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


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From http://www.ingentaconnect.com/content/bsc/...mtc77jjf7.alice

 

 

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

 

Authors: Romanholi, Daniella Jesus Patrick Carminatti; Machado, Marcio Carlos; Pereira, Camila Canteiro1; Danilovic, Debora Seguro1; Pereira, Maria Adelaide Albergaria1; Cescato, Valter Angelo S.2; Neto, Malebranche Berardo C. Cunha2; Musolino, Nina Rosa Castro2; de Mendon?a, Berenice Bilharinho1; Salgado, Luiz Roberto3

 

Source: Clinical Endocrinology, Volume 69, Number 1, July 2008 , pp. 117-122(6)

 

Publisher: Blackwell Publishing

 

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 (?) 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 ?g IV) 15-30 days after adenomectomy were used to determine ?F (absolute increment of F: F peak - F baseline). Sensitivity and specificity of ?F were calculated and a ROC curve was performed to establish an optimal cut-off for ?F to predict recurrence risk.

 

Results

 

Fifteen patients had immediate postoperative failure (basal F > 165 nmol/l; 6 ?g/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 ?F > 193 nmol/l (7 ?g/dl), but none of 30 patients who remained in prolonged remission showed ?F > 193 nmol/l after postoperative desmopressin stimulation.

 

Conclusions

 

Persistence of cortisol response (?F > 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.

 

Document Type: Research article

 

DOI: 10.1111/j.1365-2265.2007.03168.x

 

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,

 

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