The desmopressin stimulation test in dogs with Cushing's syndrome

Abstract

Desmopressin is a synthetic analogue of the hypothalamic peptide vasopressin and binds to specific pituitary vasopressin (V 3) receptors. The V 3-receptor is overexpressed in pituitary corticotrope tumors and the injection of desmopressin induces a marked ACTH and cortisol release in human patients with pituitary- (PDH), but not adrenal tumor (AT) dependent hyperadrenocorticism. In this prospective study, we investigated the effects of desmopressin on serum cortisol levels in 80 dogs suspected of Cushing's syndrome. The aim was to find a sensitive and specific test to exclude AT. According to standard tests the dogs were divided into 3 groups (group 1 = other disease, n = 27; group 2 = PDH, n = 46; group 3 = AT, n = 7). Desmopressin was injected as an i.v. bolus of 4 μg and serial blood samples were collected before and after 30, 60 and 90 min. Desmopressin significantly stimulated cortisol release in dogs with PDH (median 51%, range −24 to 563%; p < 0.0001), whereas no increase was seen in dogs with AT (median −12%, range −44 to 5%; p = 0.063) and in controls (median +7%, range −36 to 196%; p = 0.131). Using a cut off value of 10% increase over baseline, it was possible to exclude AT in 75% of patients. The results of this study suggest that the desmopressin test could be a useful tool in differentiating pituitary from adrenal dependent Cushing's syndromes. Additional dogs with adrenocortical tumor must be tested in order to recommend its use in clinical practice.