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. 2017 Nov;6(8):791-799.
doi: 10.1530/EC-17-0292. Epub 2017 Oct 10.

Usefulness of desmopressin testing to predict relapse during long-term follow-up in patients in remission from Cushing's disease

Alberto Giacinto Ambrogio  1 , Massimiliano Andrioli  1 , Martina De Martin  1 , Francesco Cavagnini  1 , Francesca Pecori Giraldi  2   3
Affiliations

Usefulness of desmopressin testing to predict relapse during long-term follow-up in patients in remission from Cushing's disease

Alberto Giacinto Ambrogio et al. Endocr Connect. 2017 Nov.

Abstract

Recurrence of Cushing's disease after successful transsphenoidal surgery occurs in some 30% of the patients and the response to desmopressin shortly after surgery has been proposed as a marker for disease recurrence. The aim of the present study was to evaluate the response to desmopressin over time after surgery. We tested 56 patients with Cushing's disease in remission after transsphenoidal surgery with desmopressin for up to 20 years after surgery. The ACTH and cortisol response to desmopressin over time was evaluated in patients on long-term remission or undergoing relapse; an increase by at least 27 pg/mL in ACTH levels identified responders. The vast majority of patients who underwent successful adenomectomy failed to respond to desmopressin after surgery and this response pattern was maintained over time in patients on long-term remission. Conversely, a response to desmopressin reappeared in patients who subsequently developed a recurrence of Cushing's disease, even years prior to frank hypercortisolism. It appears therefore that a change in the response pattern to desmopressin proves predictive of recurrence of Cushing's disease and may indicate which patients require close monitoring.

Keywords: Cushing’s disease; desmopressin; recurrence; transsphenoidal surgery.

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Figures

Figure 1
Figure 1
ACTH response to desmopressin before surgery and at early postsurgical evaluation. Graphs show ACTH incremental peak before (filled circles) and after (empty circles) surgery in each patient tested at both times. Dashed line indicates the criterion for response to desmopressin.
Figure 2
Figure 2
ACTH response to desmopressin at long-term follow-up in patients on stable remission. Left panel: ACTH concentrations upon desmopressin administration (arrow) over 2 h are depicted. Average values at different time points after surgery are color-coded as shown. Right panel: range of ACTH peak increments during follow-up. Bars comprise 25th, 50th and 75th centiles, error bars 10th and 90th centiles and individual outliers are shown. Dashed line indicates a positive response.
Figure 3
Figure 3
ACTH response to desmopressin at long-term follow-up in patients who relapsed. Incremental peak ACTH concentrations are repeated testing over time in the 13 patients shown; white circles indicate concurrent normal UFC/OST; gray circles indicate abnormal UFC/OST. Dashed line indicates a positive response.
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