Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA.
Neurosurgery. 2012 Jul;71(1):14-22. doi: 10.1227/NEU.0b013e31824f8e2e.
Inferior petrosal sinus sampling (IPSS) is a useful technique for confirming a pituitary source of adrenocorticotropic hormone (ACTH) overproduction in Cushing disease. Uncertainty remains regarding the appropriate course of therapy when an ectopic tumor is predicted by IPSS but none can be found and in circumstances when the procedure cannot be successfully completed owing to technical or anatomic limitations.
To determine an appropriate course of action after nondiagnostic IPSS.
We reviewed 288 IPSS procedures in 283 patients between 1986 and 2010 at our center. An IPS:peripheral ACTH ratio ≥ 2 at baseline or ≥ 3 after corticotrophin-releasing hormone was considered predictive of a pituitary source of ACTH. A procedure was considered nondiagnostic if the procedure was successfully performed and the results predicted an ectopic source but none could be found despite extensive imaging or if the IPS could not be bilaterally cannulated because of technical difficulties or anatomic variants.
The sensitivity, specificity, positive predictive value, and negative predictive value of IPSS for detecting a pituitary source in Cushing disease were 94%, 50%, 98%, and 29%, respectively. We identified 3 categories of nondiagnostic IPSS comprising 44 of the total procedures. These patients underwent exploratory transsphenoidal surgery, and in 42 of these patients (95%), a pituitary source was surgically proven, with a remission rate of 83%.
Transsphenoidal surgery should be considered in cases of ACTH-dependent Cushing disease and noncentralized or technically unsuccessful IPSS without evidence of ectopic tumor.
岩下窦取样（IPSS）是一种有用的技术，可用于确认库欣病中促肾上腺皮质激素（ACTH）过度产生的垂体来源。当 IPSS 预测为异位肿瘤，但无法找到肿瘤，或者由于技术或解剖限制无法成功完成该程序时，对于适当的治疗方案仍存在不确定性。
确定非诊断性 IPSS 后的适当治疗方案。
我们回顾了 1986 年至 2010 年期间在我们中心进行的 283 例患者的 288 次 IPSS 手术。基础状态下 IPS:外周 ACTH 比值≥2 或皮质激素释放激素后≥3 被认为预测 ACTH 的垂体来源。如果手术成功进行且结果预测为异位源，但尽管进行了广泛的影像学检查仍未发现肿瘤，或者由于技术困难或解剖变异无法双侧进行 IPS 插管，则认为该程序为非诊断性。
IPSS 对库欣病中检测垂体源的敏感性、特异性、阳性预测值和阴性预测值分别为 94%、50%、98%和 29%。我们确定了 3 种非诊断性 IPSS 类别，共包含 44 例总手术。这些患者接受了探索性经蝶窦手术，其中 42 例（95%）患者的垂体源得到了手术证实，缓解率为 83%。
对于 ACTH 依赖性库欣病和非中心化或技术上不成功的 IPSS 且无异位肿瘤证据的患者，应考虑经蝶窦手术。
