Role for postoperative cortisol response to desmopressin in predicting the risk for recurrent Cushing's disease.
Clin Endocrinol (Oxf)
; 69(1): 117-22, 2008 Jul.
Article
in En
| MEDLINE
| ID: mdl-18182093
ABSTRACT
UNLABELLED 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.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 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.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Postoperative Complications
/
Hydrocortisone
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Pituitary ACTH Hypersecretion
/
Deamino Arginine Vasopressin
Type of study:
Etiology_studies
/
Evaluation_studies
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Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Limits:
Adolescent
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Adult
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Aged
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Child
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Female
/
Humans
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Male
/
Middle aged
Language:
En
Journal:
Clin Endocrinol (Oxf)
Year:
2008
Document type:
Article
Affiliation country:
Brazil
Publication country:
ENGLAND
/
ESCOCIA
/
GB
/
GREAT BRITAIN
/
INGLATERRA
/
REINO UNIDO
/
SCOTLAND
/
UK
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UNITED KINGDOM