The role of inferior petrosal sinus sampling in ACTH-dependent Cushing's syndrome: review and joint opinion statement by members of the Italian Society for Endocrinology, Italian Society for Neurosurgery, and Italian Society for Neuroradiology

Author:

Giraldi Francesca Pecori12,Cavallo Luigi Maria3,Tortora Fabio4,Pivonello Rosario5,Colao Annamaria5,Cappabianca Paolo3,Mantero Franco6

Affiliation:

1. 1Department of Clinical Sciences and Community Health, University of Milan;

2. 2Neuroendocrine Research Laboratory, Istituto Auxologico Italiano, Milan;

3. 3Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, and

4. 4Department of Neuroradiology, “Magrassi Lanzara” Clinical-Surgical Department, Second University of Naples, Naples; and

5. 6Department of Clinical Medicine and Surgery, University of Naples Federico II;

6. 5Endocrinology Unit, Department of Medicine, University of Padua, Italy

Abstract

In the management of adrenocorticotropic hormone (ACTH)–dependent Cushing's syndrome, inferior petrosal sinus sampling (IPSS) provides information for the endocrinologist, the neurosurgeon, and the neuroradiologist. To the endocrinologist who performs the etiological diagnosis, results of IPSS confirm or exclude the diagnosis of Cushing's disease with 80%–100% sensitivity and over 95% specificity. Baseline central-peripheral gradients have suboptimal accuracy, and stimulation with corticotropin-releasing hormone (CRH), possibly desmopressin, has to be performed. The rationale for the use of IPSS in this context depends on other diagnostic means, taking availability of CRH and reliability of dynamic testing and pituitary imaging into account. As regards the other specialists, the neuroradiologist may collate results of IPSS with findings at imaging, while IPSS may prove useful to the neurosurgeon to chart a surgical course. The present review illustrates the current standpoint of these 3 specialists on the role of IPSS.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

Clinical Neurology,General Medicine,Surgery

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