{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T02:30:34Z","timestamp":1793154634656,"version":"4.5.0"},"reference-count":23,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Inferior petrosal sinus (IPS) sampling (IPSS) is a diagnostic procedure used to guide diagnostic localization of imaging-negative adrenocorticotropic hormone (ACTH)\u2013secreting pituitary microadenomas. However, the efficacy of IPSS has been suboptimal at accurately lateralizing the adenoma, reducing surgical cure rates and leading to unintended pituitary dysfunction due to the added exploration. One rationale for the occasional imprecision is the existence of additional petrosal sinus collateral channels that connect the IPS bilaterally, which may lead to false localization results during sampling. The aim of this study was to explore a potential connection between normal anatomical variation in the angioarchitecture of the IPSs and the ACTH results obtained in subsequent IPSS tests.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A retrospective review was performed on all cases between 1998 and 2013 involving patients at a single institution who underwent IPSS for radiographically equivocal pituitary microadenomas. Cases were reviewed for tumor laterality noted on either operative or pathology reports, as well as the presence of angiographic evidence of cross-filling between the sinuses. In addition, ACTH levels from the right and left IPSs were documented at baseline and at 2, 5, and 10 minutes after corticotropin-releasing hormone (CRH) administration. A ratio of the change in ACTH levels measured at the time of maximal response (10 minutes) versus the levels measured at the initial response (2 minutes) was computed for each patient and compared between patients by their angiographic cross-filling status.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>There were 41 patients with a histopathologically confirmed right- or left-sided ACTH-secreting pituitary microadenoma who underwent preoperative IPSS. Among these patients, 28 (68%) showed angiographic evidence of cross-filling between the IPSs, and 13 showed no cross-filling. On average, ACTH levels increased by a factor of 3.91 \u00b1 0.77 in the contralateral IPS in patients with angiographic cross-filling, compared with a factor increase of only 1.80 \u00b1 0.27 in patients without cross-filling (p = 0.014). In comparison, ACTH levels increased by a factor of 2.01 \u00b1 0.57 in the ipsilateral IPS in patients with cross-filling, and by 8.78 \u00b1 7.30 in those without cross-filling (p = 0.373).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The presence of angiographic cross-filling, suggestive of a greater degree of vascular channel networking between the right and left IPS, is a significant factor influencing the measured rates of change of ACTH in IPSS and may impact the specificity of this test to accurately determine microadenoma laterality in the preoperative setting.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.6.jns2320","type":"journal-article","created":{"date-parts":[[2023,8,12]],"date-time":"2023-08-12T03:08:32Z","timestamp":1691809712000},"page":"386-392","source":"Crossref","is-referenced-by-count":7,"title":["Angiographic cross-filling between inferior petrosal sinuses and alteration of adrenocorticotropic hormone sampling results for tumor localization in Cushing disease"],"prefix":"10.3171","volume":"140","author":[{"given":"Michael L.","family":"Martini","sequence":"first","affiliation":[{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Chase","family":"Ransom","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian S.","family":"Rechberger","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek","family":"O\u2019Keeffe","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Young","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John L. D.","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredric B.","family":"Meyer","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Rinaldo","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Carlstrom","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry J.","family":"Cloft","sequence":"additional","affiliation":[{"name":"Radiology, Mayo Clinic; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Van Gompel","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Pituitary","first-page":"179","article-title":"The incidence of Cushing\u2019s disease: a nationwide Swedish study","volume":"22","author":"Ragnarsson O","year":"2019","unstructured":"Ragnarsson O, Olsson DS, Chantzichristos D,  The incidence of Cushing\u2019s disease: a nationwide Swedish study. Pituitary. 2019;22(2):179\u2013186."},{"issue":"2","key":"b2","series-title":"Endocrinol Metab Clin North Am","first-page":"259","article-title":"Diagnosis of Cushing\u2019s syndrome in the modern era","volume":"47","author":"Nieman LK","year":"2018","unstructured":"Nieman LK. Diagnosis of Cushing\u2019s syndrome in the modern era. Endocrinol Metab Clin North Am. 2018;47(2):259\u2013273."},{"issue":"6","key":"b3","series-title":"J Clin Endocrinol Metab","first-page":"2375","article-title":"Overall and disease-specific mortality in patients with Cushing disease: a Swedish nationwide study","volume":"104","author":"Ragnarsson O","year":"2019","unstructured":"Ragnarsson O, Olsson DS, Papakokkinou E,  Overall and disease-specific mortality in patients with Cushing disease: a Swedish nationwide study. J Clin Endocrinol Metab. 2019;104(6):2375\u20132384."},{"issue":"15","key":"b4","series-title":"N Engl J Med","first-page":"1451","article-title":"Diagnosis and differential diagnosis of Cushing\u2019s syndrome","volume":"376","author":"Loriaux DL","year":"2017","unstructured":"Loriaux DL. Diagnosis and differential diagnosis of Cushing\u2019s syndrome. N Engl J Med. 2017;376(15):1451\u20131459."},{"issue":"10","key":"b5","series-title":"N Engl J Med","first-page":"937","article-title":"Pituitary-tumor endocrinopathies","volume":"382","author":"Melmed S","year":"2020","unstructured":"Melmed S. Pituitary-tumor endocrinopathies. N Engl J Med. 2020;382(10):937\u2013950."},{"issue":"5","key":"b6","series-title":"Ann Intern Med","first-page":"647","article-title":"Selective venous sampling for ACTH in Cushing\u2019s syndrome: differentiation between Cushing disease and the ectopic ACTH syndrome","volume":"94","author":"Findling JW","year":"1981","unstructured":"Findling JW, Aron DC, Tyrrell JB,  Selective venous sampling for ACTH in Cushing\u2019s syndrome: differentiation between Cushing disease and the ectopic ACTH syndrome. Ann Intern Med. 1981;94(5):647\u2013652."},{"issue":"2","key":"b7","series-title":"N Engl J Med","first-page":"100","article-title":"Preoperative lateralization of ACTH-secreting pituitary microadenomas by bilateral and simultaneous inferior petrosal venous sinus sampling","volume":"312","author":"Oldfield EH","year":"1985","unstructured":"Oldfield EH, Chrousos GP, Schulte HM,  Preoperative lateralization of ACTH-secreting pituitary microadenomas by bilateral and simultaneous inferior petrosal venous sinus sampling. N Engl J Med. 1985;312(2):100\u2013103."},{"issue":"4","key":"b8","series-title":"AJNR Am J Neuroradiol","first-page":"690","article-title":"Adrenocorticotropic hormone-dependent Cushing\u2019s syndrome: sensitivity and specificity of inferior petrosal sinus sampling","volume":"21","author":"Bonelli FS","year":"2000","unstructured":"Bonelli FS, Huston J III, Carpenter PC, Erickson D, Young WF Jr, Meyer FB. Adrenocorticotropic hormone-dependent Cushing\u2019s syndrome: sensitivity and specificity of inferior petrosal sinus sampling. AJNR Am J Neuroradiol. 2000;21(4):690\u2013696."},{"issue":"2","key":"b9","series-title":"N Engl J Med","first-page":"e3","article-title":"Diagnosis and differential diagnosis of Cushing\u2019s syndrome","volume":"377","author":"Findling JW","year":"2017","unstructured":"Findling JW, Nieman L, Tabarin A. Diagnosis and differential diagnosis of Cushing\u2019s syndrome. N Engl J Med. 2017;377(2):e3."},{"issue":"13","key":"b10","series-title":"N Engl J Med","first-page":"897","article-title":"Petrosal sinus sampling with and without corticotropin-releasing hormone for the differential diagnosis of Cushing\u2019s syndrome","volume":"325","author":"Oldfield EH","year":"1991","unstructured":"Oldfield EH, Doppman JL, Nieman LK,  Petrosal sinus sampling with and without corticotropin-releasing hormone for the differential diagnosis of Cushing\u2019s syndrome. N Engl J Med. 1991;325(13):897\u2013905."},{"issue":"2","key":"b11","series-title":"Clin Endocrinol (Oxf)","first-page":"147","article-title":"Petrosal sinus sampling for diagnosis of Cushing\u2019s disease: evidence of false negative results","volume":"45","author":"L\u00f3pez J","year":"1996","unstructured":"L\u00f3pez J, Barcel\u00f3 B, Lucas T,  Petrosal sinus sampling for diagnosis of Cushing\u2019s disease: evidence of false negative results. Clin Endocrinol (Oxf). 1996;45(2):147\u2013156."},{"issue":"5","key":"b12","series-title":"J Clin Endocrinol Metab","first-page":"1602","article-title":"Cavernous sinus sampling is highly accurate in distinguishing Cushing\u2019s disease from the ectopic adrenocorticotropin syndrome and in predicting intrapituitary tumor location","volume":"84","author":"Graham KE","year":"1999","unstructured":"Graham KE, Samuels MH, Nesbit GM,  Cavernous sinus sampling is highly accurate in distinguishing Cushing\u2019s disease from the ectopic adrenocorticotropin syndrome and in predicting intrapituitary tumor location. J Clin Endocrinol Metab. 1999;84(5):1602\u20131610."},{"issue":"8","key":"b13","series-title":"J Clin Endocrinol Metab","first-page":"2485","article-title":"Selective venous sampling from the cavernous sinuses is not a more reliable technique than sampling from the inferior petrosal sinuses in Cushing\u2019s syndrome","volume":"80","author":"Doppman JL","year":"1995","unstructured":"Doppman JL, Nieman LK, Chang R,  Selective venous sampling from the cavernous sinuses is not a more reliable technique than sampling from the inferior petrosal sinuses in Cushing\u2019s syndrome. J Clin Endocrinol Metab. 1995;80(8):2485\u20132489."},{"issue":"3","key":"b14","series-title":"J Clin Endocrinol Metab","first-page":"637","article-title":"Selective venous sampling directly from cavernous sinus in Cushing\u2019s syndrome","volume":"76","author":"Teramoto A","year":"1993","unstructured":"Teramoto A, Nemoto S, Takakura K, Sasaki Y, Machida T. Selective venous sampling directly from cavernous sinus in Cushing\u2019s syndrome. J Clin Endocrinol Metab. 1993;76(3):637\u2013641."},{"issue":"6","key":"b15","series-title":"Report of two cases. J Neurosurg","first-page":"1087","article-title":"False-positive inferior petrosal sinus sampling in the diagnosis of Cushing\u2019s disease","volume":"83","author":"Yamamoto Y","year":"1995","unstructured":"Yamamoto Y, Davis DH, Nippoldt TB, Young WF Jr, Huston J III, Parisi JE. False-positive inferior petrosal sinus sampling in the diagnosis of Cushing\u2019s disease. Report of two cases. J Neurosurg. 1995;83(6):1087\u20131091."},{"issue":"9","key":"b16","series-title":"Neurol Med Chir (Tokyo)","first-page":"419","article-title":"Surgical technique for carotid endarterectomy: current methods and problems","volume":"60","author":"Uno M","year":"2020","unstructured":"Uno M, Takai H, Yagi K, Matsubara S. Surgical technique for carotid endarterectomy: current methods and problems. Neurol Med Chir (Tokyo). 2020;60(9):419\u2013428."},{"issue":"7","key":"b17","series-title":"No To Shinkei","first-page":"647","article-title":"Evaluation of Matas test by CBF studies, angiographic cross-filling and stump pressure in CEA patients","volume":"46","author":"Okada Y","year":"1994","unstructured":"Okada Y, Shima T, Yamada T,  Evaluation of Matas test by CBF studies, angiographic cross-filling and stump pressure in CEA patients. Article in Japanese. No To Shinkei. 1994;46(7):647\u2013653."},{"issue":"1","key":"b18","series-title":"J Am Coll Surg","first-page":"93","article-title":"Angiographic criteria reliably predict when carotid endarterectomy can be safely performed without a shunt","volume":"189","author":"Wain RA","year":"1999","unstructured":"Wain RA, Veith FJ, Berkowitz BA,  Angiographic criteria reliably predict when carotid endarterectomy can be safely performed without a shunt. J Am Coll Surg. 1999;189(1):93\u2013101."},{"issue":"6","key":"b19","series-title":"Ann Vasc Surg","first-page":"830","article-title":"Correlation of intraoperative collateral perfusion pressure during carotid endarterectomy and status of the contralateral carotid artery and collateral cerebral blood flow","volume":"25","author":"AbuRahma AF","year":"2011","unstructured":"AbuRahma AF, Mousa AY, Stone PA, Hass SM, Dean LS, Keiffer T. Correlation of intraoperative collateral perfusion pressure during carotid endarterectomy and status of the contralateral carotid artery and collateral cerebral blood flow. Ann Vasc Surg. 2011;25(6):830\u2013836."},{"issue":"5","key":"b20","series-title":"Clin Endocrinol (Oxf)","first-page":"515","article-title":"Prolactin correction for adequacy of petrosal sinus cannulation may diminish diagnostic accuracy in Cushing\u2019s disease","volume":"87","author":"De Sousa SMC","year":"2017","unstructured":"De Sousa SMC, McCormack AI, McGrath S, Torpy DJ. Prolactin correction for adequacy of petrosal sinus cannulation may diminish diagnostic accuracy in Cushing\u2019s disease. Clin Endocrinol (Oxf). 2017;87(5):515\u2013522."},{"issue":"12","key":"b21","series-title":"Lancet Diabetes Endocrinol","first-page":"847","article-title":"Consensus on diagnosis and management of Cushing\u2019s disease: a guideline update","volume":"9","author":"Fleseriu M","year":"2021","unstructured":"Fleseriu M, Auchus R, Bancos I,  Consensus on diagnosis and management of Cushing\u2019s disease: a guideline update. Lancet Diabetes Endocrinol. 2021;9(12):847\u2013875."},{"issue":"5","key":"b22","series-title":"J Clin Endocrinol Metab","first-page":"e1953","article-title":"Pitfalls in performing and interpreting inferior petrosal sinus sampling: personal experience and literature review","volume":"106","author":"Perlman JE","year":"2021","unstructured":"Perlman JE, Johnston PC, Hui F,  Pitfalls in performing and interpreting inferior petrosal sinus sampling: personal experience and literature review. J Clin Endocrinol Metab. 2021;106(5):e1953\u2013e1967."},{"issue":"11","key":"b23","series-title":"J Endocrinol Invest","first-page":"1112","article-title":"Is prolactin measurement of value during inferior petrosal sinus sampling in patients with adrenocorticotropic hormone-dependent Cushing\u2019s syndrome?","volume":"36","author":"Sharma ST","year":"2013","unstructured":"Sharma ST, Nieman LK. Is prolactin measurement of value during inferior petrosal sinus sampling in patients with adrenocorticotropic hormone-dependent Cushing\u2019s syndrome?. J Endocrinol Invest. 2013;36(11):1112\u20131116."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/140\/2\/article-p386.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/140\/2\/article-p386.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/140\/2\/article-p386.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,25]],"date-time":"2024-05-25T10:21:20Z","timestamp":1716632480000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/140\/2\/article-p386.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,1]]},"references-count":23,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2023.6.jns2320","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,1]]}}}