External jugular venous sampling for Cushing's disease in a patient with hypoplastic inferior petrosal sinuses.
Abstract
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.
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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82898
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0x95644003c57E6F55A65596E3D9Eac6813e3566dA
Article ID:
82898
Unique Identifier:
10.3171/2019.11.JNS192374
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Scimatic Chain (ID: 481)
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