Inferior petrosal sinus sampling in differential diagnosis of ACTH-dependent hypercortisolism
Ivan I. Sitkin,
Anastasia A. Malygina,
Zhanna E. Belaya,
Lyudmila Y. Rozhinskaya,
Svetlana A. Buryakina https://doi.org/10.14341/serg9752
Abstract
Survival rate of patients with endogenous hypercortisolism, as well as complications reversibility and treatment effectiveness depends on on-time and precise diagnosis. In case of apparent clinical picture with all laboratory tests confirmation, the most challenging appears the differential diagnosis of ACTH-dependent hypercortisolism as none laboratory test can reveal the genesis of ACTH hypersecretion. When there is no visualization of the pituitary adenoma, the only method to confirm the diagnosis is bilateral inferior petrosal sinus sampling (BIPSS). Nevertheless, around 16% of patients have inactive pituitary incidentalomas in combination with carcinoid tumor of other localization. Epidemiologic researches show that the size of such incidentalomas tend to be less than 6 mm. According to clinical guidelines in case of such small neoplasms it’s recommended to perform bilateral inferior petrosal sinus sampling. This clinical case represent a rare exception to the rules when there is a pituitary adenoma more than 6 mm and mild hypercortisolism, possibly as the result of lung carcinoid tumor.
About the Authors
Ivan I. SitkinEndocrinology Research Centre, Moscow, Russia
Russian Federation
MD, PhD
Competing Interests:
None
Anastasia A. Malygina
Endocrinology Research Centre, Moscow, Russia
Russian Federation
MD
Competing Interests:
None
Zhanna E. Belaya
Endocrinology Research Centre, Moscow, Russia
Russian Federation
MD, PhD, Professor
Competing Interests:
None
Lyudmila Y. Rozhinskaya
Endocrinology Research Centre
Russian Federation
MD, PhD, Professor
Competing Interests:
None
Svetlana A. Buryakina
Endocrinology Research Centre
Russian Federation
Competing Interests:
None
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2. Fig. 1. Phlebogram of the inferior stony sines brain. | |
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3. Fig. 2. Computer tomography of thoracic organs cells with contrast enhancement of patient B. In the basal zone on the left, on the posterior contour of the left upper pulmonary vein, medially from the upper lobe bronchus and anterior to the left branch of the pulmonary artery determined oval-shaped soft tissue structure of 8 × 6 mm, actively accumulating contrast drug. | |
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4. Таблица 1. Динамика показателей гормональных анализов пациента Б. | |
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5. Таблица 2. Результаты селективного забора крови из нижних каменистых синусов пациента Б. | |
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For citations:
Sitkin I.I., Malygina A.A., Belaya Zh.E., Rozhinskaya L.Y., Buryakina S.A. Inferior petrosal sinus sampling in differential diagnosis of ACTH-dependent hypercortisolism. Endocrine Surgery. 2018;12(2):89-95. (In Russ.) https://doi.org/10.14341/serg9752
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