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

Romanholi, Daniella J.P.C.; Machado, Márcio Carlos; Pereira, Camila Canteiro; Danilovic, Débora Lucia Seguro; Pereira, Maria Adelaide Albergaria; Cescato, Valter Ângelo Sperling; Neto, Malebranche B. C. Cunha; Musolino, Nina Rosa Castro; Mendonça, Berenice Bilharinho; Salgado, Luiz Roberto

doi:10.1111/j.1365-2265.2007.03168.x

Cited by 40 publications

(44 citation statements)

References 33 publications

(104 reference statements)

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“…Some reported the absence of recurrence in patients who had disappearance of the response to desmopressin (37), while others found that the persistence of a response in the early post-operative period might help to identify patients at risk for late recurrence (28,45). We did not directly assess the predictive value of persistent ACTH response to desmopressin post-operatively, but our description of the recurrence patients shows that loss of response to desmopressin stimulation early post-operatively does not always predict a maintained remission and that a positive response might reappear during long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, an unsuppressed early morning post-TSS serum cortisol level can be associated with long-term remission. Dynamic tests, such as CRH and vasopressin analogs (lysine vasopressin (LVP) and desmopressin) stimulation tests, and the recently coupled dexamethasone desmopressin test, have been used to predict recurrence (15,28,29,(34)(35)(36). In patients showing ACTH and cortisol response to desmopressin in the preoperative period, the persistence or the reappearance of the positive response during long-term follow-up could be an early predictor of late recurrence, preceding by several months the classical markers of recurrence and the overt clinical signs of hypercortisolism (37,38).…”

Section: Introductionmentioning

confidence: 99%

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Sequential hormonal changes in 21 patients with recurrent Cushing's disease after successful pituitary surgery

Khalil

Baudry

Guignat

et al. 2011

European Journal of Endocrinology

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Objective: To describe the sequence of hormonal changes during recurrence of Cushing's disease (CD) after successful transsphenoidal surgery (TSS). Design: Retrospective study in a single center. Patients and methods: We studied 101 of the 127 patients treated by TSS for CD between 1996 and 2009, who had hypocortisolism or eucortisolism for at least 3 months post-TSS. We arbitrarily defined 'overt recurrence', as presence of two classical parameters of excess cortisol (increased midnight -either serum or salivary -and 24 h urinary cortisol (UC)), leading to further specific therapeutic action, and 'mild recurrence', as presence of a single classical parameter, leading to simple surveillance. Results: Of the 101 patients, 21 (20.8%) presented with recurrence, 'mild' or 'overt', during long-term follow-up (median 50.4 months, range 7-99). Recurrence occurred less frequently (16.8 vs 50%, PZ0.02), and later (mean 44.7 months, median 43, range 7-94 vs mean 21.5 months, median 17, range 3-61, PZ0.05), in patients with early post-TSS hypocortisolism compared with those with eucortisolism. Increase in midnight cortisol occurred in a mean time of 38.2 months, while UC elevation was observed at 50.6 months. Vasopressin analogs and CRH tests were eventually positive in 85 and 93% of all patients respectively; a positive response to one of the two dynamic tests preceded the increase in midnight cortisol or UC in 71 and 64% of the patients respectively. Conclusion: A positive response to vasopressin analogs and/or CRH tests occurs early in recurrence, followed by an increase in midnight cortisol, while UC elevation is at a later stage.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sequential hormonal changes in 21 patients with recurrent Cushing's disease after successful pituitary surgery

Khalil

Baudry

Guignat

et al. 2011

European Journal of Endocrinology

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Section: Teste De Supressão Com Dexametasonaunclassified

“…Contudo, em decorrência da dificuldade de importação do CRH humano e do seu alto custo, o uso do teste do DDAVP (desmopressina) no PO vem sendo sugerido como alternativa como indicador de persistência e recidiva da DC (41,(46)(47)(48), com raros e leves efeitos adversos após sua aplicação, como náuseas e rubor facial. Os indivíduos saudáveis não costumam responder ao DDAVP (48). Assim, para os pacientes com DC responsivos ao DDAVP na avaliação pré-operatória, o desaparecimento da resposta do cortisol e/ou do ACTH ao DDAVP no PO foi sugerido como marcador de remissão da DC (47) e o retorno dessa resposta como sendo um indicador de recidiva (41,48 …”

Section: Teste De Supressão Com Dexametasonaunclassified

“…Os indivíduos saudáveis não costumam responder ao DDAVP (48). Assim, para os pacientes com DC responsivos ao DDAVP na avaliação pré-operatória, o desaparecimento da resposta do cortisol e/ou do ACTH ao DDAVP no PO foi sugerido como marcador de remissão da DC (47) e o retorno dessa resposta como sendo um indicador de recidiva (41,48 …”

Section: Teste De Supressão Com Dexametasonaunclassified

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Avaliação do eixo hipotálamo-hipófise adrenal no diagnóstico e na remissão da doença de Cushing

Costenaro

Rodrigues

Rollin

et al. 2012

Arq Bras Endocrinol Metab

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A doença de Cushing (DC) permanece um desafio médico com muitas questões ainda não respondidas. O sucesso terapêutico dos pacientes com DC está ligado à correta investigação do diagnóstico síndrômico e etiológico, além da experiência e talento do neurocirurgião. A adenomectomia hipofisária transesfenoidal constitui-se no tratamento de escolha para a DC. A avaliação da remissão da doença no pós-operatório e da recorrência em longo prazo constitui um desafio ainda maior. Especial destaque deve ser dado para o cortisol sérico no pós-operatório como marcador de remissão. Adicionalmente, o uso de corticoide exógeno no pós-operatório apenas em vigência de insuficiência adrenal tem sido sugerido por alguns autores como requisito essencial para permitir a correta interpretação do cortisol sérico nesse cenário. Neste artigo, revisamos as formas de avaliação da atividade da DC e os marcadores de remissão e recidiva da DC após a realização da cirurgia transesfenoidal. Arq Bras Endocrinol Metab. 2012;56(3):159-67 Descritores Doença de Cushing; cortisol sérico; remissão; cirurgia hipofisária summArY Cushing's disease (CD) remains a medical challenge, with many questions still unanswered. Successful treatment of CD patients is closely related to correct approach to syndromic and etiological diagnosis, besides the experience and talent of the neurosurgeon. Pituitary transsphenoidal adenomectomy is the treatment of choice for DC. Assessment of remission after surgery and recurrence in the long term is an even greater challenge. In this regard, special attention should be paid to the role of postoperative serum cortisol as a marker of CD remission. Additionally, the postoperative use of exogenous glucocorticoids only in cases of adrenal insufficiency has been suggested by some authors as an essential practice to enable the use of serum cortisol in this scenario. In this article, we review the forms of evaluation of DC activity, and markers of remission and relapse of CD after transsphenoidal surgery. iNTroDuÇÃo A doença de Cushing (DC) apresenta incidência estimada de 0,7 a 3 casos/milhão/ano (1-3), com prevalência de 39,1 casos por milhão de habitantes (4). Acomete adultos jovens com pico de incidência entre a terceira e quarta décadas de vida (5) e predominantemente mulheres.Para o sucesso no manejo desses pacientes, é necessário que a investigação diagnóstica obedeça a uma sequência lógica: inicialmente o diagnóstico sindrômico e posteriormente o diagnóstico etiológico.O risco relativo de morbidade e mortalidade na DC é de 2 a 5 vezes acima da população em geral (2,3), podendo equiparar-se ao risco da população em geral durante a remissão da doença (2).

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Second-line tests in the differential diagnosis of ACTH-dependent Cushing’s syndrome

et al. 2016

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Patients with CD showed a stronger response to HDDST and CRH, and the adopted cut-offs showed a good SE and SP in discriminating them from patients with EAS. Concordant tests indicated CD when positive, whereas no response to either test was highly suggestive of EAS. The DDAVP test was of limited utility in the diagnostic phase. In conclusion, the choice of tests may play an important part in the differential diagnosis of ACTH-dependent CS.

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

Abstract: 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.

Cited by 40 publications

References 33 publications

Sequential hormonal changes in 21 patients with recurrent Cushing's disease after successful pituitary surgery

Sequential hormonal changes in 21 patients with recurrent Cushing's disease after successful pituitary surgery

Avaliação do eixo hipotálamo-hipófise adrenal no diagnóstico e na remissão da doença de Cushing

Second-line tests in the differential diagnosis of ACTH-dependent Cushing’s syndrome

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