Venous Sampling for Cushing Disease

Comparison of Internal Jugular Vein and Inferior Petrosal Sinus Sampling

Martin G. Radvany, Alfredo Quinones-Hinojosa, Gary L. Gallia, Gary S. Wand, Roberto Salvatori

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: Because magnetic resonance imaging (MRI) fails to detect many adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas, inferior petrosal sinus sampling (IPSS) is considered the gold standard to differentiate Cushing disease (CD) from ectopic ACTH secretion syndrome (EAS). Some authors have suggested internal jugular vein sampling (IJVS) as an alternative to IPSS. Methods: We simultaneously compared IJVS to IPSS in 30 consecutive patients referred for ACTH-dependent Cushing syndrome and equivocal MRI exams. Five sites were simultaneously sampled in each patient (right and left IPS, right and left IJV, and femoral vein) before and after the administration of corticotrophin-releasing hormone or desmopressin. The test was considered consistent with CD when the IPS to peripheral ratio was >2 at baseline or >3 after stimulus and the IJV to peripheral ratio was >1.7 at baseline or >2 after stimulus. Results: In 27 of 30 patients, IPSS results were consistent with a central source of ACTH. Two of the other 3 patients had EAS (one lung carcinoid and one occult), and 1 patient had pathology-proven CD. The sensitivity of IPSS was 96.4%. Only 64.2% of these patients had results meeting criteria for a central source of ACTH by IJVS criteria. Twenty patients with centralizing IPPS have undergone pituitary surgery. Of these, the central origin of excessive ACTH was confirmed with certainty in 16 patients. Among these 16 patients, the IPSS sensitivity was 93.8%, whereas 5 patients had false-negative IJVS (68.7% sensitivity). Conclusion: These results do not support the routine use of IJVS in establishing if the pituitary is the source of excessive ACTH. Abbreviations: ACTH = adrenocorticotropic hormone CD = Cushing disease CRH = corticotrophin-releasing hormone CS = Cushing syndrome DDAVP = desmopressin EAS = ectopic ACTH secretion IJVS = internal jugular vein sampling IPSS = inferior petrosal sinus sampling JVS = jugular venous sampling MRI = magnetic resonance imaging.

Original languageEnglish (US)
Pages (from-to)1057-1061
Number of pages5
JournalEndocrine Practice
Volume22
Issue number9
DOIs
StatePublished - Sep 1 2016
Externally publishedYes

Fingerprint

Petrosal Sinus Sampling
Pituitary ACTH Hypersecretion
Jugular Veins
Adrenocorticotropic Hormone
Deamino Arginine Vasopressin
Ectopic ACTH Syndrome
Ectopic Hormones
Magnetic Resonance Imaging
Cushing Syndrome
Corticotropin-Releasing Hormone
Femoral Vein
Carcinoid Tumor
Pituitary Neoplasms
Patient Rights

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Venous Sampling for Cushing Disease : Comparison of Internal Jugular Vein and Inferior Petrosal Sinus Sampling. / Radvany, Martin G.; Quinones-Hinojosa, Alfredo; Gallia, Gary L.; Wand, Gary S.; Salvatori, Roberto.

In: Endocrine Practice, Vol. 22, No. 9, 01.09.2016, p. 1057-1061.

Research output: Contribution to journalArticle

Radvany, Martin G. ; Quinones-Hinojosa, Alfredo ; Gallia, Gary L. ; Wand, Gary S. ; Salvatori, Roberto. / Venous Sampling for Cushing Disease : Comparison of Internal Jugular Vein and Inferior Petrosal Sinus Sampling. In: Endocrine Practice. 2016 ; Vol. 22, No. 9. pp. 1057-1061.
@article{d17a473f6b4d45b5b764b77333eac894,
title = "Venous Sampling for Cushing Disease: Comparison of Internal Jugular Vein and Inferior Petrosal Sinus Sampling",
abstract = "Objective: Because magnetic resonance imaging (MRI) fails to detect many adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas, inferior petrosal sinus sampling (IPSS) is considered the gold standard to differentiate Cushing disease (CD) from ectopic ACTH secretion syndrome (EAS). Some authors have suggested internal jugular vein sampling (IJVS) as an alternative to IPSS. Methods: We simultaneously compared IJVS to IPSS in 30 consecutive patients referred for ACTH-dependent Cushing syndrome and equivocal MRI exams. Five sites were simultaneously sampled in each patient (right and left IPS, right and left IJV, and femoral vein) before and after the administration of corticotrophin-releasing hormone or desmopressin. The test was considered consistent with CD when the IPS to peripheral ratio was >2 at baseline or >3 after stimulus and the IJV to peripheral ratio was >1.7 at baseline or >2 after stimulus. Results: In 27 of 30 patients, IPSS results were consistent with a central source of ACTH. Two of the other 3 patients had EAS (one lung carcinoid and one occult), and 1 patient had pathology-proven CD. The sensitivity of IPSS was 96.4{\%}. Only 64.2{\%} of these patients had results meeting criteria for a central source of ACTH by IJVS criteria. Twenty patients with centralizing IPPS have undergone pituitary surgery. Of these, the central origin of excessive ACTH was confirmed with certainty in 16 patients. Among these 16 patients, the IPSS sensitivity was 93.8{\%}, whereas 5 patients had false-negative IJVS (68.7{\%} sensitivity). Conclusion: These results do not support the routine use of IJVS in establishing if the pituitary is the source of excessive ACTH. Abbreviations: ACTH = adrenocorticotropic hormone CD = Cushing disease CRH = corticotrophin-releasing hormone CS = Cushing syndrome DDAVP = desmopressin EAS = ectopic ACTH secretion IJVS = internal jugular vein sampling IPSS = inferior petrosal sinus sampling JVS = jugular venous sampling MRI = magnetic resonance imaging.",
author = "Radvany, {Martin G.} and Alfredo Quinones-Hinojosa and Gallia, {Gary L.} and Wand, {Gary S.} and Roberto Salvatori",
year = "2016",
month = "9",
day = "1",
doi = "10.4158/EP161266.OR",
language = "English (US)",
volume = "22",
pages = "1057--1061",
journal = "Endocrine Practice",
issn = "1530-891X",
publisher = "American Association of Clinical Endocrinology",
number = "9",

}

TY - JOUR

T1 - Venous Sampling for Cushing Disease

T2 - Comparison of Internal Jugular Vein and Inferior Petrosal Sinus Sampling

AU - Radvany, Martin G.

AU - Quinones-Hinojosa, Alfredo

AU - Gallia, Gary L.

AU - Wand, Gary S.

AU - Salvatori, Roberto

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Objective: Because magnetic resonance imaging (MRI) fails to detect many adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas, inferior petrosal sinus sampling (IPSS) is considered the gold standard to differentiate Cushing disease (CD) from ectopic ACTH secretion syndrome (EAS). Some authors have suggested internal jugular vein sampling (IJVS) as an alternative to IPSS. Methods: We simultaneously compared IJVS to IPSS in 30 consecutive patients referred for ACTH-dependent Cushing syndrome and equivocal MRI exams. Five sites were simultaneously sampled in each patient (right and left IPS, right and left IJV, and femoral vein) before and after the administration of corticotrophin-releasing hormone or desmopressin. The test was considered consistent with CD when the IPS to peripheral ratio was >2 at baseline or >3 after stimulus and the IJV to peripheral ratio was >1.7 at baseline or >2 after stimulus. Results: In 27 of 30 patients, IPSS results were consistent with a central source of ACTH. Two of the other 3 patients had EAS (one lung carcinoid and one occult), and 1 patient had pathology-proven CD. The sensitivity of IPSS was 96.4%. Only 64.2% of these patients had results meeting criteria for a central source of ACTH by IJVS criteria. Twenty patients with centralizing IPPS have undergone pituitary surgery. Of these, the central origin of excessive ACTH was confirmed with certainty in 16 patients. Among these 16 patients, the IPSS sensitivity was 93.8%, whereas 5 patients had false-negative IJVS (68.7% sensitivity). Conclusion: These results do not support the routine use of IJVS in establishing if the pituitary is the source of excessive ACTH. Abbreviations: ACTH = adrenocorticotropic hormone CD = Cushing disease CRH = corticotrophin-releasing hormone CS = Cushing syndrome DDAVP = desmopressin EAS = ectopic ACTH secretion IJVS = internal jugular vein sampling IPSS = inferior petrosal sinus sampling JVS = jugular venous sampling MRI = magnetic resonance imaging.

AB - Objective: Because magnetic resonance imaging (MRI) fails to detect many adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas, inferior petrosal sinus sampling (IPSS) is considered the gold standard to differentiate Cushing disease (CD) from ectopic ACTH secretion syndrome (EAS). Some authors have suggested internal jugular vein sampling (IJVS) as an alternative to IPSS. Methods: We simultaneously compared IJVS to IPSS in 30 consecutive patients referred for ACTH-dependent Cushing syndrome and equivocal MRI exams. Five sites were simultaneously sampled in each patient (right and left IPS, right and left IJV, and femoral vein) before and after the administration of corticotrophin-releasing hormone or desmopressin. The test was considered consistent with CD when the IPS to peripheral ratio was >2 at baseline or >3 after stimulus and the IJV to peripheral ratio was >1.7 at baseline or >2 after stimulus. Results: In 27 of 30 patients, IPSS results were consistent with a central source of ACTH. Two of the other 3 patients had EAS (one lung carcinoid and one occult), and 1 patient had pathology-proven CD. The sensitivity of IPSS was 96.4%. Only 64.2% of these patients had results meeting criteria for a central source of ACTH by IJVS criteria. Twenty patients with centralizing IPPS have undergone pituitary surgery. Of these, the central origin of excessive ACTH was confirmed with certainty in 16 patients. Among these 16 patients, the IPSS sensitivity was 93.8%, whereas 5 patients had false-negative IJVS (68.7% sensitivity). Conclusion: These results do not support the routine use of IJVS in establishing if the pituitary is the source of excessive ACTH. Abbreviations: ACTH = adrenocorticotropic hormone CD = Cushing disease CRH = corticotrophin-releasing hormone CS = Cushing syndrome DDAVP = desmopressin EAS = ectopic ACTH secretion IJVS = internal jugular vein sampling IPSS = inferior petrosal sinus sampling JVS = jugular venous sampling MRI = magnetic resonance imaging.

UR - http://www.scopus.com/inward/record.url?scp=85021860319&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85021860319&partnerID=8YFLogxK

U2 - 10.4158/EP161266.OR

DO - 10.4158/EP161266.OR

M3 - Article

VL - 22

SP - 1057

EP - 1061

JO - Endocrine Practice

JF - Endocrine Practice

SN - 1530-891X

IS - 9

ER -