title: Postoperative follow-up of Cushing's disease using cortisol, desmopressin and coupled dexamethasone-desmopressin tests: a head-to-head comparison.
abstract: OBJECTIVE
  Predicting the outcome of patients operated on for Cushing's disease (CD) is a challenging task. Our objective was to assess the accuracy of immediate postsurgical plasma cortisol, desmopressin test and the coupled dexamethasone-desmopressin test (CDDT) as predictors of outcome.
  
  
  METHODS
  Sixty-seven patients with initial remission and a minimal postsurgical follow-up greater than 18 months were included in this retrospective bicentre study.
  
  
  METHODS
  Follow-up included 3-6 months followed by yearly 24-h urinary-free cortisol, ACTH and cortisol plasmatic levels, a 1-mg overnight dexamethasone suppression test (1-mg DST), desmopressin test and the CDDT. ROC curves were performed to define the optimal threshold of immediate postsurgical cortisol level and 3- to 6-month desmopressin test and CDDT, as predictors of final outcome in comparison with classical biological markers of recurrence.
  
  
  RESULTS
  Eleven patients presented recurrence. The patient's median follow-up was 52 months (range, 18-180). As early predictors of outcome, immediate postsurgical plasma cortisol level <35 nmol/l predicted the lack of recurrence with 93% negative predictive value (NPV), whereas predictive positive value (PPV) was 25%. During the follow-up, the CDDT was more precise than the desmopressin test in predicting the lack of recurrence (100% NPV) when performed in the first 3 years after surgery. Positivity of the CDDT was defined based on ROC curves by ACTH and cortisol increments >50%. The CDDT was highly reproducible, as the same response was observed every year in 91% of the patients.
  
  
  CONCLUSIONS
  Adding the CDDT the first 3 years after surgery to immediate postsurgical cortisol evaluation should allow obtaining an optimal follow-up management of patients operated for Cushing's disease.
authors: Department of Endocrinology, CHU La Timone, APHM and CRN2M-UMR 7286- Faculte de Medecine Secteur Nord, Aix Marseille Université, Marseille, France.
authors: Pauline
authors: P
authors: Le Marc'hadour
authors: Department of Endocrinology, Diabetology and Nutrition, CHU de Grenoble - Hôpital Albert Michallon, Grenoble, France.
authors: Marie
authors: M
authors: Muller
authors: Department of Endocrinology, CHU La Timone, APHM and CRN2M-UMR 7286- Faculte de Medecine Secteur Nord, Aix Marseille Université, Marseille, France.
authors: Frederique
authors: F
authors: Albarel
authors: Department of Endocrinology, Diabetology and Nutrition, CHU de Grenoble - Hôpital Albert Michallon, Grenoble, France.
authors: Anne-Laure
authors: AL
authors: Coulon
authors: Department of Endocrinology, CHU La Timone, APHM and CRN2M-UMR 7286- Faculte de Medecine Secteur Nord, Aix Marseille Université, Marseille, France.
authors: Isabelle
authors: I
authors: Morange
authors: Department of Endocrinology, Diabetology and Nutrition, CHU de Grenoble - Hôpital Albert Michallon, Grenoble, France.
authors: Monique
authors: M
authors: Martinie
authors: Department of Neurosurgery, CHU de Grenoble - Hôpital Albert Michallon, Grenoble, France.
authors: Emmanuel
authors: E
authors: Gay
authors: Department of Neurosurgery, CHU La Timone, Marseille, France.
authors: Thomas
authors: T
authors: Graillon
authors: Department of Neurosurgery, CHU La Timone, Marseille, France.
authors: Henri
authors: H
authors: Dufour
authors: Department of Endocrinology, CHU La Timone, APHM and CRN2M-UMR 7286- Faculte de Medecine Secteur Nord, Aix Marseille Université, Marseille, France.
authors: Bernard
authors: B
authors: Conte-Devolx
authors: Department of Endocrinology, Diabetology and Nutrition, CHU de Grenoble - Hôpital Albert Michallon, Grenoble, France.
authors: Olivier
authors: O
authors: Chabre
authors: Department of Endocrinology, CHU La Timone, APHM and CRN2M-UMR 7286- Faculte de Medecine Secteur Nord, Aix Marseille Université, Marseille, France.
authors: Thierry
authors: T
authors: Brue
authors: Department of Endocrinology, CHU La Timone, APHM and CRN2M-UMR 7286- Faculte de Medecine Secteur Nord, Aix Marseille Université, Marseille, France.
authors: Frederic
authors: F
authors: Castinetti
mesh_terms: D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D003894:Deamino Arginine Vasopressin / Q000097:blood*; D003907:Dexamethasone / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012372:ROC Curve; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D003894:Deamino Arginine Vasopressin; D006854:Hydrocortisone