Shaikh Salman Tehran, Karmarkar Vikram S, Deopujari Chandrashekhar Eknath
Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.
J Pediatr Neurosci. 2017 Oct-Dec;12(4):349-352. doi: 10.4103/jpn.JPN_57_17.
Inferior petrosal sinus sampling (IPSS) is a minimally invasive method done in adrenocorticotrophic hormone (ACTH)-dependent pituitary adenoma cases where magnetic resonance imaging (MRI) either gives equivocal results or fails to localize it. A 12-year-girl with cushingoid features and raised ACTH levels presented to us with two consecutive MRI's done outside showing gross change in the morphology of a left-sided pituitary adenoma. Hence, a bilateral IPSS was done which showed a higher IPS/periphery ACTH ratio on the right side as compared to left. Transsphenoidal endoscopic excision of the left pituitary adenoma along with right hemihypophysectomy was performed. ACTH levels fell postoperatively. This case stands distinct in highlighting the discordance in lateralization of pituitary adenoma on MRI and IPSS. Review of literature tells us that while IPSS is more sensitive in accurately diagnosing Cushing's disease, MRI provides better accuracy in lateralizing the site of adenoma.
岩下窦采血（IPSS）是一种微创方法，用于促肾上腺皮质激素（ACTH）依赖性垂体腺瘤病例，这些病例中磁共振成像（MRI）结果不明确或无法定位肿瘤。一名具有库欣样特征且ACTH水平升高的12岁女孩前来就诊，其在外院进行的两次连续MRI显示左侧垂体腺瘤形态有明显变化。因此，进行了双侧IPSS，结果显示右侧的岩下窦（IPS）/外周ACTH比值高于左侧。对左侧垂体腺瘤进行了经蝶窦内镜切除并同时进行了右侧垂体半切除。术后ACTH水平下降。该病例突出显示了垂体腺瘤在MRI和IPSS上定位的不一致性，具有独特之处。文献综述表明，虽然IPSS在准确诊断库欣病方面更敏感，但MRI在腺瘤定位方面具有更高的准确性。
