OBJECTIVE: We determined whether the measurement of hormones in pituitary blood permits correction for dilution by non-pituitary blood during bilateral simultaneous inferior petrosal sinus blood sampling in Cushing's syndrome. DESIGN: Bilateral simultaneous inferior petrosal sinus blood sampling was performed after combined hCRF and TRH stimulation. Peak ACTH concentrations were corrected for the TSH and PRL inter-sinus ratio, assuming uniform secretion of both hormones into each inferior petrosal sinus. PATIENTS: Eight patients with clinical and biochemical features of Cushing's syndrome. MEASUREMENTS: Basal and stimulated ACTH, TSH and PRL concentrations were measured after bilateral simultaneous inferior petrosal sinus blood sampling and simultaneously from a peripheral forearm vein. RESULTS: Basal central:peripheral ACTH ratio misdiagnosed four of eight patients as having non-pituitary disease. Peak uncorrected ACTH central:peripheral ratio erroneously suggested two of eight patients had non-pituitary disease. ACTH central:peripheral ratio corrected by TSH and PRL correctly predicted pituitary-dependent disease in all eight cases and provided correct lateralization data in four of five patients with a unilateral pituitary microadenoma. CONCLUSION: This study suggests that measuring other hormones in pituitary blood after TRH stimulation can offer a simple and reliable method for correcting for dilution by non-pituitary blood during bilateral simultaneous inferior petrosal sinus blood sampling in Cushing's syndrome.
OBJECTIVE: We determined whether the measurement of hormones in pituitary blood permits correction for dilution by non-pituitary blood during bilateral simultaneous inferior petrosal sinus blood sampling in Cushing's syndrome. DESIGN: Bilateral simultaneous inferior petrosal sinus blood sampling was performed after combined hCRF and TRH stimulation. Peak ACTH concentrations were corrected for the TSH and PRL inter-sinus ratio, assuming uniform secretion of both hormones into each inferior petrosal sinus. PATIENTS: Eight patients with clinical and biochemical features of Cushing's syndrome. MEASUREMENTS: Basal and stimulated ACTH, TSH and PRL concentrations were measured after bilateral simultaneous inferior petrosal sinus blood sampling and simultaneously from a peripheral forearm vein. RESULTS: Basal central:peripheral ACTH ratio misdiagnosed four of eight patients as having non-pituitary disease. Peak uncorrected ACTH central:peripheral ratio erroneously suggested two of eight patients had non-pituitary disease. ACTH central:peripheral ratio corrected by TSH and PRL correctly predicted pituitary-dependent disease in all eight cases and provided correct lateralization data in four of five patients with a unilateral pituitary microadenoma. CONCLUSION: This study suggests that measuring other hormones in pituitary blood after TRH stimulation can offer a simple and reliable method for correcting for dilution by non-pituitary blood during bilateral simultaneous inferior petrosal sinus blood sampling in Cushing's syndrome.
Authors: Mohammad Ghorbani; Hamideh Akbari; Christoph J Griessenauer; Christoph Wipplinger; Alireza Dastmalchi; Mojtaba Malek; Iraj Heydari; Reza Mollahoseini; Mohammad E Khamseh Journal: Heliyon Date: 2020-10-22
Authors: Jordan E Perlman; Philip C Johnston; Ferdinand Hui; Guy Mulligan; Robert J Weil; Pablo F Recinos; Divya Yogi-Morren; Roberto Salvatori; Debraj Mukherjee; Gary Gallia; Laurence Kennedy; Amir H Hamrahian Journal: J Clin Endocrinol Metab Date: 2021-04-23 Impact factor: 5.958