title: Bilateral inferior petrosal sinus sampling as a routine procedure in ACTH-dependent Cushing's syndrome.
abstract: Bilateral inferior petrosal sinus sampling was successfully performed in 12 of 13 consecutive patients with ACTH-dependent Cushing's syndrome. Ten of the patients subsequently had transsphenoidal pituitary microsurgery. Eight patients in whom the inferior petrosal sinus to peripheral vein ACTH level ratio was 1.5 or greater were found to have a pituitary adenoma. One of the remaining two patients who had ratios less than 1.5 had pituitary hyperplasia while the other had no identified abnormality. In five of the patients with pituitary tumour a ratio above 1.5 was present on only one side. Bilateral petrosal sampling is therefore always necessary. Tumour localization within the pituitary was only poorly predicted by either petrosal sinus sampling (four of eight) or computed tomography scanning (three of eight). If petrosal sinus sampling is used early in the differential diagnosis of ACTH-dependent hypercortisolism, then the use of other differential diagnostic tests may not always be necessary.
authors.affiliation: Sir George E. Clark Metabolic Unit, Department of Radiology, Royal Victoria Hospital, Belfast, UK.
authors.forename: D R
authors.initials: DR
authors.lastname: McCance
authors.forename: E
authors.initials: E
authors.lastname: McIlrath
authors.forename: A
authors.initials: A
authors.lastname: McNeill
authors.forename: D S
authors.initials: DS
authors.lastname: Gordon
authors.forename: D R
authors.initials: DR
authors.lastname: Hadden
authors.forename: L
authors.initials: L
authors.lastname: Kennedy
authors.forename: B
authors.initials: B
authors.lastname: Sheridan
authors.forename: A B
authors.initials: AB
authors.lastname: Atkinson
mesh_terms: D000236:Adenoma / Q000150:complications / Q000175:diagnosis; D000324:Adrenocorticotropic Hormone / Q000097:blood* / Q000502:physiology; D001800:Blood Specimen Collection / Q000379:methods*; D003392:Cranial Sinuses / Q000032:analysis*; D003480:Cushing Syndrome / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D010911:Pituitary Neoplasms / Q000175:diagnosis
chemical_list: D000324:Adrenocorticotropic Hormone