Desmopressin Stimulation Test for Diagnosis of ACTH-Dependent Cushing's Syndrome.

Abstract

Abstract. We evaluated the usefulness of a desmopressin (DDAVP) test in the diagnosis of ACTHdependent Cushing's syndrome. After an intravenous injection of 5 ,ug DDAVP, plasma ACTH levels increased to more than 200% of the basal levels in 10 of 10 patients with Cushing's disease, but remained less than 150% in all of 11 normal subjects, 3 patients with Addison's disease, 5 cases of Cushing's disease in remission, and 3 patients with ectopic ACTH syndrome. Peak levels of plasma cortisol after the DDAVP stimulation were 159 ± 14% in the patients with Cushing's disease, and less than 150% of the basal levels in the other 5 groups. We also found a case of Cushing's disease with periodicity which responded to DDAVP only in the active stage. In vitro studies revealed that DDAVP directly stimulates ACTH release from corticotropic adenoma cells through V1b but not V2 vasopressin receptors.In conclusion, the DDAVP stimulation test, i.e., determination of plasma ACTH levels after 5 µg DDAVP injection, seems useful for discriminating Cushing's disease from normality, and may serve to facilitate the differentiation between Cushing's disease and ectopic ACTH syndrome.

Evaluation of Diagnostic Tests for ACTH-Dependent Cushing’s Syndrome

“…We previously reported that the DDAVP test was useful for discriminating Cushing's disease from normal subjects when more than a 1.5-fold increase in the ACTH level compared with the basal level was defined a significant response [6]. In the present study, plasma ACTH levels were significantly increased in itary microadenomas, and in 8 (73%) out of 11 cases of macroadenomas with Cushing's disease (Fig.…”

“…DST and CRH tests are well known for the diagnosis of Cushing's disease [3,5]. ACTH release would be caused by an abnormal increase in vasopressin type 1b receptors in response to a vasopressin type 2 receptor agonist, DDAVP, on pituitary corticotroph adenoma cells [6], and has been used for the differential diagnosis of ACTH-dependent Cushing's syndrome [7]. Nevertheless, the data in Cushing's disease has been known to overlap with some cases of EAS [2].…”

Differentiating between Cushing's disease and pseudo-Cushing's syndrome: comparison of four tests

“…Stimulation with either CRH or desmopressin, a synthetic vasopressin analog, results in a direct release of ACTH (40,41,42). Tirabassi et al (43) reported excellent diagnostic performance as well as perfect diagnostic agreement for the human CRH test and the desmopressin test in a study with a small number of patients with PCS (nZ12), which should be confirmed by future studies.…”

Evaluation of Plasma, Salivary, and Urinary Cortisol Levels for Diagnosis of Cushing’s Syndrome

“…corticotropin-releasing hormone (CrH) test are well defined for the diagnosis of Cushing's syndrome [4][5][6], while desmopressin has been used for the differential diagnosis of ACTH-dependent Cushing's syndrome [7,8]. However, it is clear that the diagnosis and differential diagnosis of Cushing's syndrome are still challenging problems in clinical endocrinology [9,10].…”