Desmopressin and hexarelin tests in alcohol-induced pseudo-Cushing's syndrome.
BACKGROUND
A challenge in clinical endocrinology is the distinction between Cushing's disease (Cushing's syndrome dependent by adrenocorticotrophic hormone (ACTH)-secreting tumours of pituitary origin) and alcohol-dependent pseudo-Cushing's syndrome. Patients with Cushing's disease are known to have high ACTH/cortisol responses to desmopressin (DDAVP, a vasopressin analogue) and to hexarelin (HEX, a synthetic GH-releasing peptide).


OBJECTIVE
To compare the ACTH/cortisol responses to desmopressin and to hexarelin of subjects with alcohol pseudo-Cushing's syndrome with those obtained in patients with Cushing's disease and in normal controls.


METHODS
Randomized, single-blind study.


METHODS
University medical centre.


METHODS
Eight alcoholics with pseudo-Cushing's syndrome, six patients with Cushing's disease and nine age-matched normal controls.


METHODS
Three tests at weekly intervals. The dexamethasone (1 mg) suppression test (DST) was carried out first. The desmopressin (10 microg intravenously at 09:00 h) test and hexarelin (2 microgram kg-1 intravenously at 09:00 h) test were carried out in random order.


METHODS
Plasma ACTH and cortisol levels.


RESULTS
The basal plasma levels of ACTH and cortisol were significantly lower in normal subjects than in patients with Cushing's disease and in alcoholic subjects; these latter groups showed similar basal hormonal values. All normal controls, two patients with Cushing's disease and two alcoholics showed suppression of plasma cortisol levels (<5 microgram dL-1) after dexamethasone administration. Both desmopressin and hexarelin induced striking ACTH/cortisol responses in patients with Cushing's disease, whereas hexarelin, but not desmopressin, slightly increased ACTH/cortisol secretion in the normal controls. Neither desmopressin nor hexarelin administration induced any significant change in ACTH/cortisol secretion in alcoholics.


CONCLUSIONS
These data suggest that either the hexarelin or desmopressin test can be used to differentiate patients with Cushing's disease from subjects with alcohol-dependent pseudo-Cushing's syndrome.
Coiro
V
V
Department of Internal Medicine and Biomedical Sciences, University of Parma, Parma, RIA Laboratory, Hospital of Guastalla, Guastalla, Italy. volpi@iprUniverityoffce.unipr.it
Volpi
R
R
Capretti
L
L
Caffarri
G
G
Chiodera
P
P
D000324:Adrenocorticotropic Hormone / Q000097:blood* / Q000378:metabolism; D000328:Adult; D000437:Alcoholism / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D003480:Cushing Syndrome / Q000097:blood / Q000209:etiology*; D003894:Deamino Arginine Vasopressin; D000431:Ethanol / Q000009:adverse effects; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine; D008297:Male; D009842:Oligopeptides; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D011863:Radioimmunoassay; D016037:Single-Blind Method
D009842:Oligopeptides; C086184:hexarelin; D000431:Ethanol; D000324:Adrenocorticotropic Hormone; D003894:Deamino Arginine Vasopressin; D006854:Hydrocortisone