Inferior petrosal sinus sampling

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Inferior petrosal sinus sampling is a relatively new approach to the diagnosis of Cushing's disease.[1]

In essence, it tests to see the source of the raised ACTH levels in a patient with diagnosed Cushing's syndrome and high or normal serum ACTH levels. The inferior petrosal sinus is where the pituitary gland drains. Therefore, a sample from here showing raised ACTH compared to the periphery suggests that it is a pituitary cause of Cushing's, i.e. Cushing's disease. Equivocal levels of ACTH indicate ectopic or Paraneoplastic Cushing's Syndrome. The sample is usually taken after administration of Corticotropin-releasing hormone or, more recently, DDAVP,[2] which have been shown to increase ACTH production in active ACTH-producing pituitary tumors. It is used to help identify the side of lesion within the pituitary gland (Cushing's disease).[3]


  1. ^ Kurata, A; Suzuki, S; Iwamoto, K; Nakahara, K; Inukai, M; Niki, J; Satou, K; Yamada, M; Fujii, K; Kan, S; Katsuta, T (2011-06-17). "A new transvenous approach to the carotid-cavernous sinus via the inferior petrooccipital vein". Journal of Neurosurgery. 116 (3): 581–7. doi:10.3171/2011.4.JNS102155. PMID 21682561. 
  2. ^ Machado MC; et al. (2007). "The role of desmopressin in bilateral and simultaneous inferior petrosal sinus sampling for differential diagnosis of ACTH-dependent Cushing's syndrome". Clinical Endocrinology. 66 (1): 136–42. doi:10.1111/j.1365-2265.2006.02700.x. PMID 17201813. 
  3. ^ Deipolyi, A; Karaosmanoglu, A; Habito, C; Brannan, S; Wicky, S; Hirsch, J; Oklu, R (2011-02-23). "The role of bilateral inferior petrosal sinus sampling in the diagnostic evaluation of Cushing disease". Diagnostic and interventional radiology (Ankara, Turkey). 18 (1): 132–8. doi:10.4261/1305-3825.DIR.4279-11.0. PMID 21348009.