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Titolo:
Usefulness of the desmopressin test in the postoperative evaluation of patients with Cushing's disease
Autore:
Colombo, P; DallAsta, C; Barbetta, L; Re, T; Passini, E; Faglia, G; Ambrosi, B;
Indirizzi:
Univ Milan, Osped Maggiore, IRCCS, Ist Sci Endocrine, I-20122 Milan, ItalyUniv Milan Milan Italy I-20122 , Ist Sci Endocrine, I-20122 Milan, Italy Ist Clin Humanitias, Rozzano, Italy Ist Clin Humanitias Rozzano ItalyIst Clin Humanitias, Rozzano, Italy
Titolo Testata:
EUROPEAN JOURNAL OF ENDOCRINOLOGY
fascicolo: 2, volume: 143, anno: 2000,
pagine: 227 - 234
SICI:
0804-4643(200008)143:2<227:UOTDTI>2.0.ZU;2-G
Fonte:
ISI
Lingua:
ENG
Soggetto:
CORTICOTROPIN-RELEASING HORMONE; VASOPRESSIN RECEPTOR; DIFFERENTIAL-DIAGNOSIS; STIMULATION TEST; PITUITARY SURGERY; ACTH; EXPRESSION; CORTISOL; CLONING;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Life Sciences
Citazioni:
22
Recensione:
Indirizzi per estratti:
Indirizzo: Ambrosi, B Univ Milan, Osped Maggiore, IRCCS, Ist Sci Endocrine, Via F Sforza 35, I-20122 Milan, Italy Univ Milan Via F Sforza 35 Milan Italy I-20122 22 Milan, Italy
Citazione:
P. Colombo et al., "Usefulness of the desmopressin test in the postoperative evaluation of patients with Cushing's disease", EUR J ENDOC, 143(2), 2000, pp. 227-234

Abstract

Objective: To evaluate the plasma ACTH and serum cortisol responses to desmopressin in patients with Gushing's disease either before or after pituitary adenomectomy during long-term follow-up, and to compare the results withthose obtained after corticotrophin-releasing hormone (CRH) testing. Design: Plasma ACTH and serum cortisol concentrations were evaluated afterthe administration of desmopressin (10 mu g i.v.) or CRH (1 mu g/kg i.v.) in 34 patients with Gushing's disease, Twenty-four patients with active Gushing's disease were evaluated both before and after transsphenoidal pituitary surgery (TSS): these patients were followed up for 1-36 months. Ten patients were studied only after a long-term period (1-19 years, median 4 years) after TSS (six patients), TSS plus external pituitary irradiation (three patients) and TSS plus radiosurgery (one patient). Results: In 24 patients with active Gushing's disease a significant ACTH/cortisol response (P < 0.001) was induced by either desmopressin (ACTH fi oma baseline of 15.3 +/- 2.7pmol/l to a peak of 40.9 +/- 7.3 pmol/l: cortisol from 673 +/- 59 nmol/l to 1171 +/- 90 nmol/l) or CRH (ACTH from a basal of 14.2 +/- 2.5 pmol/l to a peak of 47.2 +/- 7.7 pmol/l: cortisol from 672 +/- 50nmol/l to 1192 +/- 80 nmol/l). In all patients a positive cortisol response to desmopressin was found. After pituitary adenomectomy the 14 'cured' patients were followed up for 1-36 months; desmopressin administration never induced ACTH or cortisol responsiveness in any patient. In contrast, a progressive recovery of ACTH and cortisol responses after CRH was observed at different intervals of time in all patients but one,Five patients, in whom the cortisol concentration only normalized after surgery, showed a persistent responsiveness to desmopressin, and two of them relapsed 12 and 24 months later. In five patients who were not cured, the hormonal responsiveness to either CRH or desmopressin was similar before andafter operation. Of 10 patients studied only after long-term follow-up, six were cured and a normal response to CRH was present, whereas no changes in ACTH/cortisol concentrations were induced by desmopressin. The other fourunsuccessfully operated patients underwent pituitary irradiation and showed different and equivocal hormonal responses to desmopressin and to CRH. Conclusions: During the postoperative follow-up of patients with Gushing'sdisease, the maintenance or the disappearance of the hormonal response maybe related to the persistence or the complete removal of adenomatous corticotrophs, respectively. It is suggested that desmopressin test should be performed in the preoperative evaluation and follow-up of patients with ACTH-dependent Gushing's syndrome.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 18/09/20 alle ore 17:15:02