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Diagnostic Accuracy of the Desmopressin Stimulation Test in the Comprehensive Assessment of Acth-Dependent Cushing’S Syndrome: A Comparative Analysis With Bipss and Tss Publisher Pubmed



Valizadeh M1 ; Rahmani F2 ; Nikoohemmat M1 ; Ramezani Ahmadi A3 ; Hosseinpanah F1 ; Niroomand M4 ; Khameneh Bagheri A5 ; Grossman A6, 7, 8 ; Abiri B1
Authors
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Authors Affiliations
  1. 1. Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  2. 2. Clinical Research and Development Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  3. 3. Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
  4. 4. Endocrinology Division, Department of Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  5. 5. Shohada Tajrish Hospital, Shahid Beheshti University of Medical sciences, Tehran, Iran
  6. 6. Centre for Endocrinology, Barts and The London School of Medicine, London, United Kingdom
  7. 7. ENETS Centre of Excellence, Royal Free Hospital, London, United Kingdom
  8. 8. Green Templeton College, University of Oxford, Oxford, United Kingdom

Source: Endocrine Research Published:2024


Abstract

Background: Cushing’s syndrome (CS) poses diagnostic challenges, particularly in distinguishing pituitary-dependent Cushing’s syndrome, Cushing’s disease (CD), from the ectopic ACTH syndrome (EAS). This study evaluated the diagnostic value of the desmopressin stimulation test (DST) in patients with ACTH-dependent CS in helping this discrimination. Methods: Twenty-three ACTH-dependent CS patients underwent sequential DST, bilateral inferior petrosal sinus sampling (BIPSS), and transsphenoidal surgery (TSS). Two definitions of a positive DST results were applied. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios. To avoid bias from predetermined criteria, we generated univariate receiver-operating characteristic (ROC) curves, plotting sensitivity against 1-specificity at various percentage cortisol and ACTH response levels. Results: Against BIPSS, DST demonstrated robust sensitivity (Definition 1: 90.0%, Definition 2: 76.2%) and overall accuracy (Definition 1: 87.0%, Definition 2: 73.9%). PPV was high (Definition 1: 95.0%, Definition 2: 94.1%), but NPV indicated potential false negatives. Compared to TSS, DST showed good sensitivity (Definition 1: 90.9–77.3%) and PPV (100.0%) but limited NPV (16.7%). The likelihood ratios emphasized the diagnostic value of the test. Notably, against TSS, DST showed perfect discriminatory power (AUC 1.000 for percent ACTH, 0.983 for percent cortisol). Conclusion: The desmopressin test shows promise in accurately identifying the underlying cause of ACTH-dependent CS, potentially reducing the reliance on invasive procedures and providing a practical solution for managing complex cases. Further research with larger cohorts is required to validate the utility of the DST in routine clinical practice. © 2024 Taylor & Francis Group, LLC.
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