Clinical Characteristics And Intraoperative Application Of Desmopressin Stimulating Test In Patients With Cushing’s Disease

OBJECT:Transsphenoidal adenomectomy is the first choice of treatment for Cushing’s disease.Complete resection of pituitary corticotropin adenoma is the premise to ensure the postoperative remission in patients with Cushing’s disease.This study first described the clinical characteristics of desmopressin stimulating test,a differential diagnostic method of Cushing’s syndrome,in patients with Cushing’s disease.We also applied this test in the operation to explore whether it can predict the total resection and postoperative remission of Cushing’s diseaseMETHOD:Part I:We retrospectively included all 41 patients with Cushing’s disease who were hospitalized in the department of neurosurgery in our hospital from May 2018 to September 2019 and also had undergone desmopressin stimulating test.We analyzed these patients’ basic information and their test results.Part II:We prospectively included all patients with Cushing’s disease who were hospitalized in the department of neurosurgery in our hospital from October 2019 to January 2020.These ten patients underwent transsphenoidal adenomectomy surgery by a single surgical group.All patients underwent preoperative and intraoperative desmopresssin stimulating testRESULTS:Part I:36(87.80%)patients with Cushing’s disease had positive results in desmopressin stimulating test.Patients’ plasma ACTH concentration increased by 299.09%± 482.72%,and their serum cortisol concentration increased by 76.21%± 72.37%.Part Ⅱ:During preoperative assessment,the peripheral serum ACTH increased from 68.54± 34.90 pg/ml to 344.44±394.23 pg/ml after the injection of desmopressin.Nine of the patients reached the positive reaction standard in preoperative desmopressin stimulating tests.All patients reached remission standard after operation.In intraoperative desmopressin stimulating tests,the level of serum corticotropin increased from 137.77 ±153.33 pg/ml to 141.42 ±153.64 pg/ml after the injection of desmopressin.None of the patients had a positive response to desmopressin during the surgery.Compared with the baseline,the peak or nadir of ACTH concentration intraoperative decreased by 401.41%±408.91%as preoperative.CONCLUSION:The positive rate of desmopressin stimulating test in patients with Cushing’s disease is high.The intraoperative desmopressin stimulating test can be used as an effective tool to predict the total resection of pituitary adenoma in Cushing’s disease.