Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jan-Feb;23(1):56-59.
doi: 10.4103/ijem.IJEM_486_18.

Prolactin-adjusted ACTH Ratio in Predicting Lateralization of ACTH Source During Simultaneous Bilateral Inferior Petrosal Sinus Sampling in Patients with Cushing's Disease

Kush Dev Singh Jarial  1 , Anil Bhansali  1 , Kanchan K Mukherjee  2 , Rimesh Pal  1 , Vivek Gupta  3 , Akhilesh Sharma  4 , Rakesh K Vasishta  5 , Suja P Sukumar  1 , Naresh Sachdeva  1 , Rama Walia  1
Affiliations

Prolactin-adjusted ACTH Ratio in Predicting Lateralization of ACTH Source During Simultaneous Bilateral Inferior Petrosal Sinus Sampling in Patients with Cushing's Disease

Kush Dev Singh Jarial et al. Indian J Endocrinol Metab. 2019 Jan-Feb.

Abstract

Introduction: Prolactin-adjusted adrenocorticotropic hormone (ACTH) ratio is used to improve the diagnostic accuracy of bilateral inferior petrosal sinus sampling (BIPSS) for lateralization of pituitary adenoma.

Objective: To study the use of prolactin for successful catheterization during BIPSS, the role of prolactin-normalized ACTH ratio for confirmation of Cushing's disease (CD) and prolactin-adjusted ACTH ratio in predicting the lateralization.

Patients and methods: BIPSS was done in patients with CD; prolactin-adjusted ACTH ratio was compared with intersinus ACTH ratio, magnetic resonance imaging, and intraoperative findings for localization of pituitary adenoma. Histopathology was taken as "gold standard" for the diagnosis of CD.

Results: Eight patients underwent BIPSS. All the patients underwent transsphenoidal surgery. All these patients had proper venous sampling during BIPSS as determined by inferior petrosal sinus (IPS):Peripheral prolactin ratio of ≥1.8. Prolactin-normalized ACTH ratio of ≥1.3 was achieved in all the eight patients, which was consistent with the diagnosis of CD. Concordance of intersinus ACTH ratio ≥1.4 with the intraoperative findings was found in five of eight (62.5%) patients depicting correct lateralization. Concordance of prolactin-adjusted ACTH ratio with intraoperative findings was found in four of eight (50%) patients. Seven of eight patients had concordance of intersinus ACTH ratio with prolactin-adjusted ACTH ratio.

Conclusion: Prolactin is a useful marker for successful catheterization, confirming the diagnosis of CD during BIPSS, and prolactin-adjusted ACTH ratio does not add to the accuracy of lateralization of pituitary adenoma compared with intersinus ACTH ratio.

Keywords: Bilateral inferior petrosal sinus sampling; Cushing's disease; human corticotropin releasing hormone.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Similar articles

See all similar articles

Cited by

References

    1. Oldfield EH, Doppman JL, Nieman LK, Chrousos GP, Miller DL, Katz DA, et al. Petrosal sinus sampling with and without corticotropin-releasing hormone for the differential diagnosis of Cushing's syndrome. N Engl J Med. 1991;325:897–905. - PubMed
    1. Lopez J, Barcelo B, Lucas T, Salame F, Alameda C, Boronat M, et al. Petrosal sinus sampling for diagnosis of Cushing's disease: Evidence of false negative results. Clin Endocrinol (Oxf) 1996;45:147–56. - PubMed
    1. Jarial KDS, Bhansali A, Mukherjee KK, Pal R, Sharma A, Vashishtha RK, et al. Diagnostic accuracy and comparison of BIPSS in response to lysine vasopressin and h CRH. Endocr Connect. 2018;7:425–32. - PMC - PubMed
    1. Jarial KDS, Bhansali A, Gupta V, Singh P, Mukherjee KK, Sharma A, et al. Utility of a single late-night plasma cortisol and ACTH for the diagnosis of Cushing's syndrome. Endocr Pract. 2018:156–62. - PubMed
    1. Zampetti B, Grossrubatscher E, Ciaramella PD, Boccardi E, Loli P. Bilateral inferior petrosal sinus sampling. Endocr Connect. 2016;5:R12–25. - PMC - PubMed