Dr. Tigran Khachatryan, MD, PhD.

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Inferior Petrosal Sinus Sampling

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Patient’s Guide to Inferior Petrosal Sinus Sampling (IPSS) Procedure

This booklet will help you understand Inferior Petrosal Sinus Sampling, often called IPSS. It’s a special test that helps your doctors find out why your body might be making too much of a hormone called cortisol, which can cause a condition known as Cushing’s syndrome. Specifically, it helps determine if the problem is coming from your pituitary gland, a small gland at the base of your brain, as well as determine whether the problem is located on the right or left side of the gland.

Why You Might Need This Test

  • Your doctor suspects your body is producing too much cortisol, leading to Cushing’s syndrome.
  • You've had other tests, like an MRI of your brain, that didn't clearly show a problem with your pituitary gland, even though other signs point to it.
  • Your doctors need to confirm if a small growth (tumor) on your pituitary gland is the source of the problem.
  • If there is a pituitary tumor, this test can help pinpoint which side of the gland it's on.
  • It helps tell the difference between Cushing's disease (where the problem is in the pituitary gland) and other causes of high cortisol.
It’s important to know that this test doesn’t diagnose Cushing’s syndrome itself, but rather helps find where the excess cortisol is coming from once Cushing’s syndrome is already suspected.

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How the Test Works

IPSS is a specialized procedure that involves collecting blood samples directly from the veins that drain your pituitary gland. Here’s a general idea of how it works:
  • Tiny, flexible tubes called catheters are carefully inserted into veins in your upper thigh (groin area).
  • These catheters are then gently guided up through your body’s veins until they reach the small veins around your pituitary gland.
  • Special X-ray pictures, sometimes using a dye that helps show the veins more clearly, are used to guide the catheters to the correct position.
  • A special hormone is injected to stimulate your pituitary gland.
  • Blood samples are then collected from both the catheters near your pituitary gland and from a vein in your arm over a short period (about 10-15 minutes).
  • By comparing the hormone levels in these samples, doctors can determine if your pituitary gland is the source of the problem and, if so, which side.

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Getting Ready for Your Test

Preparing for your IPSS test is important for your safety and the accuracy of the results. Your healthcare team will give you specific instructions, but here are some common guidelines:
  • Eating and Drinking: You will need to stop eating and drinking 8 hours before your test.
  • Medications: Your doctor will tell you if you need to stop any medications, especially those for Cushing’s syndrome or blood thinners, a few days before the test. Take other regular medications with a small sip of water, unless advised otherwise.
  • Personal Items: Please do not wear makeup, nail polish, or jewelry on the day of your test. Leave all valuables at home.
  • Allergies and Health Conditions: Inform your doctor or nurse about any kidney problems or allergies to X-ray dye you may have.
  • Consent: Before the procedure, a doctor will discuss the test with you, including its benefits and potential risks, and ask you to sign a consent form.
  • Transportation: You will not be able to drive yourself home after the test. Please arrange for a responsible adult to pick you up and ideally stay with you for the first night.
  • Before the test: Try to use the toilet just before the procedure begins, as you'll need to lie flat for some time.

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During Your Test

The test is usually performed in a special room with X-ray equipment. Here’s what you can expect:

  • You will lie flat on your back on an X-ray table.
  • You’ll be connected to monitors to check your heart rate, blood pressure, and oxygen levels.
  • An anesthesiologist will induce general anesthesia.
  • Your skin in the groin area will be cleaned with a special soap, and some hair may be shaved.
  • An IV line will be placed in your arm for fluids and medicines.
  • You'll receive a shot of numbing medicine (local anesthetic) in your groin.
  • The catheters will be inserted into the veins in your groin.
  • Once all the necessary blood samples are taken, the catheters will be removed. You generally won't feel them being taken out.
  • Pressure will be applied to your groin for about 5-10 minutes to help stop any bleeding.

After Your Test

Your recovery is important for preventing complications. Here’s what you should expect and how to care for yourself:
  • Lying Flat: You will be taken to a recovery area and will need to lie flat on your back and remain still for 1 to 4 hours (your nurse will tell you the exact time) to prevent bleeding from the groin area.
  • Going Home: Most people can go home the same day, typically after about four hours, provided they are feeling well.
  • Fluid Intake: Limit your fluid intake to two liters for the first 24 hours after your test. You can eat as usual, starting with water and bland foods if you feel queasy.
  • Activity Restrictions (First 24-48 hours):
  • Rest and light activity are key.
  • Do not drive or operate machinery or power tools.
  • Avoid alcohol or sedating medicines (unless prescribed by your doctor).
  • Do not make important decisions or sign legal documents.
  • Avoid being solely responsible for children or pets who need care.
  • Puncture Site Care: Keep the groin puncture sites clean and dry for the first 24 hours. You can usually shower after 24 hours, gently patting the area dry. Do not apply creams, lotions, or powders to the site.
  • Ongoing Activity (Next Few Days): For the next two to three days, avoid strenuous exercise or activities that strain your upper legs, like heavy lifting, running, or cycling. You may want to take this time off work.
  • Baths/Swimming: For 7 days, avoid taking baths, sitting in hot tubs, or swimming to protect the puncture site.
  • Pain and Bruising: You might have a slight headache (often from lying flat) or feel stiff-legged. Mild pain and bruising around the groin are also common and should fade within a few days. Over-the-counter pain relievers like paracetamol can be used if needed.
  • Results: Your doctor will usually contact you with the results within one to two weeks.

Possible Complications and When to Seek Help

While IPSS is generally a safe procedure, there are some potential risks. Your medical team will discuss these with you in detail. It’s important to be aware of certain signs and symptoms that require immediate medical attention:
  • Go to your nearest emergency department immediately if you experience any of the following:
  • Your leg or foot feels cold or numb.
  • The puncture site starts to bleed, swells, or becomes more painful, especially if you notice a lump that gradually grows and pulsates with your heartbeat.
  • You have slurred speech.
  • You have balance problems or difficulty using your arm or leg.
  • You develop a rash.
  • You have a fever higher than 101.5°F (38.6°C).
  • Less common but serious risks include: internal bleeding or damage to blood vessels, allergic reactions to the X-ray dye, or very rarely, a stroke or blood clots. Your doctors take precautions, such as giving blood-thinning medicine during the procedure, to minimize these risks.
  • Sometimes, it might be difficult to perform the test, or the results might not be clear. In such cases, your doctor will discuss alternative steps with you.

Summary

Inferior Petrosal Sinus Sampling (IPSS) is a very important and specialized test used to accurately locate the source of high cortisol levels, particularly when a pituitary gland issue is suspected but not clearly seen on other scans. While the procedure itself involves inserting catheters into veins to collect blood samples, it is generally safe and well-tolerated under general anesthesia. Careful preparation beforehand and following all post-procedure instructions, especially regarding rest and activity limitations, are crucial for a smooth recovery and reliable results. If you have any concerns or experience unexpected symptoms after your test, do not hesitate to contact your healthcare provider immediately.

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