Presentation
Patient is suffering Cushing disease.
Patient Data
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 catheterization 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 lateralization to the Right.
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