Inferior Petrosal Sinus Sampling in Cushing’s Syndrome
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Transcript of Inferior Petrosal Sinus Sampling in Cushing’s Syndrome
Inferior Petrosal Sinus Sampling
in Cushing’s Syndrome
Lia Neto
Neuroradiology Department – Santa Maria University Hospital, Lisbon - Portugal
IPSS in Cushing’s Syndrome
Cortisol
- Cushing´s Syndrome -
IPSS in Cushing’s Syndrome
80%
- ACTH Dependent Vs ACTH Independent -
IPSS in Cushing’s Syndrome
80%
- Biochemical Tests -
IPSS in Cushing’s Syndrome
80%
• Sensitivity (40-50%)
• Adenoma Dimensions
• May enhance = parenchyma
•“Incidentalomas” (6-10%)
- Imaging Tests -
IPSS in Cushing’s Syndrome
• Sensitivity 88-100%
• Specificity 70-100%
• Lateralization 70%
- Inferior Petrous Sinus Sampling -
IPSS in Cushing’s Syndrome
Pre 5’ 10’ 15’R-IPSL-IPSPV
CRH (100µg)
ACTH
IPS / PV ≥ 2 (≥ 3 post CRH) –Pituitary Cushing Synd.
IPS / PV 2 – Ectopic Cushing’s Synd.
R-PS / L-PS ≥ 1,4 - Lateralization
- Inferior Petrous Sinus Sampling -
IPSS in Cushing’s Syndrome
Objective :
Evaluate the role of simultaneous bilateral catheterization
of the Inferior Petrosal Sinuses: • in the differential diagnosis of Cushing’s Syndrome
• in the lateralization assessment of pituitary adenomas
IPSS in Cushing’s Syndrome
Material and Methods:
• Retrospective analysis: 6 patients with CS (1♂ 5♀); 28 – 70 yr
• IPSS between 2007-2010
• Sedation & Anticoagulation (5000 U)
• Bilateral femoral vein puncture – Bilateral IPS catheterization
• Venogram
• IPS and peripheral blood sampling pre and post CRH
• IPS/peripheral ACTH ratio: Pituitary Vs Ectopic Cushing’s Syndrome
• In Cushing’s Disease: lateralization assessment
IPSS in Cushing’s Syndrome
Results:
• Catheterization and sampling was possible in
all patients
• No complications (technical or clinical)
• 2 patients with ectopic ACTH source
• 4 patients with Cushing’s Disease
IPSS in Cushing’s Syndrome
Results: • Clinically (+)• Biochemically (+)• Imaging (-) 35 yr ♀
IPSS in Cushing’s Syndrome
35 yr ♀
• Clinically (+)• Biochemically (+)• Imaging (-)
Results:
IPSS in Cushing’s Syndrome
Pre 5’ 10’ 15’
R-IPS 58 132 165 56
L-IPS 175 496 509 218
PV 14 14 17 16
• IPS / PV – 12,5 / 35
• L-IPS / R-IPS – 4
35 yr ♀
• Clinically (+)• Biochemically (+)• Imaging (-)
Results:
IPSS in Cushing’s Syndrome
70 yr ♀
• Clinically (+)• Biochemically (+)• Imaging (inconclusive)
Results:
IPSS in Cushing’s Syndrome
Pre 5’ 10’ 15’
R-IPS 162 235 206 140
L-IPS 33,7 39,5 68,4 101
PV 32,6 43,5 79,8 110
70 yr ♀
• Clinically (+)• Biochemically (+)• Imaging (inconclusive)
• IPS / PV – 5
• R-IPS / E-IPS – 6
Results:
IPSS in Cushing’s Syndrome
32 yr ♀
• Clinically (+)• Biochemically (+)• Imaging (-)
Results:
IPSS in Cushing’s Syndrome
Antes 5min 10min 15min
SPI Dto 1142 5104 5916 289
SPI Esq 2114 2461 2363 1169
Veia Perif. 60.7 178 201 202
32 yr ♀
• Clinically (+)• Biochemically (+)• Imaging (-)
• IPS / PV – 35
• R-IPS / E-IPS – inconclusive
Results:
IPSS in Cushing’s Syndrome
• Originally described by Corrigan and colleagues in 1977
(unilateral venous sampling)
• Oldfield et al introduced the bilateral IPSS in the 80´s
and in the 90´s the IPSS with and without CRH.
IPSS in Cushing’s Syndrome
IPSS in Cushing’s Syndrome
• The validity of IPSS relies on successful cannulation of
the vessels• Anatomic Variations• Alternative Sampling Methods – Cavernous Sinus,
Jugular Vein
• Possible Complications (0,2%-1,1%) – vein / venule
thrombosis or rupture, SAH, ischemia (...)
IPSS in Cushing’s Syndrome
•IPSS is a safe and well tolerated procedure
•Effective in the differential diagnosis of Cushing’s Syndrome
•Useful in the localization of microadenomas and surgical
planning
Conclusion :
IPSS in Cushing’s Syndrome
The high diagnostic sensitivity, specificity, and accuracy
of IPSS have made it a gold standard tool in the
investigation of ACTH - dependent Cushing´s syndrome.
Conclusion :