2025 Proffered Presentations
S028: SIMPLIFYING INFERIOR PETROSAL SINUS SAMPLING: RESULTS OF A MULTICENTER STUDY
Paul Gardner1; Julie Silverstein2; Albert Kim2; James Evans3; Sarah Collopy3; Robert Rennert4; William Couldwell4; Garni Barkhoudarian5; Dan Kelly5; Juan Fernandez-Miranda6; Donato Pacione7; Won Kim8; Marvin Bergsneider8; Michael Chicoine9; Gabriel Zada10; Varun Kshettry11; Kyle Wu12; Carolina Benjamin13; Jamie Van Gompel14; Michael Catalino15; Adam Mamelak16; Nathan Zwagerman17; Andrew Little18; Kevin Yuen18; Ildiko Torok18; Michael Karsy19; 1University of Pittsburgh Medical Center; 2Washington University School of Medicin; 3Jefferson University; 4University of Utah; 5Pacific Neuroscience Institute; 6Stanford University; 7New York University; 8University of California, Los Angeles; 9University of Missouri; 10Keck School of Medicine; 11Cleveland Clinic Foundation; 12Ohio State College of Medicine; 13University of Miami; 14Mayo Clinic; 15University of Virginia; 16Cedars-Sinai Medical Center; 17Medical College of Wisconsin; 18Barrow Neurological Institute, St. Joseph's Hospital and Medical Center; 19Drexel University College of Medicine
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 that 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 post-stimulation 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 post-stimulation. Both corticotrophin releasing hormone (CRH) and desmopressin (DDAVP) showed best response in ACTH levels around 2-5 minutes post-stimulation. Patients with long-term remission showed a greater stimulation response also at 2-5 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 2.4X from baseline at 2 minutes can indicate a positive response. A 4-5X difference between 2-10 minutes was seen in lateralizing ACTH responses. These results may help with reducing testing burden on patients and decrease the complexity of the test.
Figure 1: Normalized ACTH levels during IPSS for localized and nonlocalized sides
Figure 2: Normalized ACTH to PRL levels during IPSS for localized and nonlocalized sides
Figure 3: Normalized ACTH levels for DDAVP vs. CRH stimulation during IPSS for localized and nonlocalized sides
Figure 4: Normalized ACTH levels for patients with and without remission/pathology during IPSS for localized and nonlocalize sides
