Selective bilateral blood sampling from the inferior petrosal sinus in cushing's disease: effects of corticotropin-releasing factor and thyrotropin-releasing hormone on pituitary secretion

We sought to enhance the sensitivity of selective bilateral blood sampling to determine adrenocorticotropin (ACTH) and prolactin levels in the inferior petrosal sinus (IPS) by administering two stimulatory agents--corticotropin-releasing factor (CRF) and thyrotropin-releasing hormone (TRH). We then...

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Bibliographic Details
Published in:Cardiovascular and interventional radiology 1993-09, Vol.16 (5), p.287-292
Main Authors: STRACK, T. R, SCHILD, H. H, BOHL, J, BEYER, J, SCHREZEMEIR, J, KAHALY, G
Format: Article
Language:English
Subjects:
Adrenocorticotropic Hormone - blood
Biological and medical sciences
Corticotropin-Releasing Hormone
Cushing Syndrome - blood
Cushing Syndrome - diagnosis
Endocrinopathies
Female
Humans
Hypothalamus. Hypophysis. Epiphysis (diseases)
Male
Medical sciences
Non tumoral diseases. Target tissue resistance. Benign neoplasms
Petrosal Sinus Sampling
Pituitary Gland, Anterior - drug effects
Pituitary Gland, Anterior - metabolism
Pituitary Neoplasms - blood
Pituitary Neoplasms - diagnosis
Prolactin - blood
Sensitivity and Specificity
Thyrotropin-Releasing Hormone
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Summary:We sought to enhance the sensitivity of selective bilateral blood sampling to determine adrenocorticotropin (ACTH) and prolactin levels in the inferior petrosal sinus (IPS) by administering two stimulatory agents--corticotropin-releasing factor (CRF) and thyrotropin-releasing hormone (TRH). We then determined the ACTH and prolactin levels in the IPS of 10 patients with Cushing's disease. After peripheral administration of both CRF and TRH, ACTH levels were significantly higher on the tumor side in all patients. The prolactin level was significantly higher on the tumor side when CRF or TRH was used to stimulate pituitary secretion. Postsurgical immunohistochemistry studies revealed production of both ACTH and prolactin in tumor cells, explaining the abnormal secretion pattern of the pituitary adenoma. The use of CRF and TRH may therefore improve the reliability of selective blood sampling and tests from the IPS in those cases of Cushing's disease for which noninvasive methods have otherwise failed to clarify the diagnosis.
ISSN:0174-1551
1432-086X
DOI:10.1007/BF02629159