American Journal of Roentgenology, Vol 154, 1075-1077, Copyright © 1990 by American Roentgen Ray Society
The diagnosis of acromegaly: value of inferior petrosal sinus sampling
JL Doppman, DL Miller, NJ Patronas, EH Oldfield, GR Merriam, SJ Frank, MR Flack, BD Weintraub and P Gorden
Department of Diagnostic Radiology, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892.
The early diagnosis of acromegaly may be difficult when serum levels of
growth hormone are minimally elevated and imaging of the pituitary gland
fails to show an adenoma. However, transsphenoidal surgery has the greatest
chance of cure at this stage. We therefore investigated the value of
sampling petrosal sinuses for measurement of growth hormone in this group
of patients. Simultaneous bilateral sampling of the inferior petrosal
sinuses to measure serum concentrations of growth hormone was performed in
five patients suspected of having acromegaly but with nondiagnostic CT
scans (n = 5) and MR images (n = 3) of the pituitary gland. Levels of
growth hormone from the petrosal sinuses were five to 36 times greater than
levels in the peripheral veins in all five patients, and three of four
showed a marked response to growth hormone-releasing hormone. During
transsphenoidal surgery, growth hormone-producing microadenomas were
resected completely in four patients. In the fifth patient, a left-sided
microadenoma had invaded the cavernous sinus and could not be resected
completely. Lateralization of the adenomas within the pituitary gland on
the basis of differences in levels of growth hormone between the two
petrosal sinuses was not completely reliable. Elevated levels of growth
hormone in selective samples from the inferior petrosal sinuses can help
support an early diagnosis of acromegaly when peripheral growth hormone
levels and imaging are not diagnostic.
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