Alternative neck access allows doctors to complete key test
Jugular-vein approach let doctors finish Cushing’s disease procedure
When standard procedures fail, doctors may still be able to diagnose Cushing’s disease by sampling blood from veins near the pituitary gland using a catheter inserted through the neck — an alternative approach described in a new case report.
The study, “Ultrasound-Guided Jugular Vein Access for Inferior Petrosal Sinus Sampling: A Safe and Feasible Technique,” was published in Cureus.
Cushing’s disease is caused by a tumor in the pituitary gland, which is a tiny structure located in the brain. In Cushing’s disease, the pituitary secretes excessive levels of a signaling molecule called adrenocorticotropic hormone (ACTH). Excess ACTH signals the adrenal glands, which sit atop the kidneys, to produce abnormally high levels of cortisol, the stress hormone that drives the condition’s symptoms.
Why IPSS is the gold-standard test for confirming Cushing’s disease
The gold standard for diagnosing Cushing’s disease is an invasive procedure called inferior petrosal sinus sampling (IPSS). This test compares ACTH levels in the veins that drain the pituitary gland with levels in the rest of the body. When ACTH is higher in these draining veins, Cushing’s disease can be diagnosed with more than 90% accuracy.
Typically, IPSS is performed by inserting a catheter (a long, thin tube) into a large vein in the leg and threading it up through the venous system to reach the veins that drain blood from the pituitary region. However, in some patients, anatomical variations make this standard femoral-vein route difficult or impossible.
In this case report, a woman was undergoing diagnostic evaluation for suspected Cushing’s disease. During the initial attempt at standard IPSS, doctors were able to obtain a sample from the right side of her body but were unable to access the left side. IPSS typically requires samples from both sides, as this can help pinpoint the location of an ACTH-secreting tumor.
Because the standard access route wasn’t working, doctors tried a different approach: inserting the catheter through the jugular vein in the neck. The left-sided access was performed under ultrasound guidance to ensure a safe and precise entry point.
Neck-based access enabled full sampling when the standard route failed
The jugular-vein approach was successful in collecting the needed left-sided samples, and the modified IPSS confirmed a diagnosis of Cushing’s disease. The woman later underwent surgery to remove the tumor.
“This method enabled successful completion of bilateral [both-sides] sampling when standard femoral [thigh] catheterization failed,” the researchers wrote.
This case illustrates that the alternative neck-based route can be considered as an option when the standard approach isn’t working, the researchers wrote, adding the case also “reinforces IPSS as a critical diagnostic tool for confirming pituitary Cushing’s disease, even in technically challenging circumstances.”
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