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Venous thrombo-embolism following inferior petrosal sinus sampling in Cushing's disease
K Obuobie1, J S Davies, A Ogunko
1Department of Medicine, University of Wales College of Medicine, Cardiff, UK.
Insights
Bilateral inferior petrosal sinus sampling is a key test for Cushing's disease. Two patients experienced blood clots after this procedure, suggesting a need for preventative anticoagulation.
Area of Science:
- Endocrinology
- Diagnostic Procedures
- Vascular Complications
Background:
- Bilateral inferior petrosal sinus sampling (BIPSS) with corticotrophin-releasing hormone (CRH) stimulation is the gold standard for differentiating pituitary Cushing's disease from ectopic ACTH syndrome.
- Cushing's syndrome is associated with an increased risk of thromboembolic events.
Observation:
- Two patients with confirmed Cushing's disease developed thromboembolic complications shortly after undergoing BIPSS with CRH stimulation.
- These complications occurred despite the established diagnostic utility of the procedure.
Findings:
- The study highlights a potential iatrogenic risk associated with BIPSS in patients with Cushing's disease.
- The underlying mechanisms linking BIPSS and subsequent thromboembolism in this patient population warrant further investigation.
Implications:
- Clinicians should be aware of the risk of thromboembolic events following BIPSS in Cushing's disease patients.
- Consideration of prophylactic anticoagulation in high-risk patients undergoing BIPSS may be necessary to mitigate these complications.
Abstract:
Bilateral inferior petrosal sinus sampling for ACTH with corticotrophin releasing hormone stimulation has become an established test in differentiating pituitary Cushing's disease from Cushing's syndrome due to ectopic ACTH secretion. We report two patients with Cushing's disease who developed thromboembolic complications soon after inferior petrosal sinus sampling. We discuss the possible mechanisms leading to this complication in a syndrome in which thromboembolic complications are well recognized and highlight the need for consideration of prophylactic anticoagulation.