Abstract

Objective: To analyse the utility of a test with desmopressin to assess the effectiveness of transsphenoidal surgery (TSS) in patients with Cushing’s disease (CD) in the post-operative period.

Design: A prospective study of 42 patients with CD operated in 2012 - 2019 was conducted. Patients were divided into 2 groups: I group-18 patients, postoperative basal cortisol ≤ 138 nmol/L, remission group and IIgr-24 patients with cortisol levels ≥ 138 nmol/L, a risk group for recurrence of the disease, although they had clinical and biochemical remission. All patients underwent a standard test with desmopressin (Newell-Price J, 1997) with a cortisol and ACTH level of 0’, 30’, 60’, 90’, 120'.

Results: The use of TD in the studied groups revealed an increased (hyper reaction) in 16.6% of patients of group I of cortisol in 2 times (on average 280.02 ± 12 nmol/L) and ACTH in 1.4 times (average 14.02 ± 2.06 ng/dl) compared with other patients, the results of which were between 30' and 60' achieved to 166.2 ± 34.4 nmol/L and 15.39 ± 3.4, respectively, which is lower than in the healthy control in 3.5 and 1.5 times with levels of 485.9 ± 25 nmol/l and 23.5 ± 1.79 ng/dl. In group II, 25% (6 patients) also had an increased response to TD between 30' and 60', while the average data in this group were significantly higher by 1.5 times and 6.6 times than group I (p < 0.05, p < 0.01) and lower by 2.6 times and 4.3 times higher than in the control (p < 0.001, p < 0.005).

Conclusion: A complete indicators using modern methods of statistical processing gave us to identify TD as the most sensitive test in determining remission and shows the insufficiency of only determining ACTH and cortisol in this.

Keywords: Cushing’s Disease; Surgery; Desmopressin; Relapse

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