Document Detail

A combined dexamethasone desmopressin test as an early marker of postsurgical recurrence in Cushing's disease.
MedLine Citation:
PMID:  19276234     Owner:  NLM     Status:  MEDLINE    
CONTEXT: Recurrence of Cushing's disease (CD) after transsphenoidal surgery (TSS) occurs in about 25% of cases. Twenty percent of patients with immediate postsurgical corticotroph deficiency will present late recurrence. OBJECTIVE: The aim of the study was to evaluate a coupled dexamethasone desmopressin test (CDDT) as a predictor of recurrence of CD. DESIGN: We conducted a prospective bicenter study (Marseille and Grenoble, France). PATIENTS: We studied 38 patients treated by TSS for CD with a mean follow-up of 60 months. INTERVENTION(S): We evaluated 24-h urinary free cortisol, ACTH, and cortisol plasmatic levels and performed low-dose dexamethasone suppression test and CDDT 3 to 6 months after surgery and then yearly. MAIN OUTCOME MEASURES: After CDDT, ACTH ratio (ACTHr) was defined as (PeakACTH - BaseACTH)/BaseACTH. Cortisol ratio (Cortisolr) was defined as (PeakCortisol - BaseCortisol)/BaseCortisol. Basal values were observed after low-dose dexamethasone suppression test. Receiver operator characteristics curve defined ACTHr and Cortisolr giving the best sensitivity and specificity associated with recurrence. RESULTS: Ten patients presented recurrence. ACTHr and Cortisolr were superior or equal to 0.5 in all patients with recurrence and in three of 28 patients in remission (100% sensitivity, 89% specificity). The test became positive in eight of 10 patients with recurrence 6-60 months before classical markers of hypercortisolism. Six patients with immediate postsurgical corticotroph deficiency presented recurrence. All of them presented CDDT positivity during the 3 yr after surgery, and recurrence 6 to 60 months after CDDT positivity. CONCLUSIONS: CDDT is an early predictor of recurrence of CD and could be of particular interest in the first 3 yr after surgery, by selecting patients at high risk of recurrence despite falsely reassuring classical hormonal markers.
Frederic Castinetti; Monique Martinie; Isabelle Morange; Henry Dufour; Nathalie Sturm; Jean-Guy Passagia; Bernard Conte-Devolx; Olivier Chabre; Thierry Brue
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study     Date:  2009-03-10
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  94     ISSN:  1945-7197     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-04     Completed Date:  2009-07-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1897-903     Citation Subset:  AIM; IM    
Department of Endocrinology, Hôpital de la Timone, 264 rue St. Pierre, Cedex 5, Marseille 13385, France.
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MeSH Terms
Adrenocorticotropic Hormone / blood
Biological Markers / analysis,  blood
Deamino Arginine Vasopressin / administration & dosage*
Dexamethasone / administration & dosage*
Diagnostic Techniques, Endocrine*
Early Diagnosis
Follow-Up Studies
Hydrocortisone / blood
Middle Aged
Pituitary ACTH Hypersecretion / blood,  diagnosis*,  pathology,  surgery*
Postoperative Complications / diagnosis
Sensitivity and Specificity
Young Adult
Reg. No./Substance:
0/Biological Markers; 16679-58-6/Deamino Arginine Vasopressin; 50-02-2/Dexamethasone; 50-23-7/Hydrocortisone; 9002-60-2/Adrenocorticotropic Hormone

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