ECEESPE2025 Poster Presentations Pituitary, Neuroendocrinology and Puberty (162 abstracts)
From CRH to the desmopressin era: a comparative study of stimulation tests in cushing’s disease
Ekin Yiğit Köroğlu 1 , Şefika Burçak Polat 2 , Abbas Ali Tam 2 , Ahmet Eren Seçen 3 , Fatma Dilek Dellal Kahramanca 1 , Cevdet Aydin 2 , Oya Topaloglu 2 , Reyhan Ersoy 2 & Bekir Cakir 2
1Ankara Bilkent City Hospital, Endocrinology and Metabolism Diseases, Ankara, Türkiye; 2Ankara Yıldırım Beyazıt University Faculty of Medicine, Endocrinology and Metabolism Diseases, Ankara, Türkiye; 3Ankara Bilkent City Hospital, Neurosurgery, Ankara, Türkiye
JOINT1095
Purpose: CRH-based dynamic tests can be used in the differential diagnosis of ACTH-dependent Cushing’s syndrome(CS) and the differentiation of CS from non-neoplastic hypercortisolism. However, after the worldwide cessation of CRH production as of December 2022, desmopressin-mediated dynamic tests are recommended as an alternative. In this study, we aimed to compare the responses of ACTH-secreting pituitary adenomas to desmopressin and CRH stimuli.
Methods: Patients who underwent a CRH or desmopressin-stimulation test for CS between December 2019 and September 2024 and who were histopathologically diagnosed with CD postoperatively were included in the study. Patients’ age, sex, screening test results for CS, baseline ACTH and cortisol levels, peak ACTH and cortisol levels during the tests, the test minute at which peak values were reached, and the rates of peak increase in ACTH(%ΔACTH) and cortisol(%ΔCort) after stimulation were recorded.
Results: A total of 30 CD patients were included in the study. Of these, 18 had a CRH-stimulation test, and 12 had a desmopressin-stimulation test. 27 patients were female(90%), and three were male(10%). The mean age was 44.70±14.44 years. The results of the patients’ baseline and screening tests for CS are shown in Table 1. The basal and peak ACTH and cortisol levels of the patients during the stimulation tests and the comparison between groups are shown in Table 2. No statistically significant difference was found when comparing the distributions of peak ACTH minutes and peak cortisol minutes of the tests(P = 0.580 and P = 0.518, respectively).
| Test | n | Value |
| ACTH(pg/mL) | 30 | 38.42±30.63 |
| Cortisol(µg/dl) | 30 | 20.60(12.50-28.20) |
| Serum Cortisol after 1 mg DST(µg/dl) | 29 | 14.45±9.67 |
| Serum Cortisol after 2 mg DST(µg/dl) | 29 | 12.14±7.93 |
| 24-hours-urinary free cortisol(µg/day) | 30 | 61.20(6.42-939.00) |
| Late-night salivary cortisol(µg/dl) | 23 | 0.60±0.36 |
| Late-night serum cortisol(µg/dl) | 28 | 16.01±5.12 |
| Parameter | CRH-stimulation | Desmopressin-stimulation | p |
| Basal ACTH pg/mL(n) | 36.13±22.22(18) | 42.15±41.99(11) | 0.617 |
| Basal Cortisol µg/dl(n) | 18.80(12.50-128.20)(18) | 21.10(13.10-24.70)(12) | 0.692 |
| Peak ACTH pg/mL(n) | 159.51±167.73(18) | 103.06±115.20(11) | 0.336 |
| Peak Cortisol µg/dl(n) | 35.05(21.50-43.10)(18) | 30.70(19.90-46.50)(12) | 0.095 |
| %ΔACTH(n) | 340.63±271.44(18) | 159.85±175.28(11) | 0.038 |
| %ΔCort(n) | 77.93±50.29(18) | 43.03±26.12(12) | 0.021 |
Conclusion: CRH and desmopressin stimulate ACTH and subsequent cortisol secretion to different degrees. Diagnostic criteria for CRH stimulation are well established, whereas this experience is not yet available for desmopressin. However, using similar diagnostic criteria for these two tests seems doubtful regarding diagnostic adequacy. To use the desmopressin stimulation test more effectively, prospective studies with large patient groups should be performed.
Volume 110
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Endocrine Abstracts
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