Vignati F, Berselli M E, Scialfa G, Boccardi E, Loli P
Divisione di Endocrinologia, Ospedale Niguarda Cà Granda, Milano, Italy.
J Endocrinol Invest. 1989 Apr;12(4):235-8. doi: 10.1007/BF03349972.
We report our experience on venous sampling of the inferior petrosal sinuses for basal and CRH-stimulated ACTH and PRL gradients in 8 patients with surgically proven Cushing's disease who had normal preoperative neuroradiological studies. In 7 patients basal plasma ACTH concentrations in the inferior petrosal sinus ipsilateral to the tumor were higher than in the contralateral sinus; the gradients were enhanced by oCRH administration. In one out of two patients who had previously undergone unsuccessful pituitary microsurgery, neither basal nor oCRH-induced ACTH increases led to correct localization of the microadenoma within the pituitary. In 4 out of 7 patients basal serum PRL concentrations in the inferior petrosal sinus ipsilateral to the tumor were higher than in the contralateral; only two out of 4 showed an increase in PRL levels after oCRH injection. Our study confirms that simultaneous and bilateral venous sampling of inferior petrosal sinuses is a valuable means to identify the site of microadenomas in patients with Cushing's disease without neuroradiological evidence of the tumor. This procedure may give misleading results in patients previously operated on. Unilateral or predominant increases of PRL concentration during catheterization of the inferior petrosal sinuses, when present, always lateralize to the side of the corticotroph adenoma, providing a possible additional signal of the presence of the tumor.
我们报告了对8例经手术证实为库欣病且术前神经放射学检查正常的患者进行岩下窦静脉采血以检测基础及促肾上腺皮质激素释放激素（CRH）刺激下促肾上腺皮质激素（ACTH）和催乳素（PRL）梯度的经验。7例患者肿瘤同侧岩下窦的基础血浆ACTH浓度高于对侧窦；静脉注射oCRH后梯度增强。在2例先前垂体显微手术失败的患者中，有1例基础及oCRH诱导的ACTH升高均未能正确定位垂体微腺瘤。7例患者中有4例肿瘤同侧岩下窦的基础血清PRL浓度高于对侧；4例中只有2例在注射oCRH后PRL水平升高。我们的研究证实，对于无肿瘤神经放射学证据的库欣病患者，同时双侧岩下窦静脉采血是识别微腺瘤部位的一种有价值的方法。该方法在既往接受过手术的患者中可能会产生误导性结果。岩下窦插管期间PRL浓度单侧或主要升高时，总是提示促肾上腺皮质激素腺瘤位于该侧，这可能是肿瘤存在的一个额外信号。
