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Related Experiment Videos

Diagnostic errors after inferior petrosal sinus sampling.

Brooke Swearingen1, Laurence Katznelson, Karen Miller

  • 1Neuroendocrine Clinical Center, Division of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. bswearingen@partners.org

The Journal of Clinical Endocrinology and Metabolism
|August 5, 2004
PubMed
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Inferior Petrosal Sinus Sampling (IPSS) can misdiagnose Cushing's syndrome. Analyzing ACTH levels alongside IPSS ratios improves accuracy, especially when pituitary tumors are suspected despite negative results.

Area of Science:

  • Endocrinology
  • Diagnostic Imaging
  • Neurosurgery

Background:

  • Inferior Petrosal Sinus Sampling (IPSS) is a key diagnostic tool for Cushing's syndrome.
  • False negative and positive results can complicate diagnosis, leading to delayed or incorrect management.
  • Patients with negative IPSS are often presumed to have occult ectopic tumors.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of IPSS in Cushing's syndrome.
  • To determine the ultimate diagnoses in patients with initially inconclusive IPSS results.
  • To assess the utility of CRH-stimulated ACTH levels in conjunction with IPSS ratios.

Main Methods:

  • Retrospective review of 185 IPSS procedures in 179 patients with Cushing's syndrome (1986-2002).
  • Analysis of inferior petrosal sinus to peripheral (IPS:P) ratios with and without CRH stimulation.

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  • Correlation of IPSS results with confirmed diagnoses after further investigations, including transsphenoidal exploration.

    • Main Results:

    • Confirmed diagnoses were available for 149 patients: 94% had pituitary adenomas, 5% bronchial carcinoids, and 1% adrenal tumors.
    • Nine cases (false negatives) showed pituitary tumors despite not meeting IPSS threshold criteria; eight had significant ACTH rise post-CRH.
    • Two cases (false positives) met IPSS criteria for pituitary source but were ectopic tumors.

    Conclusions:

    • Standard IPSS criteria may not always accurately identify the source of ACTH overproduction in Cushing's syndrome.
    • Integrating CRH-stimulated peripheral ACTH levels with IPS:P ratios can enhance diagnostic accuracy.
    • Transsphenoidal exploration is recommended for inconclusive cases, especially with elevated ACTH post-CRH, even with negative IPSS.