1 / 22

Inferior Petrosal Sinus Sampling in Cushing’s Syndrome

Inferior Petrosal Sinus Sampling in Cushing’s Syndrome. Lia Neto. Neuroradiology Department – Santa Maria University Hospital, Lisbon - Portugal. IPSS in Cushing’s Syndrome. - Cushing´s Syndrome -. Cortisol. IPSS in Cushing’s Syndrome. - ACTH Dependent Vs ACTH Independent -. 80%.

brinda
Download Presentation

Inferior Petrosal Sinus Sampling in Cushing’s Syndrome

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Inferior Petrosal Sinus Samplingin Cushing’s Syndrome Lia Neto Neuroradiology Department – Santa Maria University Hospital, Lisbon - Portugal

  2. IPSS in Cushing’s Syndrome - Cushing´s Syndrome - Cortisol

  3. IPSS in Cushing’s Syndrome - ACTH Dependent Vs ACTH Independent - 80%

  4. IPSS in Cushing’s Syndrome - Biochemical Tests - 80%

  5. IPSS in Cushing’s Syndrome - Imaging Tests - 80% • Sensitivity (40-50%) • Adenoma Dimensions • May enhance = parenchyma • “Incidentalomas” (6-10%)

  6. IPSS in Cushing’s Syndrome - Inferior Petrous Sinus Sampling - • Sensitivity 88-100% • Specificity 70-100% • Lateralization 70%

  7. IPSS in Cushing’s Syndrome - Inferior Petrous Sinus Sampling - CRH (100µg) ACTH IPS / PV ≥ 2 (≥ 3 post CRH) –Pituitary Cushing Synd. IPS / PV  2 – Ectopic Cushing’s Synd. R-PS / L-PS ≥ 1,4 - Lateralization

  8. IPSS in Cushing’s Syndrome Objective : • Evaluate the role of simultaneous bilateral catheterization • of the Inferior Petrosal Sinuses: • in the differential diagnosis of Cushing’s Syndrome • in the lateralization assessment of pituitary adenomas

  9. IPSS in Cushing’s Syndrome Material and Methods: • Retrospective analysis: 6 patients with CS (1♂ 5♀); 28 – 70 yr • IPSS between 2007-2010 • Sedation & Anticoagulation (5000 U) • Bilateral femoral vein puncture – Bilateral IPS catheterization • Venogram • IPS and peripheral blood sampling pre and post CRH • IPS/peripheral ACTH ratio: Pituitary Vs Ectopic Cushing’s Syndrome • In Cushing’s Disease: lateralization assessment

  10. IPSS in Cushing’s Syndrome Results: • Catheterization and sampling was possible in all patients • No complications (technical or clinical) • 2 patients with ectopic ACTH source • 4 patients with Cushing’s Disease

  11. IPSS in Cushing’s Syndrome Results: • Clinically (+) • Biochemically (+) • Imaging (-) 35 yr ♀

  12. IPSS in Cushing’s Syndrome Results: • Clinically (+) • Biochemically (+) • Imaging (-) 35 yr ♀

  13. IPSS in Cushing’s Syndrome Results: • Clinically (+) • Biochemically (+) • Imaging (-) 35 yr ♀ • IPS / PV – 12,5 / 35 • L-IPS / R-IPS – 4

  14. IPSS in Cushing’s Syndrome • Clinically (+) • Biochemically (+) • Imaging (inconclusive) Results: 70 yr ♀

  15. IPSS in Cushing’s Syndrome • Clinically (+) • Biochemically (+) • Imaging (inconclusive) Results: 70 yr ♀ • IPS / PV – 5 • R-IPS / E-IPS – 6

  16. IPSS in Cushing’s Syndrome Results: • Clinically (+) • Biochemically (+) • Imaging (-) 32 yr ♀

  17. IPSS in Cushing’s Syndrome Results: • Clinically (+) • Biochemically (+) • Imaging (-) 32 yr ♀ • IPS / PV – 35 • R-IPS / E-IPS – inconclusive

  18. IPSS in Cushing’s Syndrome • Originally described by Corrigan and colleagues in 1977 (unilateral venous sampling) • Oldfield et al introduced the bilateral IPSS in the 80´s and in the 90´s the IPSS with and without CRH.

  19. IPSS in Cushing’s Syndrome

  20. IPSS in Cushing’s Syndrome • The validity of IPSS relies on successful cannulation of the vessels • Anatomic Variations • Alternative Sampling Methods – Cavernous Sinus, Jugular Vein • Possible Complications (0,2%-1,1%) – vein / venule thrombosis or rupture, SAH, ischemia (...)

  21. IPSS in Cushing’s Syndrome Conclusion : • IPSS is a safe and well tolerated procedure • Effective in the differential diagnosis of Cushing’s Syndrome • Useful in the localization of microadenomas and surgical planning

  22. IPSS in Cushing’s Syndrome Conclusion : The high diagnostic sensitivity, specificity, and accuracy of IPSS have made it a gold standard tool in the investigation of ACTH - dependent Cushing´s syndrome.

More Related