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Consent for inferior petrosal sinus sampling and administration of - virginia

Consent for inferior petrosal sinus sampling and administration of - virginia 2025

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The document is a consent form from the University of Virginia Health System for inferior petrosal sinus sampling and administration of anesthesia or sedation. It outlines the procedure, associated risks, potential need for additional procedures, and the involvement of qualified practitioners including residents. The patient acknowledges understanding their diagnosis (Cushing's disease), the risks and benefits of the procedure, alternatives available, and consent to the use of any removed tissues for lawful purposes. It also includes sections for patient signature, physician statement, and interpreter attestation.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the patient's name and medical record number in the designated fields at the top of the form.
In Section A, authorize the physician by writing their names clearly. Ensure you understand the procedures being consented to, including any potential additional procedures.
Review your diagnosis and confirm it is accurately stated as cushing’s disease. This section is crucial for clarity regarding your condition.
Carefully read through the risks and benefits outlined in the form. Make sure you understand all possible complications before proceeding.
In Section B, consent to anesthesia or sedation by checking appropriate boxes and acknowledging understanding of associated risks.
Sign and date at Section C, ensuring that you are either 18 years or have legal authority to consent. If applicable, indicate your relationship to the patient.
Finally, ensure that a physician's statement is completed in Section D, confirming that they have explained everything thoroughly.

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What is venous sampling of inferior petrosal sinus?

Inferior petrosal sinus sampling (IPSS) is an invasive procedure in which adrenocorticotropic hormone (ACTH) levels are sampled from the veins that drain the pituitary gland; these levels are then compared with the ACTH levels in the peripheral blood to determine whether a pituitary tumor (as opposed to an ectopic

Is inferior petrosal sinus sampling safe?

The technique is an invasive but relatively safe method for measuring ACTH in blood samples from the bilateral inferior petrosal sinuses (IPSs) compared to a simultaneous peripheral sample (the IPS/P ratio), and its diagnostic accuracy is much improved by using CRH stimulation.

How is inferior petrosal sinus sampling done?

How do we do an IPSS procedure? Typically under general anesthesia, we place small tubes (catheters) into the femoral veins (the main vein draining the legs) at the level of the groin. From there, under X-ray guidance, we navigate those catheters to the main veins which drain the Pituitary gland.

What are the indications for inferior petrosal sinus sampling?

Indication. Inferior petrosal sinus sampling is most frequently indicated when patients have confirmed ACTH dependent Cushings syndrome. ACTH secreting pituitary microadenomas, which may be inapparent on imaging in 40 to 50% of cases, account for 80% of non-adrenal, non-iatrogenic cases.

Is petrosal sinus sampling painful?

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.