Role for postoperative cortisol response to desmopressin in predicting the risk for recurrent Cushing's disease

Clinical Endocrinology
Daniella Jesus Patrick Carminatti RomanholiLuiz Roberto Salgado

Abstract

In the early postoperative period of Cushing's disease patients, desmopressin may stimulate ACTH secretion in the remnant corticotrophic tumour, but not in nontumour suppressed cells. The aim of this study is to evaluate the serum cortisol responses to desmopressin after pituitary surgery, establishing an optimal cut-off for absolute increment (Delta) of serum cortisol (F) suitable to predict recurrence risk. Retrospective case record study. Fifty-seven Cushing's disease patients submitted to pituitary surgery and desmopressin stimulation in the early postoperative with a long-term follow-up (20-161 months) were studied. Serum cortisol levels after desmopressin test (10 microg i.v.) 15-30 days after adenomectomy were used to determine DeltaF (absolute increment of F: F peak - F baseline). Sensitivity and specificity of DeltaF were calculated and a ROC curve was performed to establish an optimal cut-off for DeltaF to predict recurrence risk. Fifteen patients had immediate postoperative failure (basal F > 165 nmol/l; 6 microg/dl) and one patient was lost during the follow-up. Forty-one patients achieved initial remission and were followed-up. Five of 11 patients who recurred had DeltaF > 193 nmol/l (7 microg/dl), but none of 30 p...Continue Reading

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Citations

Sep 8, 2010·Reviews in Endocrine & Metabolic Disorders·Ty B Carroll, James W Findling
Sep 3, 2011·European Journal of Endocrinology·Roula Bou KhalilJérôme Bertherat
Sep 6, 2008·Clinical Endocrinology·B AmbrosiC Dall'Asta
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