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Inferior petrosal sinus sampling

Case contributed by: Dr Lawrence Josey

Presentation:

Patient is suffering cushings disease.

Patient Data:

Age: 22

Gender: Male

Race: Caucasian

From the case: Inferior petrosal sinus sampling

Modality: DSA (angiography)

Check venograms performed prior to inferior petrosal sinus sampling, immediately prior to stimulation (CRF 100ug IV) and after the procedure. On each occasion, satisfactory position shown.

Simultaneous specimens were taken from right and left inferior petrosal sinuses and peripherally. 2 baselines. 3 specimens in the first 5 minutes. 10 minutes. 15 minutes.

Case Discussion:

Laboratory report:

Central:peripheral prolactin gradients (>=1.8) indicate successful catheterisation of both IPS.
Central:peripheral ACTH gradients (>=2.0 pre,>=3.0 post-CRH) indicate a pituitary source of ACTH in this case. Left gradients borderline.
Intercavernous ACTH gradients (>=1.4) would be considered by some to be
significant for lateralisation to the Right.

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