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Inferior Petrosal Sampling for the Differential Diagnosis of ACTH-Dependent Cushing’s Syndrome

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Cushing's Syndrome

Part of the book series: Contemporary Endocrinology ((COE))

Summary

Despite the high pretest probability of a pituitary adenoma in patients with adrenocorticotropic hormone (ACTH)-dependent Cushing’s syndrome, a definitive diagnosis is elusive for many patients. Pituitary imaging and biochemical testing have limited diagnostic accuracy. Bilateral simultaneous inferior petrosal sinus ACTH sampling (IPSS) has become the test of choice in the differential evaluation of ACTH-dependent Cushing’s syndrome. Administration of corticotropin-releasing hormone further enhances the sensitivity of this test. The use of IPSS for lateralization of corticotroph microadenomas is controversial and has not yet replaced the thorough examination of the pituitary gland by an experienced neurosurgeon after the diagnosis of Cushing’s disease has been made. IPSS is feasible and safe in most individuals. It is not, however, without significant risks, costs, and limitations. IPSS should be incorporated into clinical practice in a logical manner to minimize risks and maximize diagnostic utility.

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  1. Department of Medicine, Endocrinology Center, Medical College of Wisconsin, Building A, Suite 203, Menomonee Falls, WI, 53051, USA

    Bradley R. Javorsky MD (Assistant Professor of Medicine)

  2. Department of Medicine, Endocrinology Center, Medical College of Wisconsin, Menomonee Falls, WI, USA

    James W. Findling MD (Professor of Clinical Medicine, Director of Community Endocrine Services)

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  1. , Division of Endocrinology and Metabolism, Hospital das Clínicas, University of Sao, Sao Paulo, 05403-000, Brazil

    Marcello D. Bronstein

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Javorsky, B.R., Findling, J.W. (2010). Inferior Petrosal Sampling for the Differential Diagnosis of ACTH-Dependent Cushing’s Syndrome. In: Bronstein, M. (eds) Cushing's Syndrome. Contemporary Endocrinology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-449-4_9

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