Is Petrosal Sinus Sampling Painful?

Inferior petrosal sinus sampling (IPSS) is an invasive procedure usually performed under general or local anesthesia used to sample adrenocorticotropic hormone (ACTH) levels from the pituitary gland. The procedure is used to diagnose conditions like Cushing's syndrome and Addison's disease.

Inferior petrosal sinus sampling (IPSS) is an invasive procedure used to sample adrenocorticotropic hormone (ACTH) levels from the veins that drain the pituitary gland. 

Cushing’s syndrome is a condition that results from excess levels of the hormone cortisol in the body. Cortisol is produced by the adrenal gland or another tumor that causes the adrenal gland to produce too much cortisol. The tumors cause this excess cortisol production by releasing ACTH. 

Inferior petrosal sinus sampling is performed to check if too much ACTH is causing the excess production of cortisol, and where it is coming from. 

Inferior petrosal sinus sampling is performed to check if too much ACTH is causing the excess production of cortisol, and where it is coming from. 

IPSS is usually performed under general anesthesia, or local anesthesia to the area where the catheters will be, so the procedure itself is not painful. If local anesthesia is used, patients may feel some gentle pushing as catheters are inserted into the main vein in each groin.

Some patients report feeling a sensation behind their nose and eyes once the catheters are guided through the veins up into the vein near the pituitary gland, and a rushing noise in their ears when X-ray contrast is injected, but most of the time patients do not consider it painful. 

Patients may be prescribed pain medications following the procedure, if needed.

During the procedure: 

• Patients are asked to lie flat on a special X-ray table
• An injection of local anesthetic is given to numb the area
• Patients will feel some gentle pushing as catheters are inserted into the main vein in each groin
• The catheters are then guided through the veins up into the vein near the pituitary gland
• X-rays are taken to make sure the catheters are being guided to the correct place
• A series of blood samples are taken over a period of 10 minutes
• An injection of a hormone, called CRH, will be given through one of the catheters which may cause a “flushing” sensation for a few seconds
• The catheters are removed once blood samples are taken
• Patients are asked to remain lying flat for about half an hour before being returned to the recovery area where they are gradually allowed to sit up in bed
• After a period of time, if all is well, patients are allowed to go home