performed in an interventional neuroradiology suite, involving a multidisciplinary team of neuroradiologists, endocrinologists and laboratory professionals...

This study takes Cushing's syndrome, a rare disease, as a model, and adopts the path of "Plan, Do, Check, Action" (PDCA) to explore new methods to optimize the clinical path, can improve the quality and efficiency of diagnosis and treatment of rare diseases. After sorting out the problems existing in the previous diagnosis and treatment mode, our team optimizes the path in various ways and establishes a standard operation procedure (SOP) for the new path. In the evaluation of the optimized mode, 55 patients with Cushing's syndrome were admitted to the Department of Endocrinology, Peking Union Medical College Hospital, including 19 males and 36 females, aged (41...

PURPOSE:  To assess radiation exposure and diagnostic performance of bilateral inferior petrosal sinus sampling for the distinction of pituitary and ectopic adrenocorticotropin-dependent Cushing's 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...

Cushing's syndrome (CS) is a rare clinical entity that results from prolonged exposure to supraphysiological levels of glucocorticoids. It may result from adrenocorticotropic hormone (ACTH)-dependent or nondependent stimuli. In very rare cases, ACTH production does not derive from the pituitary gland but is of an ectopic origin. We present a case of a 51-year-old woman with cushingoid physical features, who was admitted to the emergency department with a hypertensive crisis, hyperglycemic state, and severe hypokalemia...

OBJECTIVE: Bilateral inferior petrosal sinus sampling (BIPSS) is regarded as gold standard to differentiate between Cushing´s disease (CD) and ectopic Cushing's syndrome (ECS). However, published data e.g. on the diagnostic value of additional prolactin analysis is controversial. Thus, we evaluated the diagnostic performance of BIPSS with and without prolactin in a multicenter study. DESIGN AND METHODS: Retrospective study in 5 European reference centers. Patients with overt adrenocorticotropin (ACTH)-dependent Cushing's syndrome at the time of BIPSS with human corticotropin-releasing hormone stimulation were eligible...

INTRODUCTION AND IMPORTANCE: When treating adrenocorticotropic hormone (ACTH)-producing adenoma, accurate tumor localization is critical. We report a case of Cushing's disease in which MRI with a spoiled-gradient echo 3D T1-weighted sequence was useful in precise localization of an ACTH-producing adenoma and deciding appropriate treatment strategy. CASE PRESENTATION: A 47-year-old woman was admitted to our hospital with signs and symptoms of Cushing's disease. Laboratory findings showed hypercortisolemia and suggested Cushing's disease...

INTRODUCTION: Endogenous Cushing's syndrome (CS) is a rare, severe disease that can cause multiple systemic involvement and behavioral problems due to excessive cortisol production. Structural changes can be noted in the brain magnetic resonance imaging (MRI) scans of these cases. CASES: A 9-year-old girl and a 13-year-old boy were admitted with hypercortisolism. In the female patient, altered consciousness was prominent along with cerebral and cerebellar brain atrophy, and findings indicating posterior reversible encephalopathy syndrome were detected in the brain MRI...

BACKGROUND: Ectopic ACTH pituitary adenomas (EAPA), located outside the sella turcica and deriving from cellular remnants of Rathke's pouch are a very rare cause of Cushing's syndrome (CS). The diagnosis is often difficult and delayed, even after comprehensive work-up. To our knowledge, we report for the first time an ectopic corticotroph tumor of the posterior wall of the sphenoid sinus, leading to false positive results of bilateral inferior petrosal sinus sampling (BIPPS) and which was finally localized by a co-registered11 C Methionine PET/MR imaging...

BACKGROUND: Cushing disease (CD) arises due to a pituitary corticotroph adenoma, which is the most common cause of Cushing syndrome (CS). Bilateral inferior petrosal sinus sampling (BIPSS) is a safe method for differentiating CD from ectopic adrenocorticotropic hormone (ACTH)-dependent CS. Enhanced high-resolution magnetic resonance imaging (MRI) can localize tiny pituitary lesions. The aim of this study was to compare the preoperative diagnostic accuracy of BIPSS versus MRI for CD in CS patients...

OBJECTIVE: Previous studies have shown inconsistent results about the usefulness of prolactin adjustment in bilateral inferior petrosal sinus sampling (BIPSS) in the differential diagnosis of adrenocorticotropic hormone (ACTH) -dependent Cushing syndrome (CS). This meta-analysis compared the diagnostic accuracy of prolactin adjustment vs. no adjustment in BIPSS. METHODS: This study searched PubMed, Embase, Web of Science, Cochrane library, and Wanfang database for published data on the use of prolactin adjustment in BIPSS to differentially diagnose ACTH-dependent CS as of March 2022...

BACKGROUND: The common causes of adrenocorticotrophic hormone (ACTH)-dependent Cushing's syndrome (CS) include Cushing's disease (CD) and ectopic ACTH syndrome (EAS). The differential diagnosis and lesion location of CD and EAS often bring great difficulties to clinical diagnosis and treatment. This article reports the localization diagnosis, treatment, and follow-up results of two patients with ACTH-dependent CS with different causes and reviews the literature. CASE DESCRIPTION: Case 1: a 29-year-old female patient attended the clinic because of irregular menstruation, weight gain, and violaceous striae...

BACKGROUND: We report four pediatric subjects with Cushing's disease (CD) diagnosed in the Czech Republic. We focus on initial symptoms of Cushing's syndrome (CS) which can lead to early diagnosis, on typical symptoms of CS in children, their age and sex distribution, the mean length of symptoms prior to diagnosis, indication for examination, post-cure growth, sexual development and pituitary function in our four CD patients after transsphenoidal pituitary surgery (TSS). We describe the diagnostic process leading to confirmation of CD and we emphasize the biochemical and radiological diagnostic difficulties...

BACKGROUND: The purpose of this study is to determine the accuracy of bilateral inferior petrosal sinus sampling (IPSS) in lateralization and to investigate variables associated with accurate IPSS lateralization prediction. METHODS: Initially, data from 55 patients who underwent IPSS in our institution were reviewed retrospectively. IPSS lateralization and pituitary magnetic resonance imaging (MRI) results of these patients were compared with postoperative follow-up and immunohistochemical data to calculate the positive predictive values (PPVs) for IPSS and MRI...

Ectopic Cushing's syndrome (CS) is rare and difficult to cure when the source is elusive. Medical management is complex and often times contraindicated in the medically complex patient. We present a complicated case of ectopic CS where bilateral percutaneous microwave ablation (MWA) of the adrenal glands successfully cured hypercortisolism when surgery and medical therapies were contraindicated. A 71-year-old male was diagnosed with ectopic CS after adrenocorticotropic hormone-dependent hypercortisolism persisted after hypophysectomy despite a positive gradient of >3 on inferior petrosal sinus sampling...

The desmopressin test was first described 30 years ago. Based on the differential secretagogue properties of desmopressin on adrenocorticotropin (ACTH) release between normal and corticotroph tumor cells, this test was intended to facilitate the diagnosis of Cushing syndrome (CS). The distinct expression of the various arginine vasopressin receptors between normal pituitary, corticotroph tumors, or neuroendocrine tumors cells secreting ACTH ectopically suggested that this test could facilitate the etiological diagnosis of ACTH-dependent CS...

Cushing syndrome results from supraphysiological exposure to glucocorticoids and is associated with significant morbidity and mortality. The pathogenesis includes administration of corticosteroids (exogenous Cushing syndrome) or autonomous cortisol overproduction, whether or not ACTH-dependent (endogenous Cushing syndrome). An early diagnosis of Cushing syndrome is warranted; however, in clinical practice, it is very challenging partly because of resemblance with other common conditions (ie, pseudo-Cushing syndrome)...

Cushing's syndrome (CS) is a rare but detrimental endocrine disorder. Early diagnosis and prompt treatment are essential since the duration of hypercortisolism has an adverse impact on the extent of comorbidities and overall survival. The diagnostic approach involves a stepwise process that includes (1) screening and confirming the diagnosis and (2) establishing the aetiology of CS. The tests currently used to confirm the diagnosis of CS include urinary free cortisol measurements, the dexamethasone suppression test and late- night salivary cortisol or midnight serum cortisol measurements...

OBJECTIVES: The differential diagnosis of ACTH-dependent Cushing's disease (CS) is challenging. The gold standard approach bilateral inferior petrosal sinus sampling (BIPSS) is expensive and invasive, while other noninvasive tests, like the high-dose dexamethasone suppression test (HDDST), provide unsatisfactory diagnostic accuracy. This study aimed to find a new noninvasive practical approach with higher diagnostic accuracy to differently diagnose ACTH-dependent CS, which can be used in centers where BIPSS cannot be applied...