Desmopressin stimulation test for diagnosis of ACTH-dependent Cushing's syndrome

We evaluated the usefulness of a desmopressin (DDAVP) test in the diagnosis of ACTH-dependent Cushing's syndrome. After an intravenous injection of 5 microg DDAVP, plasma ACTH levels increased to more than 200% of the basal levels in 10 of 10 patients with Cushing's disease, but remained l...

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Bibliographic Details
Published in:Endocrine journal 1997-10, Vol.44 (5), p.687-695
Main Authors: Sakai, Y, Horiba, N, Tozawa, F, Sakai, K, Kuwayama, A, Demura, H, Suda, T
Format: Article
Language:English
Subjects:
Adenoma - chemistry
Adenoma - pathology
Adrenal Cortex Function Tests - methods
Adrenocorticotropic Hormone - blood
Adrenocorticotropic Hormone - drug effects
Adrenocorticotropic Hormone - metabolism
Adult
Cohort Studies
Cushing Syndrome - blood
Cushing Syndrome - diagnosis
Cyclic AMP - metabolism
Deamino Arginine Vasopressin - administration & dosage
Deamino Arginine Vasopressin - pharmacology
Female
Humans
Hydrocortisone - blood
Hydrocortisone - metabolism
Injections, Intravenous
Kidney - chemistry
Kidney - pathology
Male
Middle Aged
Receptors, Vasopressin - classification
Receptors, Vasopressin - genetics
Reference Values
Renal Agents - administration & dosage
Renal Agents - pharmacology
Sensitivity and Specificity
Time Factors
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Summary:We evaluated the usefulness of a desmopressin (DDAVP) test in the diagnosis of ACTH-dependent Cushing's syndrome. After an intravenous injection of 5 microg 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 microg 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.
ISSN:0918-8959
1348-4540
DOI:10.1507/endocrj.44.687