title: Desmopressin test in the diagnosis and follow-up of cyclical Cushing's disease.
abstract: OBJECTIVE
  To assess the utility of the desmopressin (DDAVP) test in the diagnosis and follow-up of a cyclical Cushing's disease (CCS) case.
  
  
  METHODS
  Laboratory tests included morning and midnight serum cortisol levels, 24h urine free cortisol excretion, midnight salivary cortisol levels, serum cortisol levels after low (1 mg) and high (8 mg) dexamethasone, plasma ACTH and serum cortisol levels after DDAVP. Magnetic resonance imaging (MRI) was used to assess the presence of a pituitary adenoma. The resected tumor specimen was studied by histological, immunohistochemical and cell biology techniques.
  
  
  RESULTS
  A patient was referred to our unit with a diagnosis of Cushing's syndrome (CS) for further evaluation and treatment. However, no biochemical evidence of hypercortisolism was observed in the follow-up evaluations. Furthermore, the typical features of CS fluctuated throughout this period. A consistent positive response to the DDAVP stimulation test was observed during the diagnostic work-up, even when overt clinical features of CS were not apparent, raising suspicion for CCS. After two years of follow-up a definitive diagnosis of hypercortisolism was established. An MRI scan revealed a pituitary adenoma, as the source of ACTH production. After transphenoidal surgery, clinical signs of CS resolved and the response to DDAVP became negative. DDAVP induced a significant increase in ACTH levels in cultured pituitary adenoma cells, consistent with the in vivo DDAVP test results.
  
  
  CONCLUSIONS
  Our case illustrates the utility of the DDAVP test in the evaluation of patients with suspected CCS. The DDAVP test could facilitate the management of CCS by shortening the time of diagnosis.
authors.affiliation: Instituto de Biomedicina de Sevilla (IBiS), University Hospital Virgen del Rocío/Consejo Superior de Investigaciones Científicas/University of Sevilla and Division of Endocrinology, Virgen del Rocío University Hospital, Sevilla, Spain; Departamento de Biología Celular, Fisiología e Inmunología, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC); CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn); Departamento de Bioquímica Clínica, Hospital Universitario Virgen del Rocío, Sevilla, Spain. Electronic address: alealcerro@us.es.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Leal-Cerro
authors.affiliation: Instituto de Biomedicina de Sevilla (IBiS), University Hospital Virgen del Rocío/Consejo Superior de Investigaciones Científicas/University of Sevilla and Division of Endocrinology, Virgen del Rocío University Hospital, Sevilla, Spain.
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Martín-Rodríguez
authors.affiliation: Departamento de Biología Celular, Fisiología e Inmunología, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC); CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn).
authors.forename: Alejandro
authors.initials: A
authors.lastname: Ibáñez-Costa
authors.affiliation: Instituto de Biomedicina de Sevilla (IBiS), University Hospital Virgen del Rocío/Consejo Superior de Investigaciones Científicas/University of Sevilla and Division of Endocrinology, Virgen del Rocío University Hospital, Sevilla, Spain.
authors.forename: Ainara
authors.initials: A
authors.lastname: Madrazo-Atutxa
authors.affiliation: Instituto de Biomedicina de Sevilla (IBiS), University Hospital Virgen del Rocío/Consejo Superior de Investigaciones Científicas/University of Sevilla and Division of Endocrinology, Virgen del Rocío University Hospital, Sevilla, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Venegas-Moreno
authors.affiliation: Departamento de Bioquímica Clínica, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: León-Justel
authors.affiliation: Instituto de Biomedicina de Sevilla (IBiS), University Hospital Virgen del Rocío/Consejo Superior de Investigaciones Científicas/University of Sevilla and Division of Endocrinology, Virgen del Rocío University Hospital, Sevilla, Spain.
authors.forename: Natividad
authors.initials: N
authors.lastname: García-Hernández
authors.affiliation: Departamento de Biología Celular, Fisiología e Inmunología, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC); CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn).
authors.forename: Raúl M
authors.initials: RM
authors.lastname: Luque
authors.affiliation: Departamento de Biología Celular, Fisiología e Inmunología, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC); CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn).
authors.forename: Justo P
authors.initials: JP
authors.lastname: Castaño
authors.affiliation: Instituto de Biomedicina de Sevilla (IBiS), University Hospital Virgen del Rocío/Consejo Superior de Investigaciones Científicas/University of Sevilla and Division of Endocrinology, Virgen del Rocío University Hospital, Sevilla, Spain.
authors.forename: David A
authors.initials: DA
authors.lastname: Cano
authors.affiliation: Instituto de Biomedicina de Sevilla (IBiS), University Hospital Virgen del Rocío/Consejo Superior de Investigaciones Científicas/University of Sevilla and Division of Endocrinology, Virgen del Rocío University Hospital, Sevilla, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Soto-Moreno
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000150:complications* / Q000175:diagnosis / Q000235:genetics / Q000601:surgery; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000328:Adult; D002940:Circadian Rhythm; D003894:Deamino Arginine Vasopressin / Q000494:pharmacology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000378:metabolism; D007016:Hypophysectomy; D008279:Magnetic Resonance Imaging; D010507:Periodicity; D010641:Phenotype; D047748:Pituitary ACTH Hypersecretion / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000652:urine; D010911:Pituitary Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000235:genetics / Q000601:surgery; D012333:RNA, Messenger / Q000235:genetics / Q000302:isolation & purification; D012334:RNA, Neoplasm / Q000235:genetics / Q000302:isolation & purification; D060888:Real-Time Polymerase Chain Reaction; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014407:Tumor Cells, Cultured
chemical_list: D012333:RNA, Messenger; D012334:RNA, Neoplasm; D000324:Adrenocorticotropic Hormone; D003894:Deamino Arginine Vasopressin; D006854:Hydrocortisone
keywords: Cyclical Cushing's disease; Desmopressin test; Enfermedad de Cushing cíclica; Hipercortisolismo; Hypercortisolism; Prueba de desmopresina