Simplifying Inferior Petrosal Sinus Sampling: Results of a Multicenter Study

Paul Gardner; Julie Silverstein; Albert Kim; James Evans; Sarah Collopy; Robert Rennert; William Couldwell; Garni Barkhoudarian; Dan Kelly; Juan Fernandez-Miranda; Donato Pacione; Won Kim; Marvin Bergsneider; Michael Chicoine; Gabriel Zada; Varun Kshettry; Kyle Wu; Carolina Benjamin; Jamie Van Gompel; Michael Catalino; Adam Mamelak; Nathan Zwagerman; Andrew Little; Kevin Yuen; Ildiko Torok; Michael Karsy

doi:10.1055/s-0045-1803045

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2025; 86(S 01): S1-S576
DOI: 10.1055/s-0045-1803045

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Simplifying Inferior Petrosal Sinus Sampling: Results of a Multicenter Study

Authors

Paul Gardner

¹University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
Julie Silverstein

²Washington University School of Medicine, United Sates
Albert Kim

²Washington University School of Medicine, United Sates
James Evans

³Jefferson University, Philadelphia, Pennsylvania, United States
Sarah Collopy

³Jefferson University, Philadelphia, Pennsylvania, United States
Robert Rennert

⁴University of Utah, Salt Lake City, Utah, United States
William Couldwell

⁴University of Utah, Salt Lake City, Utah, United States
Garni Barkhoudarian

⁵Pacific Neuroscience Institute, Santa Monica, California, United States
Dan Kelly

⁵Pacific Neuroscience Institute, Santa Monica, California, United States
Juan Fernandez-Miranda

⁶Stanford University, Stanford, California, United States
Donato Pacione

⁷New York University, New York, New York, United States
Won Kim

⁸University of California, Los Angeles, United States
Marvin Bergsneider

⁸University of California, Los Angeles, United States
Michael Chicoine

⁹University of Missouri, Columbia, Missouri, United States
Gabriel Zada

¹⁰Keck School of Medicine, Los Angeles, California, United States
Varun Kshettry

¹¹Cleveland Clinic Foundation, Cleveland, Ohio, United Sates
Kyle Wu

¹²Ohio State College of Medicine, Ohio State University, Columbus, Ohio, United States
Carolina Benjamin

¹³University of Miami, Coral Gables, Florida, United States
Jamie Van Gompel

¹⁴Mayo Clinic
Michael Catalino

¹⁵University of Virginia, Charlottesville, Virginia, United States
Adam Mamelak

¹⁶Cedars-Sinai Medical Center, Los Angeles, California, United Kingdom
Nathan Zwagerman

¹⁷Medical College of Wisconsin, Wisconsin, United States
Andrew Little

¹⁸Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
Kevin Yuen

¹⁸Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
Ildiko Torok

¹⁸Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
Michael Karsy

¹⁹Drexel University College of Medicine, Philadelphia, Pennsylvania, United Sates

Abstract

Full Text

Introduction: Inferior petrosal sinus sampling (IPSS) is an important method for confirming a central source and lateralization for adrenocorticotrophin (ACTH) secretion in Cushing’s disease (CD), though it is technically challenging requiring synchronized blood draws at numerous time points before and after stimulation We explored IPSS results from a multicenter experience to determine if it might be possible to decrease the number of blood draws and retain diagnostic utility.

Methods: Patients from the Registry of Adenomas of the PItuitary and Related Disorders (RAPID) who underwent IPSS for management of CD were included. An analysis of surgical characteristics and laboratory values as well as stimulation protocols and response was performed. Lateralized IPSS ACTH levels with the highest values were normalized to peripheral levels.

Results: Of the 780 patients who were included, 108 underwent IPSS. No differences in baseline characteristics were seen but a higher number of patients with IPSS had MRI-negative disease (81.8 vs. 66.1%, p = 0.02) and long-term remission (71.9 vs. 57.8%, p = 0.01). Among patients with IPSS, 93/108 (86.11%) demonstrated positive pathology or long-term disease remission. Stimulation paradigms showed a 5.0-, 4.6-, and 4.2-fold increase in IPSS ACTH at 2, 5, and 10 minutes poststimulation at the lateralized side of IPSS sampling compared with nonlateralized side, respectively. A 2.4-fold increase in IPSS at the localized side compared with baseline was seen at 2 minutes poststimulation. Both corticotrophin releasing hormone (CRH) and desmopressin (DDAVP) showed best response in ACTH levels around 2 to 5 minutes poststimulation. Patients with long-term remission showed a greater stimulation response also at 2 to 5 minutes compared with those who did not have long-term remission or positive pathology.

Discussion: Pituitary teams can use these data suggesting that stimulation responses of 2.4× from baseline at 2 minutes can indicate a positive response. A four to five times difference between 2 and 10 minutes was seen in lateralizing ACTH responses. These results may help with reducing testing burden on patients and decrease the complexity of the test.

Fig. 1 Normalized ACTH levels during IPSS for localized and nonlocalized sides.

Fig. 2 Normalized ACTH to PRL levels during IPSS for localized and nonlocalized sides.

Fig. 3 Normalized ACTH levels for DDAVP vs. CRH stimulation during IPSS for localized and nonlocalized sides.

Fig. 4 Normalized ACTH levels for patients with and without remission/pathology during IPSS for localized and nonlocalize sides.

Figures

Fig. 1 Normalized ACTH levels during IPSS for localized and nonlocalized sides.

Fig. 2 Normalized ACTH to PRL levels during IPSS for localized and nonlocalized sides.

Fig. 3 Normalized ACTH levels for DDAVP vs. CRH stimulation during IPSS for localized and nonlocalized sides.

Fig. 4 Normalized ACTH levels for patients with and without remission/pathology during IPSS for localized and nonlocalize sides.