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

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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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Document Type: Research Article

Affiliations: 1: Division of Endocrinology and Metabolism and 2: Neuroendocrine Unit, Division of Neurosurgery, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil 3: Neuroendocrine Unit, Division of Endocrinology and Metabolism, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil,

Publication date: 01 July 2008

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