{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T20:10:07Z","timestamp":1781295007170,"version":"3.54.1"},"reference-count":37,"publisher":"FapUNIFESP (SciELO)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Bras Endocrinol Metab"],"published-print":{"date-parts":[[2007,11]]},"abstract":"<jats:p>Adrenocorticotropin hormone (ACTH)-dependent Cushing's syndrome is most often due to a pituitary corticotroph adenoma, with ectopic ACTH-secreting tumors representing approximately 15% of cases. Biochemical and radiological techniques have been established to help distinguish between these two entities, and thus aid in the localization of the neoplastic lesion for surgical resection. The test that offers the highest sensitivity and specificity is bilateral inferior petrosal sinus sampling (BIPSS). BIPSS is an interventional radiology procedure in which ACTH levels obtained from venous drainage very near the pituitary gland are compared to peripheral blood levels before and after corticotropin hormone (CRH) stimulation. A gradient between these two locations indicates pituitary Cushing's, whereas the absence of a gradient suggests ectopic Cushing's. Accurate BIPSS results require hypercortisolemia to suppress normal corticotroph ACTH production and hypercortisolemia at the time of the BIPSS to assure excessive ACTH secretion. In some cases, intrapituitary gradients from side-to-side can be helpful to localize small corticotroph adenomas within the sella. BIPSS has rare complications and is considered safe when performed at centers with experience in this specialized technique.<\/jats:p>","DOI":"10.1590\/s0004-27302007000800019","type":"journal-article","created":{"date-parts":[[2008,1,18]],"date-time":"2008-01-18T08:16:55Z","timestamp":1200644215000},"page":"1329-1338","source":"Crossref","is-referenced-by-count":30,"title":["The role of bilateral inferior petrosal sinus sampling in the diagnosis of Cushing's syndrome"],"prefix":"10.1590","volume":"51","author":[{"given":"Andrea","family":"Utz","sequence":"first","affiliation":[{"name":"Massachusetts General Hospital, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverly M.K.","family":"Biller","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","reference":[{"key":"ref1","first-page":"1619","article-title":"Biochemical assessment of Cushing's disease in patients with corticotroph macroadenomas","volume":"83","author":"Katznelson L","year":"1998","journal-title":"J Clin Endocrinol Metab","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"key":"ref2","first-page":"647","article-title":"The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states","volume":"19","author":"Newell-Price J","year":"1998","journal-title":"Endocr Rev","ISSN":"https:\/\/id.crossref.org\/issn\/0163-769X","issn-type":"print"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1002\/cncr.20412","article-title":"The prevalence of pituitary adenomas","volume":"101","author":"Ezzat S","year":"2004","journal-title":"Cancer","ISSN":"https:\/\/id.crossref.org\/issn\/0008-543X","issn-type":"print"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1210\/jc.2002-021438","article-title":"Spoiled gradient recalled acquisition in the steady state technique is superior to conventional postcontrast spin echo technique for magnetic resonance imaging detection of adrenocorticotropin-secreting pituitary tumors","volume":"88","author":"Patronas N","year":"2003","journal-title":"J Clin Endocrinol Metab","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"5593","DOI":"10.1210\/jc.2003-030871","article-title":"Diagnosis and complications of Cushing's syndrome: A consensus statement","volume":"88","author":"Arnaldi G","year":"2003","journal-title":"J Clin Endocrinol Metab","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"key":"ref6","first-page":"1780","article-title":"Effectiveness versus efficacy: The limited value in clinical practice of high dose dexamethasone suppression testing in the differential diagnosis of adrenocorticotropin-dependent Cushing's syndrome","volume":"82","author":"Aron DC","year":"1997","journal-title":"J Clin Endocrinol Metab","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.ecl.2005.01.009","article-title":"Differential diagnosis and imaging in Cushing's syndrome","volume":"34","author":"Lindsay J","year":"2005","journal-title":"Endocrinol Metab Clin North Am","ISSN":"https:\/\/id.crossref.org\/issn\/0889-8529","issn-type":"print"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"3752","DOI":"10.1210\/jc.2003-032249","article-title":"Diagnostic errors after inferior petrosal sinus sampling","volume":"89","author":"Swearingen B","year":"2004","journal-title":"J Clin Endocrinol Metab","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"3795","DOI":"10.1210\/jc.2003-032014","article-title":"Jugular venous sampling: An alternative to petrosal sinus sampling for the diagnostic evaluation of adrenocorticotropic hormone-dependent Cushing's syndrome","volume":"89","author":"Ilias I","year":"2004","journal-title":"J Clin Endocrinol Metab","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1056\/NEJM197704142961508","article-title":"Selective venous sampling to differentiate ectopic ACTH secretion from pituitary Cushing's syndrome","volume":"196","author":"Corrigan D","year":"1977","journal-title":"NEJM"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"647","DOI":"10.7326\/0003-4819-94-5-647","article-title":"Selective venous sampling for ACTH in Cushing's syndrome","volume":"94","author":"Findling J","year":"1981","journal-title":"Ann Intern Med","ISSN":"https:\/\/id.crossref.org\/issn\/0003-4819","issn-type":"print"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1148\/radiology.150.1.6316418","article-title":"Petrosal sinus sampling for Cushing syndrome: Anatomical and technical considerations. Work in progress","volume":"150","author":"Doppman J","year":"1984","journal-title":"Radiology","ISSN":"https:\/\/id.crossref.org\/issn\/0033-8419","issn-type":"print"},{"key":"ref13","first-page":"503","article-title":"The limited ability of inferior petrosal sinus sampling with corticotropin-releasing hormone to distinguish Cushing's disease from pseudo-Cushing states or normal physiology","volume":"77","author":"Yanovski J","year":"1993","journal-title":"J Clin Endocrinol Metab","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1148\/radiology.178.1.1845785","article-title":"Petrosal sinus sampling: Technique and rationale","volume":"178","author":"Miller D","year":"1991","journal-title":"Radiology","ISSN":"https:\/\/id.crossref.org\/issn\/0033-8419","issn-type":"print"},{"key":"ref15","first-page":"57","article-title":"Cavernous sinus venography","volume":"104","author":"Shiu P","year":"1968","journal-title":"Am J Radiol"},{"key":"ref16","first-page":"475","article-title":"Venous angiography is needed to interpret inferior petrosal sinus and cavernous sinus sampling data for lateralizing adrenocorticotropin-secreting adenomas","volume":"81","author":"Mamelak A","year":"1996","journal-title":"J Clin Endocrinol Metab","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1210\/jcem-69-1-165","article-title":"The ovine corticotropin-releasing hormone (CRH) stimulation test is superior to the human CRH stimulation test for the diagnosis of Cushing's disease","volume":"69","author":"Nieman L","year":"1989","journal-title":"J Clin Endocrinol Metab","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1056\/NEJM199109263251301","article-title":"Petrosal sinus sampling with and without corticotropin-releasing hormone for the differential diagnosis of Cushing's syndrome","volume":"325","author":"Oldfield E","year":"1991","journal-title":"NEJM"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1097\/00005792-199503000-00002","article-title":"Differential diagnosis in Cushing syndrome: Use of corticotropin-releasing hormone","volume":"74","author":"Freda P","year":"1995","journal-title":"Medicine","ISSN":"https:\/\/id.crossref.org\/issn\/0025-7974","issn-type":"print"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1210\/jc.2002-020374","article-title":"Accuracy of bilateral inferior petrosal or cavernous sinuses sampling in predicting the lateralization of Cushing's disease pituitary microadenoma: Influence of catheter position and anatomy of venous drainage","volume":"88","author":"Lefournier V","year":"2003","journal-title":"J Clin Endocrinol Metab","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"key":"ref21","first-page":"533","article-title":"The hypoplastic inferior petrosal sinus: A potential source of false-negative results in petrosal sampling for Cushing's disease","volume":"84","author":"Doppman JL","year":"1999","journal-title":"J Clin Endocrinol Metab","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"key":"ref22","first-page":"777","article-title":"Pulmonary thromboembolism after inferior petrosal sinus sampling in Cushing's syndrome","volume":"46","author":"Diez J","year":"1997","journal-title":"Clin Endocrinol"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1007\/BF03343772","article-title":"Venous thrombo-embolism following inferior petrosal sinus sampling in Cushing's disease","volume":"23","author":"Obuobie K","year":"2000","journal-title":"J Endocrinol Invest","ISSN":"https:\/\/id.crossref.org\/issn\/0391-4097","issn-type":"print"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1136\/jnnp.62.5.527","article-title":"A neurological complication of inferior petrosal sinus sampling during investigation for Cushing's disease: A case report","volume":"62","author":"Sturrock N","year":"1997","journal-title":"J Neurol Neurosurg Psychiatry","ISSN":"https:\/\/id.crossref.org\/issn\/0022-3050","issn-type":"print"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1148\/radiology.185.1.1523298","article-title":"Neurologic complications of petrosal sinus sampling","volume":"185","author":"Miller D","year":"1992","journal-title":"Radiology","ISSN":"https:\/\/id.crossref.org\/issn\/0033-8419","issn-type":"print"},{"key":"ref26","first-page":"3401","article-title":"One transient neurological complication (sixth nerve palsy) in 166 consecutive inferior petrosal sinus samplings for the etiological diagnosis of Cushing's syndrome","volume":"84","author":"Lefournier V","year":"1999","journal-title":"J Clin Endocrinol Metab","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"key":"ref27","first-page":"306","article-title":"Venous subarachnoid hemorrhage after inferior petrosal sinus sampling for adrenocorticotropic hormone","volume":"20","author":"Bonelli FS","year":"1999","journal-title":"AJNR Am J Neuroradiol","ISSN":"https:\/\/id.crossref.org\/issn\/0195-6108","issn-type":"print"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1111\/j.1365-2265.2004.01990.x","article-title":"Internal jugular vein sampling in adrenocorticotropic hormone-dependent Cushing's syndrome: A comparison with inferior petrosal sinus sampling","volume":"60","author":"Erickson D","year":"2004","journal-title":"Clin Endocrinol"},{"key":"ref29","first-page":"1602","article-title":"Cavernous sinus sampling is highly accurate in distinguishing Cushing's disease from the ectopic adrenocorticotropin syndrome and in predicting intrapituitary tumor location","volume":"84","author":"Graham KE","year":"1999","journal-title":"J Clin Endocrinol Metab","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"890","DOI":"10.3171\/jns.1998.89.5.0762","article-title":"Cavernous sinus sampling in patients with adrenocorticotrophic hormone-dependent Cushing's syndrome with emphasis on inter- and intracavernous adrenocorticotrophic hormone gradients","volume":"89","author":"Teramoto A","year":"1998","journal-title":"J Neurosurg","ISSN":"https:\/\/id.crossref.org\/issn\/0022-3085","issn-type":"print"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"6005","DOI":"10.1210\/jc.2004-1378","article-title":"Identification of patients with Cushing's disease with negative pituitary adrenocorticotropin gradients during inferior petrosal sinus sampling: Prolactin as an index of pituitary venous effluent","volume":"89","author":"Findling JW","year":"2004","journal-title":"J Clin Endocrinol Metab","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"205","DOI":"10.3171\/jns.1988.68.2.0205","article-title":"Usefulness of inferior petrosal sinus venous endocrine markers in Cushing's disease","volume":"68","author":"Zovickian J","year":"1988","journal-title":"J Neurosurg","ISSN":"https:\/\/id.crossref.org\/issn\/0022-3085","issn-type":"print"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1111\/j.1365-2265.2006.02700.x","article-title":"The role of desmopressin in bilateral and simultaneous inferior petrosal sinus sampling for differential diagnosis of ACTH-dependent Cushing's syndrome","volume":"66","author":"Machado MC","year":"2007","journal-title":"Clin Endocrinol"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"2080","DOI":"10.1210\/jc.2006-2691","article-title":"The application of the combined corticotropin-releasing hormone plus desmopressin stimulation during petrosal sinus sampling is both sensitive and specific in differentiating patients with Cushing's disease from patients with the occult ectopic adrenocorticotropin syndrome","volume":"92","author":"Tsagarakis S","year":"2007","journal-title":"J Clin Endocrinol Metab","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1046\/j.1365-2265.1997.1971007.x","article-title":"Metyrapone pre-treated inferior petrosal sinus sampling in the differential diagnosis of ACTH-dependent Cushing's syndrome","volume":"46","author":"Cuneo R","year":"1997","journal-title":"Clin Endocrinol"},{"key":"ref36","first-page":"1485","article-title":"Plasma levels of corticotropin-releasing hormone in the inferior petrosal sinuses of healthy volunteers, patients with Cushing's syndrome, and patients with pseudo-Cushing states","volume":"83","author":"Yanovski JA","year":"1998","journal-title":"J Clin Endocrinol Metab","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1056\/NEJM198501103120207","article-title":"Preoperative lateralization of ACTH-secreting pituitary microadenomas by bilateral and simultaneous inferior petrosal venous sinus sampling","volume":"312","author":"Oldfield E","year":"1985","journal-title":"NEJM"}],"container-title":["Arquivos Brasileiros de Endocrinologia &amp; Metabologia"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/pdf\/abem\/v51n8\/17.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T10:48:09Z","timestamp":1708512489000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0004-27302007000800019&lng=en&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,11]]},"references-count":37,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2007,11]]}},"alternative-id":["S0004-27302007000800019"],"URL":"https:\/\/doi.org\/10.1590\/s0004-27302007000800019","relation":{},"ISSN":["0004-2730"],"issn-type":[{"value":"0004-2730","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,11]]}}}