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Does concomitant prolactin measurement ıncrease the accuracy of ınferior petrosal sinus sampling?

  • Interventional Neuroradiology
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Abstract

Introduction

Prolactin (PRL) measurement during inferior petrosal sinus sampling (IPSS) can be helpful to improve the accuracy. We aimed to evaluate the effect of measuring PRL levels as a predictor for the accuracy of IPSS and evaluate its impact on the lateralization of adenomas.

Methods

In this retrospective cohort study, we reviewed 51 patients who had undergone IPSS for the investigation of ACTH-dependent hypercortisolism.

Results

Forty-nine patients had proven Cushing’s disease (CD), one had EAS, and the remaining one patient had adrenal adenoma. Forty-seven patients had an above 2 ACTH IPS/P ratio at baseline, and all the post-corticotropin-releasing hormone (CRH) ACTH IPS/P ratios of patients with proven CD were above 3. In these two patients whose ACTH IPS/P ratio at baseline was below 2, PRL IPS/P ratios were above 1.8 in only the dominant side, which was considered secondary to a prolactin intersinus gradient due to the biological effects of the tumor. PRL-adjusted ACTH IPS/P ratios were > 1.3 in all patients with proven CD; it was 0.7 in the patient with EAS. Surgically confirmed positive lateralization was observed in 55.1% of patients with the ACTH gradient, but when PRL-adjusted ACTH IPS/IPS ratios were used in addition to the ACTH gradient, the ratio increased to 67.3%.

Conclusion

Although PRL-adjusted ACTH IPS/P ratios can be helpful to improve the accuracy of results during IPSS procedures, a prolactin intersinus gradient towards the ACTH-dominant side in patients with CD may invalidate PRL as an indicator of pituitary venous outflow.

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Abbreviations

CD:

Cushing’s disease

CS:

Cushing’s syndrome

DST:

Dexamethasone-suppression test

EAS:

Ectopic ACTH syndrome

IPS:

Inferior petrosal sinus

IPS:

Inferior petrosal sinus sampling

P:

Peripheral

UFC:

24-Hour urinary free cortisol

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Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey

    Tugce Apaydin, Mehmet Yasar  & Dilek Gogas Yavuz

  2. Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey

    Feyyaz Baltacioglu

  3. Department of Biochemistry, Marmara University School of Medicine, Istanbul, Turkey

    Goncagul Haklar

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  1. Tugce Apaydin
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All authors made substantial contributions to conception and design, and/or acquisition of data, and/or analysis and interpretation of data; participated in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be submitted.

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Correspondence to Tugce Apaydin.

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Apaydin, T., Yasar , M., Baltacioglu, F. et al. Does concomitant prolactin measurement ıncrease the accuracy of ınferior petrosal sinus sampling?. Neuroradiology 64, 1411–1418 (2022). https://doi.org/10.1007/s00234-021-02886-6

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