title: Role for postoperative cortisol response to desmopressin in predicting the risk for recurrent Cushing's disease.
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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  Retrospective case record study.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 patients who remained in prolonged remission showed DeltaF > 193 nmol/l after postoperative desmopressin stimulation.
  
  
  CONCLUSIONS
  Persistence of cortisol response (DeltaF > 193 nmol/l) to desmopressin in the early postoperative period can help to identify Cushing's disease patients with initial remission who present risk for later recurrence.
authors.affiliation: Neuroendocrine Unit, Division of Endocrinology and Metabolism, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil.
authors.forename: Daniella Jesus Patrick Carminatti
authors.initials: DJ
authors.lastname: Romanholi
authors.forename: Marcio Carlos
authors.initials: MC
authors.lastname: Machado
authors.forename: Camila Canteiro
authors.initials: CC
authors.lastname: Pereira
authors.forename: Debora Seguro
authors.initials: DS
authors.lastname: Danilovic
authors.forename: Maria Adelaide Albergaria
authors.initials: MA
authors.lastname: Pereira
authors.forename: Valter Angelo S
authors.initials: VA
authors.lastname: Cescato
authors.forename: Malebranche Berardo C
authors.initials: MB
authors.lastname: Cunha Neto
authors.forename: Nina Rosa Castro
authors.initials: NR
authors.lastname: Musolino
authors.forename: Berenice Bilharinho
authors.initials: BB
authors.lastname: de Mendonça
authors.forename: Luiz Roberto
authors.initials: LR
authors.lastname: Salgado
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050034:Antidiuretic Agents / Q000008:administration & dosage / Q000494:pharmacology; D002648:Child; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage / Q000494:pharmacology*; D003940:Diagnostic Techniques, Endocrine; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis*; D011184:Postoperative Period; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D050034:Antidiuretic Agents; D003894:Deamino Arginine Vasopressin; D006854:Hydrocortisone