Twenty-two children with Cushing's disease were submitted to sequential plasma ACTH assays

Abstract

Most patients were sampled before and after the injection of Lysine-Vasopressin (LVP), 10 IU / 1.73m2. Non treated patients had basal ACTH values within the normal range (< 100 pg/ml). After treatment, in spite of the wide dispersion of the natural course of the disease, the rises in ACTH levels were as follow: ACTH values remained-moderately elvated (<200μg/ml and 300pg/ml respectively before and after LVP )in patients treated with o-p'DDD ( 2-9g/day ) associated ( 3 patients) or not (8 patients) with pituitary cobalt therapy. A relapse was observed in 5 patients of the later group. After bilateral adrenalectomy ( 14 patients ) ACTH rose until much higher values. In this last group were observed 7 out of the 8 cases of confirmed ( 5 ) or suspected ( 3 ) Nelson's syndroms. ACTH values of those patients were as high as 6,000 pg/ml and 25,000'pg/ml respectivly before and after LVP. Important rise in ACTH levels at sequential determinations is thus a strorg argument for the detection of pituirary tumors and appear to be very useful for managenent of treatment and follow-up.