Endocrine Abstracts

Hypercorticism is a syndrome caused by extended and very high exposure of glucocorticoids to the body. ACTH-dependent Cushing’s syndrome develops as a result of the overproduction of adrenocorticotropic hormone by the pituitary adenoma. The main treatment for ACTH-dependent Cushing’s is transnasal transsphenoidal removal of the pituitary adenoma. A the same time, the recurrence rate of Cushing syndrome is observed up to 3% during the year and up to 3% –22% of cases within 3 years. The test with the introduction of desmopressin(TD) after surgery along with other samples to determine the presence of residual neoplastic corticotrophs, that is, an increased risk of reccurence.

Objective: to analyze the prognostic value of aTD to assess the effectiveness of TSS in patients with ACTH-dependent CS in the postoperative period

Material and Methods: 42 patients with ACTH-dependent Cushing’s syndrome were examined, operated on in the neurosurgery departments of the RSSPMCE from 2000 to 2019. Patients were divided into 2 groups: 1 gr had cortisol levels ≤ 138 nmol/l (18patients), and group 2 (24 patients) had cortisol levels ≥ 138 nmol/l in the first 1–3 days after transsphenoidal pituitary adenomectomy (TSS). The control group consisted of 20 healthy individuals of a similar age. The research methods were general clinical, instrumental,hormonal, functional test with desmopressin and statistical methods

Results: It was found that in the group of patients in remission, in 3 patients ACTH levels during desmopressin test increased significantly (on average 14.02 ± 2.06 ng/dl), leading to a corresponding increase in the level cortisol (average 280.02 ± 12 nmol/l) in the blood. Moreover, the peak of ACTH secretion was accounted for and held equally high at 301 and 601. As the test results show, the averaged ACTH and cortisol indicators in group I differed from the control group, although not significantly (P > 0.05). While, a significant reaction was noted in response to desmopressin, which increased 4 times more than in the control group. In the second group, 6 patients out of 24 of patients had a positive reaction to desmopressin, as evidenced by an increase in cortisol levels and which can serve as a negative prognostic marker of the probability of a relapse.

Conclusions: Thus, according to the initial results of our studies, analysis of the results of the desmopressin test in patients withACTH-dependent Cushing’s syndrome showed that desmopressin test is a sensitive tool in determining the reactivity of corticotrophic pituitary cells.