A Multicenter Comparison of CRH versus DDAVP Stimulation Responses in Inferior Petrosal Sinus Sampling for Cushing’s Disease

Michael Karsy; Julie Silverstein; Albert Kim; James Evans; Sarah Collopy; Robert Rennert; William Couldwell; Garni Barkhoudarian; Dan Kelly; Juan Fernandez-Miranda; Donato Pacione; Won Kim; Marvin Bergsneider; Michael Chicoine; Gabriel Zada; Varun Kshettry; Kyle Wu; Carolina Benjamin; Jamie Van Gompel; Michael Catalino; Adam Mamelak; Nathan Zwagerman; Andrew Little; Kevin Yuen; Ildiko ITorok; Paul Gardner

doi:10.1055/s-0045-1803037

Journal of Neurological Surgery Part B: Skull Base, Inhaltsverzeichnis

J Neurol Surg B Skull Base 2025; 86(S 01): S1-S576
DOI: 10.1055/s-0045-1803037

Presentation Abstracts

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Oral Presentations

A Multicenter Comparison of CRH versus DDAVP Stimulation Responses in Inferior Petrosal Sinus Sampling for Cushing’s Disease

Authors

Michael Karsy

¹Drexel University College of Medicine, Philadelphia, Pennsylvania, United Sates
Julie Silverstein

²Washington University School of Medicine, United Sates
Albert Kim

²Washington University School of Medicine, United Sates
James Evans

³Jefferson University, Philadelphia, Pennsylvania, United States
Sarah Collopy

³Jefferson University, Philadelphia, Pennsylvania, United States
Robert Rennert

⁴University of Utah, Salt Lake City, Utah, United States
William Couldwell

⁴University of Utah, Salt Lake City, Utah, United States
Garni Barkhoudarian

⁵Pacific Neuroscience Institute, Santa Monica, California, United States
Dan Kelly

⁵Pacific Neuroscience Institute, Santa Monica, California, United States
Juan Fernandez-Miranda

⁶Stanford University, Stanford, California, United States
Donato Pacione

⁷New York University, New York, New York, United States
Won Kim

⁸University of California, Los Angeles, United States
Marvin Bergsneider

⁸University of California, Los Angeles, United States
Michael Chicoine

⁹University of Missouri, Columbia, Missouri, United States
Gabriel Zada

¹⁰Keck School of Medicine, University of Southern California, Los Angeles, California, United States
Varun Kshettry

¹¹Cleveland Clinic Foundation, Cleveland, Ohio, United Sates
Kyle Wu

¹²Ohio State College of Medicine, Ohio State University, Columbus, Ohio, United States
Carolina Benjamin

¹³Miller School of Medicine, University of Miami, Coral Gables, Florida, United States
Jamie Van Gompel

¹⁴Mayo Clinic
Michael Catalino

¹⁵University of Virginia, Charlottesville, Virginia, United States
Adam Mamelak

¹⁶Cedars-Sinai Medical Center, Los Angeles, California, United Kingdom
Nathan Zwagerman

¹⁷Medical College of Wisconsin, Milwaukee, Wisconsin, United States
Andrew Little

¹⁸Barrow Neurological Institute, Phoenix, Arizona, United Sates
Kevin Yuen

¹⁸Barrow Neurological Institute, Phoenix, Arizona, United Sates
Ildiko ITorok

¹⁸Barrow Neurological Institute, Phoenix, Arizona, United Sates
Paul Gardner

¹⁹University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

Abstract

Volltext

Introduction: Inferior petrosal sinus sampling (IPSS) is an important method for confirming a central source of hypercortisolism and diagnosis of Cushing’s disease (CD). IPSS can be especially helpful in MRI-negative disease or unclear sources of adrenocorticotropin hormone (ACTH). Recently, centers are stimulating with desmopressin/DDAVP instead of corticotropin-releasing hormone (CRH) due to reagent availability. To study the potential clinical implications of this change, we compared the stimulation profiles of DDAVP and CRH in the multicenter Registry of Adenomas of the PItuitary and Related Disorders (RAPID).

Methods: Patients who underwent IPSS for management of CD were included. A descriptive analysis of surgical characteristics and laboratory values as well as stimulation protocols and response were performed. Changes in ACTH level on the IPSS localized and nonlocalized sides were compared after DDAVP or CRH stimulation. ACTH levels were normalized to peripheral levels.

Results: Out of 780 patients, 108 patients with CD underwent IPSS testing. Among patients with IPSS, 93/108 (86.11%) demonstrated positive pathology or long-term hormonal remission. Stimulation agents included DDAVP (n = 57), CRH (n = 36) or both (n = 1). No differences in demographic, surgical, or pathology characteristics were seen between DDAVP or CRH patients (p > 0.05). Long-term remission was similar for treated patients after DDAVP versus CRH stimulation (66.7 vs. 74.1%; p = 0.05) workup with a mean follow-up of 28.8 ± 25.2 and 24.9 ± 24.7 months. Peak ACTH levels of 44.7 ± 73.1 and 57.1 ± 70.0 pg/mL at 5 minutes (p = 0.4) corresponded to a 2.7× increase in ACTH for both DDAVP vs. CRH paradigms. CRH stimulation peaked earlier than DDAVP, showing a 6.2× increase in ACTH at 2 minutes, compared to 2.0× for DDAVP.

Discussion: CRH stimulation showed a more robust stimulation response than DDAVP for localizing ACTH levels during IPSS at 2 minutes but both agents showed efficacy at 5 minutes. Given the limited availability of CRH, elevations of ACTH of 2.0 to 2.7× after DDAVP stimulation at 2 to 5 minutes may help identify ACTH lateralization thresholds for DDAVP.

Fig. 1 Normalized ACTH levels for DDAVP vs. CRH stimulation during IPSS for localized sides.

Fig. 2 Comparison of normalized ACTH after DDAVP or CRH stimulation.

Abbildungen

Fig. 1 Normalized ACTH levels for DDAVP vs. CRH stimulation during IPSS for localized sides.

Fig. 2 Comparison of normalized ACTH after DDAVP or CRH stimulation.