Role for postoperative cortisol response to desmopressin in predicting the risk for recurrent Cushing's disease

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Abstract
Summary: 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 (Δ) of serum cortisol (F) suitable to predict recurrence risk.Design  Retrospective case record study.Patients  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 and measurements  Serum cortisol levels after desmopressin test (10 µg IV) 15–30 days after adenomectomy were used to determine ΔF (absolute increment of F: F peak − F baseline). Sensitivity and specificity of ΔF were calculated and a ROC curve was performed to establish an optimal cut‐off for ΔF to predict recurrence risk.Results  Fifteen patients had immediate postoperative failure (basal F > 165 nmol/l; 6 µg/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 ΔF > 193 nmol/l (7 µg/dl), but none of 30 patients who remained in prolonged remission showed ΔF > 193 nmol/l after postoperative desmopressin stimulation.Conclusions  Persistence of cortisol response (ΔF > 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.

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