Angiographic Cross Filling between Inferior Petrosal Sinuses as a Factor Impacting ACTH Sampling in the Setting of Cushing's Disease

Abstract

Background: Inferior petrosal sinus (IPS) sampling (IPSS) is a diagnostic procedure used to help localize potential corticotropin (ACTH)-secreting pituitary tumors resulting in Cushing's disease. In the setting of ACTH-secreting pituitary microadenomas, IPSS has been used to determine tumor laterality and ultimately guide surgical resection strategy. IPSS lateralizes to the correct side of the pathology around 50% of the time. Therefore, a strong need exists to better predict microadenoma laterality. We hypothesize that dominant drainage patterns of the IPS alter IPSS correctly lateralizing.