Cortisol and adrenocorticotropin response to desmopressin in women with Cushing's disease compared with depressive illness.

Abstract

The pituitary-adrenal responsiveness to desmopressin of women with depressive illness was compared with that of patients with Cushing's disease, who are known to be highly responsive, and to that of normal controls, who are known to be poorly responsive to the peptide. Although 100% of the patients in the group with Cushing's disease met the response criterion with cortisol increases of 632 +/- 80 nmol/L above baseline (mean +/- SE), the prevalence of responders was 36% in the depressive group and 10% in normal controls, with cortisol changes from baseline of 154 +/- 28 and 79 +/- 15 nmol/L, respectively. All response parameters were significantly higher in the patients with Cushing's disease and did not differ between depressive patients and normal controls, who exhibited the same general pattern of cortisol and ACTH responses. It is concluded that the desmopressin test can be used in the differentiation between depression and Cushing's disease, and that the hypothalamic-pituitary-adrenal regulation is distinct in these two conditions.

Recurrence of Cushing's Disease Preceded by the Reappearance of ACTH and Cortisol Responses to Desmopressin Test

“…It has been reported that desmopressin test is able to differentiate patients with Cushing's disease from the majority of normal subjects and patients with obesity, depression or pseudo-Cushing states [14,16,17,[22][23][24]. It has been reported that desmopressin test is able to differentiate patients with Cushing's disease from the majority of normal subjects and patients with obesity, depression or pseudo-Cushing states [14,16,17,[22][23][24].…”

The limited value of the desmopressin test in the diagnostic approach to Cushing's syndrome

“… The table shows the number of positive ACTH responses to DDAVP according to the criteria developed by the authors in each study. Malerbi et al (1996) evaluated the response to DDAVP in terms of cortisol percent increment. …”

Desmopressin stimulation test before and after pituitary surgery in patients with Cushing's disease

“…The following criteria were used to classify a positive response to desmopressin: (i) Preoperatively, plasma ACTH and serum cortisol increases of at least 30% and 20% above baseline, respectively. In the range of ACTH and cortisol concentrations usually found in patients with active Cushing's disease, this corresponds approximately to an increment of at least four times the intra‐assay coefficient of variation at baseline used in other studies (Nieman et al ., 1986; Malerbi et al ., 1993; Malerbi et al ., 1996). (ii) In the early postoperative period, the same criteria were used.…”