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Radiology, Vol 150, 99-103, Copyright © 1984 by Radiological Society of North America

ARTICLES

Petrosal sinus sampling for Cushing syndrome: anatomical and technical considerations. Work in progress

JL Doppman, E Oldfield, AG Krudy, GP Chrousos, HM Schulte, M Schaaf and DL Loriaux

ACTH-producing microadenomas of the pituitary gland drain unilaterally into the adjacent cavernous sinus; therefore, petrosal sinus sampling to distinguish pituitary from ectopic-ACTH syndromes must always be performed bilaterally. A negative finding from a unilateral petrosal sinus sample does not exclude the presence of a contralateral ACTH- producing microadenoma. Hemiresection of the pituitary gland based on results of bilateral sampling can be performed if the adenoma is too small to be recognized at surgery. Large pituitary adenomas produce elevated ACTH levels in the petrosal sinuses bilaterally. However, if plain radiographs or CT scans provide unequivocally positive findings in Cushing syndrome (less than 20%), inferior petrosal sinus sampling is not indicated.


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