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Review
. 2022 Jul;64(7):1411-1418.
doi: 10.1007/s00234-021-02886-6. Epub 2022 Jan 22.

Does concomitant prolactin measurement ıncrease the accuracy of ınferior petrosal sinus sampling?

Tugce Apaydin  1 , Mehmet Yasar  2 , Feyyaz Baltacioglu  3 , Goncagul Haklar  4 , Dilek Gogas Yavuz  2
Affiliations
Review

Does concomitant prolactin measurement ıncrease the accuracy of ınferior petrosal sinus sampling?

Tugce Apaydin et al. Neuroradiology. 2022 Jul.

Abstract

Introduction: Prolactin (PRL) measurement during inferior petrosal sinus sampling (IPSS) can be helpful to improve the accuracy. We aimed to evaluate the effect of measuring PRL levels as a predictor for the accuracy of IPSS and evaluate its impact on the lateralization of adenomas.

Methods: In this retrospective cohort study, we reviewed 51 patients who had undergone IPSS for the investigation of ACTH-dependent hypercortisolism.

Results: Forty-nine patients had proven Cushing's disease (CD), one had EAS, and the remaining one patient had adrenal adenoma. Forty-seven patients had an above 2 ACTH IPS/P ratio at baseline, and all the post-corticotropin-releasing hormone (CRH) ACTH IPS/P ratios of patients with proven CD were above 3. In these two patients whose ACTH IPS/P ratio at baseline was below 2, PRL IPS/P ratios were above 1.8 in only the dominant side, which was considered secondary to a prolactin intersinus gradient due to the biological effects of the tumor. PRL-adjusted ACTH IPS/P ratios were > 1.3 in all patients with proven CD; it was 0.7 in the patient with EAS. Surgically confirmed positive lateralization was observed in 55.1% of patients with the ACTH gradient, but when PRL-adjusted ACTH IPS/IPS ratios were used in addition to the ACTH gradient, the ratio increased to 67.3%.

Conclusion: Although PRL-adjusted ACTH IPS/P ratios can be helpful to improve the accuracy of results during IPSS procedures, a prolactin intersinus gradient towards the ACTH-dominant side in patients with CD may invalidate PRL as an indicator of pituitary venous outflow.

Keywords: Bilateral inferior petrosal sinus sampling; Cushing’s disease; Pituitary; Prolactin.

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