Evaluating prolactin levels during bilateral inferior petrosal sinus sampling: a potential solution to false-negative results in Cushing's disease diagnosis.

BACKGROUND

This review aims to evaluate the utility of prolactin (PRL) measurements during bilateral inferior petrosal sinus sampling (BIPSS) as a diagnostic tool for Cushing’s disease (CD), focusing on its potential to enhance diagnostic accuracy and reduce false-negative results.

METHODS

The review synthesizes existing literature on the role of PRL in confirming correct catheter placement during BIPSS, examining various studies that assess its effectiveness as an indicator of pituitary venous effluent. It discusses the mechanisms behind PRL adjustments, the impact of different stimulation methods, and the interpretation of PRL-normalized adrenocorticotropic hormone (ACTH), ratios.

RESULTS

Prolactin measurements have shown promise in identifying unsuccessful catheterization and improving diagnostic accuracy in patients with suspected CD. Studies indicate that a baseline PRL IPS: P ratio of ≥ 1.8 suggests successful catheter placement, while normalized ACTH/PRL ratios can differentiate between CD and ectopic ACTH secretion. However, the interpretation of intermediate values remains unclear, necessitating further investigation.

CONCLUSIONS

Incorporating PRL measurements into BIPSS protocols may enhance the diagnostic process for CD by reducing false negatives and improving patient management. Despite its potential benefits, further prospective studies are needed to establish standardized cut-off values and clarify the clinical implications of PRL measurements in this context.