Martines Valentina, Mansueto Giancarlo, Tosi Flavia, Caruso Beatrice, Castello Roberto, Procacci Carlo
Istituto di Radiologia, Policlinico G. B. Rossi, Università degli Studi di Verona, Verona, Italy.
Radiol Med. 2003 Apr;105(4):356-61.
To evaluate the sensitivity of selective sampling from the inferior petrosal sinuses in the differential diagnosis of ACTH-dependent hypercortisolism with non-diagnostic pituitary imaging.
Between 1987 and 2001, 17 patients (14 women and 3 men, aged 18-63 years) with ACTH-dependent hypercortisolism and negative X-ray of the sellar region, underwent simultaneous bilateral sampling from the inferior petrosal sinuses with ACTH measurement, at baseline and after stimulation with CRH (100 micro i.v.). Baseline samplings were also carried out at the level of the infrarenal and suprarenal inferior vena cava, of the adrenal and suprahepatic veins, of the superior vena cava, of the jugular veins, and of a peripheral vein. A central/peripheral gradient >2 at baseline and/or one >3 after stimulation with CRH was considered indicative of the pituitary origin of ACTH. Bilateral femoral venous catheterization was performed in an angiographic room using 5-French introducers after local anaesthesia. Selective catheterization of the inferior petrosal sinuses was achieved with 100 cm-long, steam-bent (45 degrees) 5-French catheters, without lateral holes.
Twelve patients exhibited ACTH central/ peripheral gradients indicating the pituitary origin of the hormonal hyperincretion; this was confirmed by surgical exploration of the hypophysis in 10 patients, whereas 2 refused surgery and were therefore "lost". Of the five patients without ACTH central/peripheral gradients, one had an adrenal metastasis from ACTH-secreting lung neoplasia (with ACTH gradient in the blood flowing back from the adrenal gland), one had a hepatic CRHoma (with high levels of CRH in the suprahepatic veins), whereas the origin of the hyperincretion remained indeterminate in three.
Bilateral simultaneous selective sampling from the inferior petrosal sinuses for ACTH measurements proved to be highly sensitive and free of complications in the differential diagnosis of ACTH-dependent forms of hypercortisolism.
评估在垂体成像无诊断价值的情况下，从岩下窦进行选择性采样在促肾上腺皮质激素（ACTH）依赖性皮质醇增多症鉴别诊断中的敏感性。
1987年至2001年间，17例（14例女性，3例男性，年龄18 - 63岁）ACTH依赖性皮质醇增多症且蝶鞍区X线检查阴性的患者，在基线状态以及促肾上腺皮质激素释放激素（CRH，静脉注射100微克）刺激后，接受双侧岩下窦同步采样并检测ACTH。还在肾下和肾上腔静脉、肾上腺和肝上静脉、上腔静脉、颈静脉以及外周静脉水平进行基线采样。基线时中心/外周梯度>2和/或CRH刺激后>3被认为提示ACTH来源于垂体。局部麻醉后，在血管造影室使用5F导管鞘进行双侧股静脉插管。使用100厘米长、蒸汽弯曲（45度）的无侧孔5F导管对岩下窦进行选择性插管。
12例患者的ACTH中心/外周梯度提示激素分泌过多源于垂体；10例患者经垂体手术探查得以证实，而2例拒绝手术，因此“失访”。在5例无ACTH中心/外周梯度的患者中，1例有分泌ACTH的肺癌肾上腺转移（肾上腺回流血液中有ACTH梯度），1例有肝CRH瘤（肝上静脉中CRH水平高），而3例患者分泌过多的来源仍不确定。
双侧同时从岩下窦进行选择性采样检测ACTH，在ACTH依赖性皮质醇增多症的鉴别诊断中被证明具有高度敏感性且无并发症。
