DIAGNOSIS OF ENDOCRINE DISEASE: The role of the desmopressin test in the diagnosis and follow-up of Cushing's syndrome

European Journal of Endocrinology
D Vassiliadi, S Tsagarakis

Abstract

Desmopressin is a vasopressin analogue selective for type 2 vasopressin receptors that mediate renal water retention. In contrast to the native hormone arginine vasopressin, a well-known ACTH secretagogue, desmopressin, exerts minimal or no activity on ACTH excretion. However, in a substantial proportion of patients with ACTH-dependent Cushing's syndrome (CS), desmopressin elicits an ACTH and cortisol response, which contrasts with the minimal responses obtained in healthy subjects. The mechanism underlying this paradoxical response involves upregulation of vasopressin type 3 and/or the aberrant expression of type 2 receptors by neoplastic ACTH-producing cells. This makes desmopressin administration a suitable test enabling the distinction between neoplastic from functional (formerly termed 'pseudo-Cushing syndrome') ACTH-dependent cortisol excess. Several studies have now established an adjunctive role of desmopressin in the initial diagnostic workup of CS. Despite some early data indicating that this test may also have a role in distinguishing between Cushing's disease (CD) and ectopic ACTH secretion, subsequent studies failed to confirm this observation. The ability of the paradoxical response to desmopressin to depict the p...Continue Reading

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Citations

Nov 16, 2019·Journal of Clinical Medicine·Hiroshi Nishioka, Shozo Yamada
Dec 4, 2019·Frontiers in Endocrinology·José Miguel Hinojosa-AmayaMaria Fleseriu
Jul 1, 2020·The Journal of Clinical Endocrinology and Metabolism·Caroline FreteAntoine Tabarin
Aug 20, 2020·Expert Review of Endocrinology & Metabolism·Cristina CapatinaMaria Fleseriu
Oct 7, 2020·The Journal of Clinical Endocrinology and Metabolism·Lynnette K Nieman
Jan 22, 2021·Best Practice & Research. Clinical Endocrinology & Metabolism·José Miguel Hinojosa-Amaya, Daniel Cuevas-Ramos
Mar 7, 2020·Best Practice & Research. Clinical Endocrinology & Metabolism·Oskar Ragnarsson
May 11, 2021·Frontiers in Endocrinology·Renata Świątkowska-StodulskaKrzysztof Sworczak
Jun 11, 2021·Annals of Laboratory Medicine·Silvia PinelliFilippo Ceccato

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