The desmopressin stimulation test in the differential diagnosis of Cushing's syndrome

Malerbi, Domingos Augusto Cherino; Mendonça, Berenice Bilharinho; Liberman, Bernardo; Toledo, S. P. A.; Corradini, Maria Cristina M.; Cunha-Neto, Malebranche Berardo Carneiro da; Fragoso, Maria Candida Barisson Villares; Wajchenberg, B. L.

doi:10.1111/j.1365-2265.1993.tb00341.x

Cited by 140 publications

(116 citation statements)

References 24 publications

Supporting

Mentioning

105

Contrasting

Unclassified

Order By: Relevance

“…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].…”

Section: Low-dose Dexamethasone Suppression Test (Dst)mentioning

confidence: 99%

“…The DDAVP test has been used for the diagnosis and differential diagnosis of ACTH-dependent Cushing's syndrome from pseudo-Cushing's syndrome; plasma ACTH levels were increased in a response to DDAVP in Cushing's disease, but classically, there was a slight response in normal or EAS cases [7]. 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].…”

Section: Bmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2009

View full text Add to dashboard Cite

because of the Cushingoid appearance, with the characteristic features of central obesity, moon face, skin atrophy, purple striae and buffalo hump, and the clinical criteria are clear, a debate exists in the literature over the biochemical diagnosis of this disease [3]. Recently, the diagnostic criteria for Cushing's disease have been reported by the Ministry of Health, Labour, and Welfare of Japan [4]. In the guideline, the following endocrinological findings were considered as diagnostic criteria: 1) The presence of a Cushingoid appearance; 2) Evidence of autonomic or abnormal secretion of ACTH, such as (a) normal-high ACTH and cortisol levels, and (b) high levels of urinary excretion of free cortisol; 3) Screening tests show (a) incomplete suppression of cortisol (> 5 µg/dl) by a lowdose (0.5 mg) overnight dexamethasone suppression test (DST), (b) high cortisol levels (> 5 µg/dl) during night time sleeping, and (c) response of plasma ACTH levels to the desmopressin (DDAVP) test; 4) The dif- Abstract. We evaluated the usefulness and accuracy of diagnostic tests for adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome, based on our experience of 88 cases, including 73 cases with Cushing's disease, and 15 cases with ectopic ACTH syndrome (EAS). In our study, 0.5 mg of dexamethasone failed to suppress the morning cortisol secretion in 100% of cases with Cushing's disease and EAS. Plasma ACTH levels were significantly increased by desmopressin (DDAVP) in 86% of cases with Cushing's disease, especially in microadenomas (90%), while these levels were not affected in normal subjects. In EAS, 44% responded to DDAVP. Plasma ACTH levels were increased in response to the human corticotropin-releasing hormone (CRH) test in 100% of microadenomas and 73% of macroadenomas with Cushing's disease, but only in 27% of cases with EAS. A high dose (8 mg) of dexamethasone suppressed the morning cortisol secretion in 89% of microadenomas with Cushing's disease, and in 82% of all cases with Cushing's disease, while it did in only 20% of cases with EAS. Taken together, the 0.5 mg dexamethasone suppression test (DST) and DDAVP test are considerably useful for the screening of ACTH-dependent Cushing's syndrome. The CRH test and 8 mg DST would be effective for the diagnosis of Cushing's diseases, because our study shows a sensitivity of 81% in cases with Cushing's disease when these tests are considered together. These data were submitted to prepare the diagnostic criteria for Cushing's disease, suggested by the working group of the Ministry of Health, Labour, and Welfare of Japan.

show abstract

Section: Low-dose Dexamethasone Suppression Test (Dst)mentioning

confidence: 99%

Section: Bmentioning

confidence: 99%

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

et al. 2009

View full text Add to dashboard Cite

show abstract

“…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].…”

mentioning

confidence: 99%

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

et al. 2010

View full text Add to dashboard Cite

“…Desmopressin has been used for the differential diagnosis of ACTH-dependent Cushing's syndrome since 1993 (87). Moreover, it has also been studied with the aim of differentiating Cushing's syndrome from states of pseudo-Cushing's (88).…”

Section: Desmopressin Testmentioning

confidence: 99%

“…The desmopressin test has been used for the differential diagnosis of ACTH-dependent Cushing's syndrome since 1993 (87). Subsequently, several studies have shown a response in the majority of patients with CD (~80%) (1).…”

Section: Desmopressin Testmentioning

confidence: 99%

Recommendations of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism for the diagnosis of Cushing’s disease in Brazil

Machado

Fragoso

Moreira

et al. 2016

Arch. Endocrinol. Metab.

View full text Add to dashboard Cite

Although it is a rare condition, the accurate diagnosis and treatment of Cushing's disease is important due to its higher morbidity and mortality compared to the general population, which is attributed to cardiovascular diseases, diabetes mellitus and infections. Screening for hypercortisolism is recommended for patients who present multiple and progressive clinical signs and symptoms, especially those who are considered to be more specific to Cushing's syndrome, abnormal findings relative to age (e.g., spinal osteoporosis and high blood pressure in young patients), weight gain associated with reduced growth rate in the pediatric population and for those with adrenal incidentalomas. Routine screening is not recommended for other groups of patients, such as those with obesity or diabetes mellitus. Magnetic resonance imaging (MRI) of the pituitary, the corticotropin-releasing hormone (CRH) test and the high-dose dexamethasone suppression test are the main tests for the differential diagnosis of ACTH-dependent Cushing's syndrome. Bilateral and simultaneous petrosal sinus sampling is the gold standard method and is performed when the triad of initial tests is inconclusive, doubtful or conflicting. The aim of this article is to provide information on the early detection and establishment of a proper diagnosis of Cushing's disease, recommending follow-up of these patients at experienced referral centers. Arch Endocrinol Metab. 2016;60(3):267-86

show abstract

The desmopressin stimulation test in the differential diagnosis of Cushing's syndrome

Abstract: Desmopressin was able to stimulate the pituitary-adrenal axis in patients with Cushing's disease and, like corticotrophin releasing hormone, it may prove useful in the differential diagnosis of Cushing's syndrome.

Cited by 140 publications

References 24 publications

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

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

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

Recommendations of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism for the diagnosis of Cushing’s disease in Brazil

Contact Info

Product

Resources

About

The desmopressin stimulation test in the differential diagnosis of Cushing's syndrome

Abstract: Desmopressin was able to stimulate the pituitary-adrenal axis in patients with Cushing's disease and, like corticotrophin releasing hormone, it may prove useful in the differential diagnosis of Cushing's syndrome.

Cited by 140 publications

References 24 publications

Evaluation of Diagnostic Tests for ACTH-Dependent Cushing&rsquo;s Syndrome

Evaluation of Diagnostic Tests for ACTH-Dependent Cushing&rsquo;s Syndrome

Evaluation of Plasma, Salivary, and Urinary Cortisol Levels for Diagnosis of Cushing&rsquo;s Syndrome

Recommendations of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism for the diagnosis of Cushing’s disease in Brazil

Contact Info

Product

Resources

About

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

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

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