Cited by 130Pituitary Gland Disorders and TreatmentsAdrenal and Paraganglionic TumorsAdrenal Hormones and Disorders

Bilateral inferior petrosal sinus sampling

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Zampetti, Benedetta, Grossrubatscher, Erika, Dalino Ciaramella, Paolo, Boccardi, Edoardo, Loli, Paola·2016·Endocrine Connections

Abstract

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. Direct stimulation of the pituitary corticotroph with corticotrophin-releasing hormone enhances the sensitivity of the procedure. The procedure must be undertaken in the presence of hypercortisolemia, which suppresses both the basal and stimulated secretory activity of normal corticotrophic cells: ACTH measured in the sinus is, therefore, the result of the secretory activity of the tumor tissue. The poor accuracy in lateralization of BIPSS (positive predictive value of 50–70%) makes interpetrosal ACTH gradient alone not sufficient for the localization of the tumor. An accurate exploration of the gland is recommended if a tumor is not found in the predicted area. Despite the fact that BIPSS is an invasive procedure, the occurrence of adverse events is extremely rare, particularly if it is performed by experienced operators in referral centres.

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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 [78]

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Cited by

Sorted by citations

Authors
Zampetti, B., Grossrubatscher, E., Dalino Ciaramella, P., Boccardi, E., & Loli, P.
Affiliations
  • Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT)
  • 1Department of EndocrinologyOspedale Niguarda, Milano, Italy
Corresponding author
  • Zampetti, Benedetta
  • Loli, Paola
Venue
Endocrine Connections
Published
2016-07
Volume
5
Issue
4
Pages
R12-R25
ISSN
2049-3614 (ISSN-L)
OpenAlex
W2474530751
Cited by
130
References
140
Citations by year
2026: 10 · 2025: 11 · 2024: 9 · 2023: 18 · 2022: 12 · 2021: 20 · 2020: 11 · 2019: 14 · 2018: 4 · 2017: 7 · 2016: 4 · 2015: 1 · 2014: 4 · 2013: 4 · 2012: 1
FWCI
1.42
Type
journal article
Language
en
Open access
Locations
  • Endocrine Connections (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
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
bilateral inferior petrosal sinus sampling, Cushing's syndrome, hypercortisolism, ACTH, Cushing's disease, ectopic ACTH syndrome, tumor localization, diagnostic accuracy, adverse events

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