Abstract | OBJECTIVE: To assess the ability of desmopressin administration to stimulate ACTH/ cortisol secretion in patients with Cushing's disease, either before or after surgery, and in patients with other states characterized by ACTH hypersecretion, and to compare the results with those obtained after CRH testing. DESIGN AND SUBJECTS: RESULTS: In 16 patients with Cushing's disease with microadenoma a positive ACTH/ cortisol rise occurred in 11 patients after both desmopressin and CRH, 2 other patients were responsive only to desmopressin and 2 only to CRH, while in 1 patient equivocal responses to both tests were found. The persistence of a hormonal response to desmopressin after pituitary adenomectomy for Cushing's disease correlated with unsuccessful surgery, while, contrary to CRH, absent ACTH/ cortisol rises were found in cured patients 1 and 12 months after operation. In 1 patient suspected for ectopic ACTH hypersecretion, desmopressin and CRH administration did not cause any ACTH/ cortisol rise. Significant ACTH rises occurred after both desmopressin and CRH testing in patients with Addison's disease. All the 3 patients adrenalectomized for Cushing's syndrome showed a rise of ACTH levels after CRH, while a similar response after desmopressin occurred in only one of them. CONCLUSIONS:
Desmopressin is able to stimulate ACTH and hence cortisol release in Cushing's disease. It may be a useful test in patients with doubtful responses to CRH test, in those exhibiting responses to CRH indistinguishable from those of normal subjects and in the postoperative follow-up of Cushing's disease. In some patients with abolished or reduced cortisol feed-back at hypothalamic-pituitary level the sensitivity of normal corticotrophs to desmopressin is enhanced.
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Authors | P Colombo, E Passini, T Re, G Faglia, B Ambrosi |
Journal | Clinical endocrinology
(Clin Endocrinol (Oxf))
Vol. 46
Issue 6
Pg. 661-8
(Jun 1997)
ISSN: 0300-0664 [Print] England |
PMID | 9274696
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Renal Agents
- Adrenocorticotropic Hormone
- Corticotropin-Releasing Hormone
- Deamino Arginine Vasopressin
- Hydrocortisone
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Topics |
- ACTH Syndrome, Ectopic
(blood, diagnosis)
- Addison Disease
(blood, diagnosis)
- Adenoma
(surgery)
- Adrenal Gland Diseases
(blood, surgery)
- Adrenalectomy
- Adrenocorticotropic Hormone
(blood, metabolism)
- Adult
- Aged
- Corticotropin-Releasing Hormone
- Cushing Syndrome
(blood, diagnosis, surgery)
- Deamino Arginine Vasopressin
- Female
- Follow-Up Studies
- Humans
- Hydrocortisone
(blood, metabolism)
- Male
- Middle Aged
- Pituitary Neoplasms
(surgery)
- Renal Agents
- Stimulation, Chemical
- Treatment Outcome
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