The corticotropin-releasing factor test in the differential diagnosis of Cushing's syndrome: A comparison with the lysine-vasopressin test

Tabarin, Antoine; Galli, F. San; Dezou, S.; Leprat, F.; Corcuff, J.-B.; Latapie, J. L.; Guérin, J.; Roger, Patrick

doi:10.1530/acta.0.1230331

Cited by 43 publications

(22 citation statements)

References 26 publications

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“…Similar results have been obtained also with the synthetic analogue of vasopressin, lysine-vasopressin (LVP) (2), through the action on V3 receptors recently cloned in the pituitary (3±5).…”

Section: Introductionsupporting

confidence: 77%

Usefulness of the desmopressin test in the postoperative evaluation of patients with Cushing's disease

Colombo

Dall’Asta

Barbetta

et al. 2000

European Journal of Endocrinology

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Objective: To evaluate the plasma ACTH and serum cortisol responses to desmopressin in patients with Cushing's disease either before or after pituitary adenomectomy during long-term follow-up, and to compare the results with those obtained after corticotrophin-releasing hormone (CRH) testing. Design: Plasma ACTH and serum cortisol concentrations were evaluated after the administration of desmopressin (10 mg i.v.) or CRH (1 mg/kg i.v.) in 34 patients with Cushing's disease. Twenty-four patients with active Cushing'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 Cushing's disease a signi®cant ACTH/cortisol response (P < 0.001) was induced by either desmopressin (ACTH from a baseline of 15.3 6 2.7 pmol/l to a peak of 40.9 6 7.3 pmol/l; cortisol from 673 6 59 nmol/l to 1171 6 90 nmol/l) or CRH (ACTH from a basal of 14.2 6 2.5 pmol/l to a peak of 47.2 6 7.7 pmol/l; cortisol from 672 6 50 nmol/l to 1192 6 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 ®ve patients who were not cured, the hormonal responsiveness to either CRH or desmopressin was similar before and after 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 four unsuccessfully 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 Cushing's disease, the maintenance or the disappearance of the hormonal response may be 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 Cushing's syndrome.

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Section: Introductionsupporting

confidence: 77%

Usefulness of the desmopressin test in the postoperative evaluation of patients with Cushing's disease

Colombo

Dall’Asta

Barbetta

et al. 2000

European Journal of Endocrinology

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“…CRH serum cortisol response can be considered more specific when compared with ACTH response because non-intact ACTH molecules exhibit less biological activity. However, the complete discrimination between ACTH secretion in Cushing's disease and the ectopic ACTH secretion by non-pituitary tumors is not always achieved by the CRH test only, since 8-10% of pituitary adenomas do not respond to the test and around 20% of patients with EAS can exhibit response to CRH (19,20,23). CRH peptide is not available in our institution; thus, the CRH test was performed only in two cases.…”

Section: Discussionmentioning

confidence: 95%

“…For ACTH-dependent differential diagnosis, patients underwent HDDST (8 mg) (14)(15)(16), desmopressin test (17,18), corticotropin-releasing hormone (CRH) test (19)(20)(21)(22)(23), growth hormone releasing peptide (GHRP)-6 test (24,25), and IPSS (26)(27)(28) with desmopressin stimulus indicated when magnetic resonance imaging (MRI) was negative for a pituitary lesion. IPSS was performed by collecting blood samples simultaneously from the inferior petrosal sinuses and a peripheral vein before and 3, 5, and 10 min after 10 mg of IV desmopressin (DDAVP, Ferring Pharmaceuticals, Limhamn, Sweden) (29 (31)(32)(33).…”

Section: Diagnosis Of Ectopic Acth Syndromementioning

confidence: 99%

Ectopic ACTH syndrome: our experience with 25 cases

Fragoso²,

et al. 2006

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Objective: Ectopic ACTH syndrome (EAS) occurs in about 5-10% of all patients with ACTH-dependent hypercortisolism with most of them caused by intrathoracic neoplasms. It may be associated with overt malignancies or with occult and indolent tumors. We assessed the accuracy of dynamic tests, inferior petrosal sinus sampling (IPSS) using desmopressin, and imaging in the work-up diagnosis of EAS. Design and subjects: Tumor markers, imaging, and outcome data from 25 patients (13F/12M) aged 18-72 years. High dexamethasone suppression test (HDDST), desmopressin test, GHRP-6 test, corticotropin-releasing hormone (CRH) test, IPSS, computed tomography (CT), magnetic resonance imaging (MRI), and 111 In-pentetreotide scintigraphy were revised. Results: In 5 out of 20 patients HDDST was positive. In 13 patients who underwent desmopressin test, ACTH-and cortisol-positive responses were seen in six and five patients respectively. GHRP-6 test was positive in two out of three cases. Two patients underwent CRH test with negative response. In the seven patients submitted to IPSS using desmopressin in six of them, none had ACTH gradients. CT was positive in 15 out of 21 patients and MRI in 8 out of 17 cases.111 In-pentetreotide scintigraphy was positive in three out of five patients. Fourteen patients had intrathoracic tumors, five had pheochromocytomas, three had pancreatic tumors, one had a glomic tumor, and had three occult tumors. Six out of 11 patients with metastasis died and 3 others without metastasis died. Conclusions: IPSS with desmopressin was helpful for differential diagnosis. Patients initially harboring occult carcinoids may also exhibit severe hypercortisolism and those harboring tymic carcinoids had poor prognoses when compared with bronchial carcinoids and pheocromocytomas.European Journal of Endocrinology 155 725-733

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“…64 Lysine or arginine AVP and desmopressin, a long-acting analogue of AVP, stimulate ACTH release via the specific corticotroph AVP receptor, particularly from ACTH secreting pituitary tumours, and have also been used for the differential diagnosis of ACTH-dependent CS; however, these tests appear to be inferior to the CRH stimulation test. 1,65,66 Desmopressin (DDAVP) lacks the V1 renal receptor and thus the pressor side effects observed with the AVP analogues. 1 In order to improve the sensitivity of CRH stimulation, the combination of 10μg of DDAVP i.v.…”

Section: Corticotrophin Releasing Hormone (Crh) Vasopressin (Avp) Dmentioning

confidence: 99%

The diagnosis and differential diagnosis of endogenous Cushing?s syndrome

Makras¹,

Toloumis²,

Papadogias³

et al. 2006

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AbstrActcushing's syndrome (cs) is a physically and psychologically disabling disease associated with high morbidity resulting from inappropriate elevation of circulating free cortisol levels. the main features of cs are disturbance of the normal circadian rhythm of cortisol secretion, impairment of the normal feedback of the hypothalamo-pituitary-adrenal (HPA)-axis, and excessive integrated 24 hours cortisol secretion. All biochemical tests used for the diagnosis of cs rely upon the ascertainment of a disturbance of these features. However, the diagnosis of cs (endogenous hypercortisolism) still remains a challenge, although the evolution of several diagnostic tests has allowed diagnosis at an earlier stage. In the initial investigation of cs, tests of high sensitivity are required to identify patients at risk, which are followed by tests of high specificity to confirm the diagnosis and establish the precise aetiology. this review will discuss the various causes of endogenous cs and focus on established and evolving diagnostic procedures used for its diagnosis, as several studies with large number of patients have recently appeared in the literature validating current practice and proposing improved diagnostic algorithms.

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The corticotropin-releasing factor test in the differential diagnosis of Cushing's syndrome: A comparison with the lysine-vasopressin test

Cited by 43 publications

References 26 publications

Usefulness of the desmopressin test in the postoperative evaluation of patients with Cushing's disease

Usefulness of the desmopressin test in the postoperative evaluation of patients with Cushing's disease

Ectopic ACTH syndrome: our experience with 25 cases

The diagnosis and differential diagnosis of endogenous Cushing?s syndrome

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