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).
  
  
  CONCLUSIONS
  These results do not support the routine use of IJVS in establishing if the pituitary is the source of excessive ACTH.
  
  
  BACKGROUND
  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.
authors.forename: Martin G
authors.initials: MG
authors.lastname: Radvany
authors.forename: Alfredo
authors.initials: A
authors.lastname: Quinones-Hinojosa
authors.forename: Gary L
authors.initials: GL
authors.lastname: Gallia
authors.forename: Gary S
authors.initials: GS
authors.lastname: Wand
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvatori
mesh_terms: D000182:ACTH Syndrome, Ectopic / Q000097:blood / Q000175:diagnosis; D049913:ACTH-Secreting Pituitary Adenoma / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism; D000236:Adenoma / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism; D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000032:analysis / Q000097:blood*; D000328:Adult; D000368:Aged; D003480:Cushing Syndrome / Q000097:blood / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000737:chemistry*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017591:Petrosal Sinus Sampling / Q000379:methods*; D047748:Pituitary ACTH Hypersecretion / Q000097:blood / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000324:Adrenocorticotropic Hormone