Role for postoperative cortisol response to desmopressin in predicting the risk for recurrent Cushing's disease.
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.
Romanholi
Daniella Jesus Patrick Carminatti
DJ
Neuroendocrine Unit, Division of Endocrinology and Metabolism, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil.
Machado
Marcio Carlos
MC
Pereira
Camila Canteiro
CC
Danilovic
Debora Seguro
DS
Pereira
Maria Adelaide Albergaria
MA
Cescato
Valter Angelo S
VA
Cunha Neto
Malebranche Berardo C
MB
Musolino
Nina Rosa Castro
NR
de Mendonça
Berenice Bilharinho
BB
Salgado
Luiz Roberto
LR
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
D050034:Antidiuretic Agents; D003894:Deamino Arginine Vasopressin; D006854:Hydrocortisone