Bilateral inferior petrosal sinus sampling: Experience in 327 patients

Amy Deipolyi, Alexander Bailin, Joshua A. Hirsch, T. Gregory Walker, Rahmi Oklu

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective To describe findings and outcomes of 331 bilateral inferior petrosal sinus sampling (BIPSS) procedures performed in 327 patients evaluated for Cushing disease (CD). Materials and methods The radiology department's electronic database was searched to identify all BIPSS procedures (1990-2013). Electronic medical records were used to identify demographics, laboratory, procedural, surgical and pathologic findings. Results A total of 331 BIPSS procedures were performed in 327 patients (254 F, 73 M), mean age 41 (range 7-81) years. The overall technical success rate was 88% for bilateral cannulation, though nearly twothirds of the technical failures had unilateral sampling that diagnosed CD. Of the 331 BIPSS procedures, 40 were performed without, and 291 with stimulation by Acthrel or desmopressin. Sensitivity was 89-94% for unstimulated BIPSS, 96% for stimulated BIPSS, and 77% for MRI. BIPSS lateralization was accurate in about half of patients, compared with 75% accuracy for MRI. Mean inferior petrosal sinus (IPS):peripheral adrenocorticotropic hormone ratio was 17.3 (SE 1.8) at baseline, and 99.2 (SE 14.8) at 3 min, with decreasing values over time. All patients with follow-up after surgical resection for centralizing BIPSS were reported to be cured, with cortisol levels significantly decreased from 19 to 4 μg/dL (p<0.0001). Complications from BIPSS were rare, including groin hematoma (2.5%), but no thromboembolic complications were seen. Conclusions BIPSS remains the 'gold standard' for diagnosing CD. Stimulation with Acthrel or desmopressin is key to increasing specificity. When only one IPS can be successfully cannulated, results may still be diagnostic. BIPSS findings cannot be used to accurately lateralize lesions within the pituitary.

Original languageEnglish (US)
Pages (from-to)196-199
Number of pages4
JournalJournal of NeuroInterventional Surgery
Volume9
Issue number2
DOIs
StatePublished - Feb 1 2017

Fingerprint

Petrosal Sinus Sampling
Pituitary ACTH Hypersecretion
Deamino Arginine Vasopressin
Groin
Electronic Health Records
Radiology
Catheterization
Hematoma
Adrenocorticotropic Hormone

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Bilateral inferior petrosal sinus sampling : Experience in 327 patients. / Deipolyi, Amy; Bailin, Alexander; Hirsch, Joshua A.; Walker, T. Gregory; Oklu, Rahmi.

In: Journal of NeuroInterventional Surgery, Vol. 9, No. 2, 01.02.2017, p. 196-199.

Research output: Contribution to journalArticle

Deipolyi, Amy ; Bailin, Alexander ; Hirsch, Joshua A. ; Walker, T. Gregory ; Oklu, Rahmi. / Bilateral inferior petrosal sinus sampling : Experience in 327 patients. In: Journal of NeuroInterventional Surgery. 2017 ; Vol. 9, No. 2. pp. 196-199.
@article{e7578a0758ae4c0aa815770fd2bb60ee,
title = "Bilateral inferior petrosal sinus sampling: Experience in 327 patients",
abstract = "Objective To describe findings and outcomes of 331 bilateral inferior petrosal sinus sampling (BIPSS) procedures performed in 327 patients evaluated for Cushing disease (CD). Materials and methods The radiology department's electronic database was searched to identify all BIPSS procedures (1990-2013). Electronic medical records were used to identify demographics, laboratory, procedural, surgical and pathologic findings. Results A total of 331 BIPSS procedures were performed in 327 patients (254 F, 73 M), mean age 41 (range 7-81) years. The overall technical success rate was 88{\%} for bilateral cannulation, though nearly twothirds of the technical failures had unilateral sampling that diagnosed CD. Of the 331 BIPSS procedures, 40 were performed without, and 291 with stimulation by Acthrel or desmopressin. Sensitivity was 89-94{\%} for unstimulated BIPSS, 96{\%} for stimulated BIPSS, and 77{\%} for MRI. BIPSS lateralization was accurate in about half of patients, compared with 75{\%} accuracy for MRI. Mean inferior petrosal sinus (IPS):peripheral adrenocorticotropic hormone ratio was 17.3 (SE 1.8) at baseline, and 99.2 (SE 14.8) at 3 min, with decreasing values over time. All patients with follow-up after surgical resection for centralizing BIPSS were reported to be cured, with cortisol levels significantly decreased from 19 to 4 μg/dL (p<0.0001). Complications from BIPSS were rare, including groin hematoma (2.5{\%}), but no thromboembolic complications were seen. Conclusions BIPSS remains the 'gold standard' for diagnosing CD. Stimulation with Acthrel or desmopressin is key to increasing specificity. When only one IPS can be successfully cannulated, results may still be diagnostic. BIPSS findings cannot be used to accurately lateralize lesions within the pituitary.",
author = "Amy Deipolyi and Alexander Bailin and Hirsch, {Joshua A.} and Walker, {T. Gregory} and Rahmi Oklu",
year = "2017",
month = "2",
day = "1",
doi = "10.1136/neurintsurg-2015-012164",
language = "English (US)",
volume = "9",
pages = "196--199",
journal = "Journal of NeuroInterventional Surgery",
issn = "1759-8478",
publisher = "BMJ Publishing Group",
number = "2",

}

TY - JOUR

T1 - Bilateral inferior petrosal sinus sampling

T2 - Experience in 327 patients

AU - Deipolyi, Amy

AU - Bailin, Alexander

AU - Hirsch, Joshua A.

AU - Walker, T. Gregory

AU - Oklu, Rahmi

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Objective To describe findings and outcomes of 331 bilateral inferior petrosal sinus sampling (BIPSS) procedures performed in 327 patients evaluated for Cushing disease (CD). Materials and methods The radiology department's electronic database was searched to identify all BIPSS procedures (1990-2013). Electronic medical records were used to identify demographics, laboratory, procedural, surgical and pathologic findings. Results A total of 331 BIPSS procedures were performed in 327 patients (254 F, 73 M), mean age 41 (range 7-81) years. The overall technical success rate was 88% for bilateral cannulation, though nearly twothirds of the technical failures had unilateral sampling that diagnosed CD. Of the 331 BIPSS procedures, 40 were performed without, and 291 with stimulation by Acthrel or desmopressin. Sensitivity was 89-94% for unstimulated BIPSS, 96% for stimulated BIPSS, and 77% for MRI. BIPSS lateralization was accurate in about half of patients, compared with 75% accuracy for MRI. Mean inferior petrosal sinus (IPS):peripheral adrenocorticotropic hormone ratio was 17.3 (SE 1.8) at baseline, and 99.2 (SE 14.8) at 3 min, with decreasing values over time. All patients with follow-up after surgical resection for centralizing BIPSS were reported to be cured, with cortisol levels significantly decreased from 19 to 4 μg/dL (p<0.0001). Complications from BIPSS were rare, including groin hematoma (2.5%), but no thromboembolic complications were seen. Conclusions BIPSS remains the 'gold standard' for diagnosing CD. Stimulation with Acthrel or desmopressin is key to increasing specificity. When only one IPS can be successfully cannulated, results may still be diagnostic. BIPSS findings cannot be used to accurately lateralize lesions within the pituitary.

AB - Objective To describe findings and outcomes of 331 bilateral inferior petrosal sinus sampling (BIPSS) procedures performed in 327 patients evaluated for Cushing disease (CD). Materials and methods The radiology department's electronic database was searched to identify all BIPSS procedures (1990-2013). Electronic medical records were used to identify demographics, laboratory, procedural, surgical and pathologic findings. Results A total of 331 BIPSS procedures were performed in 327 patients (254 F, 73 M), mean age 41 (range 7-81) years. The overall technical success rate was 88% for bilateral cannulation, though nearly twothirds of the technical failures had unilateral sampling that diagnosed CD. Of the 331 BIPSS procedures, 40 were performed without, and 291 with stimulation by Acthrel or desmopressin. Sensitivity was 89-94% for unstimulated BIPSS, 96% for stimulated BIPSS, and 77% for MRI. BIPSS lateralization was accurate in about half of patients, compared with 75% accuracy for MRI. Mean inferior petrosal sinus (IPS):peripheral adrenocorticotropic hormone ratio was 17.3 (SE 1.8) at baseline, and 99.2 (SE 14.8) at 3 min, with decreasing values over time. All patients with follow-up after surgical resection for centralizing BIPSS were reported to be cured, with cortisol levels significantly decreased from 19 to 4 μg/dL (p<0.0001). Complications from BIPSS were rare, including groin hematoma (2.5%), but no thromboembolic complications were seen. Conclusions BIPSS remains the 'gold standard' for diagnosing CD. Stimulation with Acthrel or desmopressin is key to increasing specificity. When only one IPS can be successfully cannulated, results may still be diagnostic. BIPSS findings cannot be used to accurately lateralize lesions within the pituitary.

UR - http://www.scopus.com/inward/record.url?scp=85011406169&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85011406169&partnerID=8YFLogxK

U2 - 10.1136/neurintsurg-2015-012164

DO - 10.1136/neurintsurg-2015-012164

M3 - Article

C2 - 26880723

AN - SCOPUS:85011406169

VL - 9

SP - 196

EP - 199

JO - Journal of NeuroInterventional Surgery

JF - Journal of NeuroInterventional Surgery

SN - 1759-8478

IS - 2

ER -