Inferior petrosal sinus sampling in Cushing’s syndrome: usefulness and pitfalls
Abstract
In patients with ACTH-dependent Cushing's syndrome (CS), the differentiation between Cushing's disease (CD) and ectopic ACTH secretion (EAS) can often be challenging. The traditionally used biochemical tests have limited diagnostic accuracy and imaging modalities may fail to detect the culprit lesion. Inferior petrosal sinus sampling (IPSS) was introduced more than 3 decades ago as a test with optimal diagnostic accuracy and has since become the gold standard in the differential diagnosis between CD and EAS. However, several, albeit rare, pitfalls may limit its diagnostic accuracy and awareness is needed to avoid incorrect interventions. Moreover, it is an invasive and demanding procedure, available in a limited number of centers worldwide. This review aims to critically present the usefulness and pitfalls of IPSS and define strategies for its optimal place in the contemporary management of CS.
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Sensitivity of BIPSS can be increased by obtaining ACTH levels under CRH stimulation.
“Sensitivity can be increased by obtaining ACTH levels under CRH stimulation (1, 76, 78).”
From Approach to the Patient: Diagnosis of Cushing Syndrome (2022) · cites this paper as [76]
There can be false-positive pituitary MRI findings in patients with EAS.
“There can also be false-positive pituitary MRI findings in patients with EAS (76).”
From Approach to the Patient: Diagnosis of Cushing Syndrome (2022) · cites this paper as [76]
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References 83 · Cited by 31
- Authors
- Vassiliadi, D. A., Mourelatos, P., Kratimenos, T., & Tsagarakis, S.
- Affiliations
- Evangelismos Hospital (GR)
- Corresponding author
- Tsagarakis, S.
- Venue
- Endocrine
- Published
- 2021-06-02
- Volume
- 73
- Issue
- 3
- Pages
- 530-539
- ISSN
- 0969-711X (ISSN-L)
- 1355-008X
- 1559-0100
- OpenAlex
- W3164825167
- Cited by
- 31
- References
- 83
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 5 · 2023: 11 · 2022: 6
- FWCI
- 0.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Endocrine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- inferior petrosal sinus sampling, Cushing's syndrome, ACTH-dependent Cushing's syndrome, Cushing's disease, ectopic ACTH syndrome, differential diagnosis, diagnostic accuracy, pituitary adenoma, adrenal incidentaloma
- MeSH terms
- ACTH Syndrome, Ectopic, Adrenocorticotropic Hormone, Cushing Syndrome, Diagnosis, Differential, Humans, Petrosal Sinus Sampling, Pituitary ACTH Hypersecretion
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