Use of the desmopressin test in the differential diagnosis of pseudo-Cushing state from Cushing's disease
| Autor: | Giacomo Tirabassi, Emanuela Faloia, Roberta Papa, Giorgio Arnaldi, Giorgio Furlani, Marco Boscaro |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Hydrocortisone Endocrinology Diabetes and Metabolism Clinical Biochemistry Context (language use) Biochemistry Sensitivity and Specificity Statistics Nonparametric Diagnosis Differential Cushing syndrome Endocrinology Internal medicine medicine Humans Deamino Arginine Vasopressin Prospective Studies Desmopressin Prospective cohort study Pituitary ACTH Hypersecretion Cushing Syndrome Retrospective Studies Analysis of Variance business.industry Biochemistry (medical) Retrospective cohort study Cushing's disease medicine.disease ROC Curve Area Under Curve Female Analysis of variance Differential diagnosis business hormones hormone substitutes and hormone antagonists medicine.drug |
| Zdroj: | The Journal of clinical endocrinology and metabolism. 95(3) |
| ISSN: | 1945-7197 |
| Popis: | The desmopressin (DDAVP) test has been proposed to discriminate Cushing's disease (CD) from pseudo-Cushing states (PC); however, current information on its value is scarce and contradictory.The aim of the study was to assess the ability of the DDAVP test in distinguishing between these conditions, with emphasis on subjects with mild hypercortisolism.We conducted a retrospective/prospective study at the Division of Endocrinology, Polytechnic University of Marche, Ancona, Italy.The study included 52 subjects with CD, 28 with PC, and 31 control subjects (CT).We performed the DDAVP test and standard diagnostic procedures for the diagnosis of Cushing's syndrome.The diagnosis/exclusion of CD was measured.Interpretation of the DDAVP test based on percentage and absolute increment of cortisol and ACTH did not afford acceptable values of both sensitivity (SE) and specificity (SP). CD diagnosis based on simultaneous positivity for basal serum cortisol greater than 331 nmol/liter and absolute ACTH increment greater than 4 pmol/liter and its exclusion in subjects negative for one or both measures yielded an SE of 90.3% and an SP of 91.5%. The approach was also highly effective in distinguishing PC from: 1) CD with moderate values of urinary free cortisol (SE, 86.9%; SP, 92.8%); 2) CD with moderate values of serum cortisol after dexamethasone suppression (SE, 86.6%; SP, 92.8%); and 3) CD with moderate values of midnight serum cortisol (SE, 100%; SP, 92.8%).Interpretation of the DDAVP test through a combination of parameters allowed effective discrimination of CD from PC, even in subjects with mild hypercortisolism. |
| Databáze: | OpenAIRE |
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