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

The DOI matches its Crossref record; 114 of the 114 references it cites were found in a registry or an index.

Bilateral inferior petrosal sinus sampling

Open access
Zampetti, Benedetta, Grossrubatscher, Erika, Dalino Ciaramella, Paolo, Boccardi, Edoardo, Loli, Paola·2016·Endocrine Connections
DOI 10.1530/ec-16-0029PMC PMC5002953
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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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Figure 1 Algorithm representing authors’ current practice on the indication for BIPPS. CRH +: positive response to CRH stimulation test defined as an increment ≥30% of serum cortisol over baseline or ≥50% or more of plasma ACTH over baseline. CRH −: negative response to CRH stimulation test defined as an increment <30% of serum cortisol over baseline or <50% of plasma ACTH over baseline. *Use of BIPPS controversial, see text.
Figure 1 Algorithm representing authors’ current practice on the indication for BIPPS. CRH +: positive response to CRH stimulation test defined as an increment ≥30% of serum cortisol over baseline or ≥50% or more of plasma ACTH over baseline. CRH −: negative response to CRH stimulation test defined as an increment <30% of serum cortisol over baseline or <50% of plasma ACTH over baseline. *Use of BIPPS controversial, see text.CC BY-NC · PubMed Central
Figure 2 (A) Plasma ACTH concentration (pg/mL) in a patient with final diagnosis of Cushing’s disease (example of BIPSS data from the authors’ series). (B) Plasma ACTH concentration (pg/mL) in a patient with final diagnosis of EAS due to bronchial carcinoid (example of BIPSS data from the authors’ series).
Figure 2 (A) Plasma ACTH concentration (pg/mL) in a patient with final diagnosis of Cushing’s disease (example of BIPSS data from the authors’ series). (B) Plasma ACTH concentration (pg/mL) in a patient with final diagnosis of EAS due to bronchial carcinoid (example of BIPSS data from the authors’ series).CC BY-NC · PubMed Central

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Citations

Cites

Show all 114 references

Research works printed but not linked: 6

  1. [12]Hermus AR Pieters GF Pesman GJ Smals AG Benraad TJ Kloppenborg PW. The corticotropin-releasing-hormone test vs. the high-dose dexamethasone test in the differential diagnosis of Cushing’s syndrome. Lancet 1986 2 540– 544. (10.1016/s0140-6736(86)90113-3) 2875282 · DOI
  2. [38]Schulte HM Allolio B Gunther RW Benker G Winkelmann W Hollmann JP Windeck R Reinwein D. Simultaneous bilateral catheterization of the inferior petrosal sinus in Cushing’s syndrome. ACTH determination for the diagnosis and location of the side of a hypophyseal microadenoma before and after administration of corticotropin-releasing hormone. Deutsche Medizinische Wochenschrift 1987 112 1767– 1771. (10.1055/s-2008-1068326) 2824162 · DOI
  3. [88]Shi X Sun Q Bian L Zhao W Shen J Wang W Ning G Assessment of bilateral inferior petrosal sinus sampling in the diagnosis and surgical treatment of the ACTH-dependent Cushing’s syndrome: a comparison with other tests. Neuro Endocrinology Letters 2011 32 865– 873. 22286783
  4. [95]Colao A Merola B Tripodi FS Di Sarno A Esposito V Marzullo P La Tessa G Spaziante R Lombardi G. Simultaneous and bilateral inferior petrosal sinus sampling for the diagnosis of Cushing’s syndrome: comparison of multihormonal assay, baseline multiple sampling and ACTH-releasing hormone test. Hormone Research 1993 40 209– 16. (10.1159/000183797) 8112722 · DOI
  5. [115]Teramoto A Nemoto S Takakura K Sasaki Y Machida T. Selective venous sampling directly from cavernous sinus in Cushing’s syndrome. Journal of Clinical Endocrinology and Metabolism 1993 76 637– 641. (10.1210/jc.76.3.637) 8383143 · DOI
  6. [119]Doppman JL Nieman LK Chang R Yanovski J Cutler GB Jr Chrousos GP Oldfield EH. Selective venous sampling from the cavernous sinuses is not a more reliable technique than sampling from the inferior petrosal sinuses in Cushing’s disease. Journal of Clinical Endocrinology and Metabolism 1995 80 2485– 2489. (10.1210/jc.80.8.2485) 7629247 · DOI

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Metadata

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
ORCID
Venue
Endocrine Connections
Publisher
Bioscientifica
Published
2016-07
Volume
5
Issue
4
Pages
R12-R25
ISSN
2049-3614 (ISSN-L)
DOI
10.1530/ec-16-0029
PMC
PMC5002953
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
FWCI
1.42
Type
journal article
Language
en
Open access
Licence
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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