Persistent adrenocorticotropin response to desmopressin in the early postoperative period predicts recurrence of Cushing's disease

J Clin Endocrinol Metab. 2009 Sep;94(9):3322-8. doi: 10.1210/jc.2009-0844. Epub 2009 Jul 7.


Context: Patients with Cushing's disease (CD) often show an ACTH and cortisol response to desmopressin (DDAVP).

Objective: We tested whether persistence of a positive response to DDAVP after successful surgery identifies patients at risk of CD recurrence.

Design: We prospectively included all CD patients who had a positive response to DDAVP before successful surgery from 1995 through 2007.

Setting: The study was performed at a university hospital.

Patients: One hundred seventy-four patients with CD, 148 women and 26 men, mean age 36.1 +/- 0.8 yr, were studied. The median follow-up after surgery was 58 months (interquartile range 22-93 months).

Intervention: DDAVP test was performed immediately before and after surgery.

Main outcome measure: An ACTH and cortisol increment of at least 30 and 20% above baseline, respectively, were considered as a positive response to DDAVP. The risk of CD recurrence was analyzed according to the postoperative hormonal response to DDAVP.

Results: Recurrence of CD occurred in 19 patients (10.9%). The recurrence-free survival at 5 yr was 89.8% [95% confidence interval (CI) 84.2-95.4]. Patients with a positive ACTH response had a 5-yr recurrence-free survival of 82.6% (95% CI 70.6-94.6%) as compared with 94.0% (95% CI 88.2-99.8%; P < 0.01) in patients without it. Multivariate analysis showed that persistence of a positive ACTH response to DDAVP was significantly associated with CD recurrence.

Conclusion: Positive ACTH response to DDAVP after surgery is associated with an increased risk of CD recurrence. However, the specificity and predictive value of this finding are low.

MeSH terms

  • Adrenocorticotropic Hormone / blood*
  • Adult
  • Deamino Arginine Vasopressin / pharmacology*
  • Female
  • Humans
  • Hydrocortisone / blood
  • Male
  • Pituitary ACTH Hypersecretion / blood
  • Pituitary ACTH Hypersecretion / etiology*
  • Pituitary ACTH Hypersecretion / mortality
  • Pituitary ACTH Hypersecretion / surgery
  • Postoperative Period
  • Prospective Studies
  • Recurrence


  • Adrenocorticotropic Hormone
  • Deamino Arginine Vasopressin
  • Hydrocortisone