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Master Thesis

La réponse persistante du cortisol au test à la desmopressine prédit la récidive de la maladie de Cushing chez les patients présentant une insuffisance corticotrope post-opératoire

Abstract : Objective: cushing’s disease (CD) may recur despite corticotropic insufficiency (CI) following pituitary surgery. The predictive value of the desmopressin test (DT) for recurrence in this setting remains controversial. We have evaluated whether persistent response to DT predicts recurrence in patients with post-operative CI, in a large cohort using robust reference standards. Design: multicentre retrospective study Methods: 95 patients with CD (women 82%, age 4114 years), responding preoperatively to desmopressin, and with early post-operative CI (8-am cortisol<138 nmol/L), underwent a DT within 3 months post-surgery. Association between DT findings and the prediction of recurrence was tested using regression and ROC analyses. Results: recurrence occurred in 17/95 patients within 29 to 91months. Post-operative cortisol was increased in recurrence versus remission group: 6339 versus 4429 nmol/L, p=0.03. The cortisol peak during DT was greater in the recurrence versus remission group (327, 95% confidence interval [237-417] versus 121 [79-164] nmol/L, p=0.0001). This association persisted after multiple adjustments, without interaction with early post-operative cortisol concentrations. In the context of CI, cortisol peak >100 nmol/l had the best specificity/sensitivity combination, predicting recurrence better than early post-operative 8am cortisol 50 nmol/L: AUC 0.758 (0.657–0.857) versus 0.600 (0.460–0.734), p<0.0001. A cortisol peak>100 nmol/l was associated with 8-fold increased risk of recurrence (odds ratio 8.30 [2.45–38.35], p=0.0004). Conclusion: the cortisol peak during the post-operative DT is independently associated with CD recurrence, and offers an incremental prognostic value, which may help to stratify patients with CI and refine their follow-up according to the risk of recurrence
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https://dumas.ccsd.cnrs.fr/dumas-02492648
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Sophie Cambos. La réponse persistante du cortisol au test à la desmopressine prédit la récidive de la maladie de Cushing chez les patients présentant une insuffisance corticotrope post-opératoire. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02492648⟩

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