External jugular venous sampling for Cushing's disease in a patient with hypoplastic inferior petrosal sinuses.

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ID: 82898
2020
The authors report the case of a 30-year-old female patient with suspected Cushing's disease with an anatomical variation of hypoplastic inferior petrosal sinuses and nearly exclusive anterior drainage from the cavernous sinus, who underwent external jugular venous blood sampling with successful disease confirmation and microadenoma localization. The patient presented with signs and symptoms consistent with Cushing's syndrome, but with discordant preliminary diagnostic testing. She underwent attempted bilateral inferior petrosal sinus sampling; however, she had hypoplastic inferior petrosal sinuses bilaterally and predominantly anterior drainage from the cavernous sinus into the external jugular circulation. Given this finding, the decision was made to proceed with external jugular venous access and sampling in addition to internal jugular venous sampling. A positive adrenocorticotropic hormone (ACTH) response to corticotropin-releasing factor was obtained in the right external jugular vein alone, suggesting a right-sided pituitary microadenoma as the cause of her Cushing's disease. The patient subsequently underwent a transsphenoidal hypophysectomy that confirmed the presence of a right-sided ACTH-secreting microadenoma, which was successfully resected. She was hypocortisolemic on discharge and has had no signs of recurrence or relapse at 6 months postoperation.
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Authors Peterson, Keyan A;Burnette, Christofer D;Fargen, Kyle M;Brown, Patrick A;West, James L;Tatter, Stephen B;Wolfe, Stacey Q;
Journal journal of neurosurgery
Year 2020
DOI 10.3171/2019.11.JNS192374
URL
Keywords
jugular vein pituitary surgery cerebral angiography cd = cushing’s disease cs = cushing’s syndrome acth = adrenocorticotropic hormone crf = corticotropin-releasing factor ej = external jugular vein ij = internal jugular vein ips = inferior petrosal sinus ipss = inferior petrosal sinus sampling cavernous sinus petrosal sinus sampling pituitary tumor venous anatomy

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