title: Bilateral inferior petrosal sinus sampling using desmopressin or corticotropic-releasing hormone: a single-center experience.
abstract: BACKGROUND
  Bilateral inferior petrosal sinus sampling (BIPSS) following corticotropic-releasing hormone (CRH) stimulation is the current gold standard technique in the diagnosis of Cushing disease. However, as a result of CRH shortage, desmopressin (DDAVP) has been used instead for BIPSS. We present the experience of a single tertiary care center using the modified BIPSS protocol and compare the results obtained with DDAVP with those obtained with CRH.
  
  
  METHODS
  Using the radiology department's electronic database, BIPSS procedures performed at our institution using DDAVP and CRH were identified. Electronic medical records and imaging studies were reviewed and the clinical history, demographic data, endocrine test results, complications of BIPSS, and patient outcomes were recorded. BIPSS data were analyzed for centralization and lateralization of pituitary adrenocorticotropic hormone (ACTH) source. We identified 20 BIPSS cases (16 women, mean age 38 years) performed using DDAVP between 2012 and 2013.
  
  
  RESULTS
  The 20 cases demonstrated conventional inferior petrosal sinus anatomy and were successfully cannulated bilaterally. Of these, 18 met the criteria for both centralization and lateralization. A total of 18 patients underwent trans-sphenoidal tumor resection; one patient was lost to follow-up and one is still being followed. There were no complications resulting from the use of DDAVP, specifically no thromboembolic events. Calculated sensitivity for BIPSS with DDAVP was 94.5%. There was also no significant difference in the biochemical results produced by BIPSS using either DDAVP or CRH. All 18 patients demonstrated an ACTH-secreting adenoma on pathology review.
  
  
  CONCLUSIONS
  DDAVP is a safe alternative to CRH, producing comparable diagnostic results.
authors.affiliation: Division of Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Deipolyi
authors.affiliation: Division of Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Bailin
authors.initials: B
authors.lastname: Alexander
authors.affiliation: Division of Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Rho
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA Division of Interventional Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Hirsch
authors.affiliation: Division of Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Rahmi
authors.initials: R
authors.lastname: Oklu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003346:Corticotropin-Releasing Hormone / Q000627:therapeutic use*; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017591:Petrosal Sinus Sampling / Q000379:methods*; D047748:Pituitary ACTH Hypersecretion / Q000175:diagnosis; D055815:Young Adult
chemical_list: D003346:Corticotropin-Releasing Hormone; D003894:Deamino Arginine Vasopressin
keywords: Angiography; MRI; Tumor; Vein