Daniel Rodriguez Bejarano MD, Presenter: Nothing to Disclose

Lucia Aja MD, Abstract Co-Author: Nothing to Disclose

Juan Jose Sanchez Fernandez MD, Abstract Co-Author: Nothing to Disclose

Evelyn Claudia Montano Claure MD, Abstract Co-Author: Nothing to Disclose

Lara Farras, Abstract Co-Author: Nothing to Disclose

Lisbeth Valoyes Guerrero MD, Abstract Co-Author: Nothing to Disclose

ACTH-dependent CS is a diagnostic challenge.  The goal is to distinguish pituitary from ectopic ACTH secretion; BIPSS is sensitive and specific in the diagnosis of this entity and helps in location of the adenoma. An adequate knowledge of venous anatomy and a proper technique are essential to avoid complications with interpretable results.

CS is an uncommon endocrine disorder associating increased morbidity and mortality. Endogenous CS is mostly due to ACTH-secreting pituitary adenomas. Features of pituitary and ectopic ACTH-dependent CS (carcinoid tumors...) are undistinguishable. BIPSS is the gold standard to identify the source of ACTH secretion. Knowledge of pituitary venous drainage is essential for IPSS technique.  As venous drainage from pituitary is usually unilateral, a bilateral approach is required. Our protocol includes a bilateral femoral venous access (5F sheath in each femoral vein). When catheters are placed, we started to sample ACTH from peripheral blood and from both IPS at baseline, and after CRH stimulation (3, 5, 15, 30 minutes). After samples are obtained, both femoral sheaths are removed. To interpret results, the ratio of IPS/peripheral ACTH level is calculated. It’s a safe procedure, if it’s done by experienced personal. The most frequent complication is groin hematoma; neurologic complications are rare.  

http://abstract.rsna.org/uploads/2014/14003466/14003466_854h.pdf

Rodriguez Bejarano, D, Aja, L, Sanchez Fernandez, J, Montano Claure, E, Farras, L, Valoyes Guerrero, L, BIlateral Inferior Petrosal Sinus Sampling (BIPSS) in Diagnostic Evaluation of ACTH-dependent Cushing Syndrome (CS): A Pictorial Review.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003466.html