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Vasopressin and desmopressin stimulation test

Author
André Lacroix, MD
Section Editor
Lynnette K Nieman, MD
Deputy Editor
Kathryn A Martin, MD

INTRODUCTION

Arginine-vasopressin (AVP) is the natural human nonapeptide which, in addition to its antidiuretic, vasoconstrictive, glycogenolytic and platelet aggregation actions, plays an important role in the regulation of the corticotropin (ACTH)-adrenal axis. AVP and some of its analogs such as porcine 8-lysine-vasopressin (LVP), terlipressin (triglycyl-lysine-vasopressin), and desmopressin (1-deamino, 8-D arginine-vasopressin) have been utilized to assess this axis for different purposes including to:

Test pituitary ACTH secretion (AVP, LVP)

Evaluate the cause or cure (remission) of ACTH-dependent Cushing's syndrome (desmopressin)

Stimulate ACTH secretion during petrosal sinus sampling (desmopressin alone or in combination with corticotropin-releasing hormone [CRH])

Distinguish between Cushing’s syndrome and pseudo-Cushing’s (CRH versus desmopressin tests)

             

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Literature review current through: Nov 2016. | This topic last updated: Thu Dec 12 00:00:00 GMT+00:00 2013.
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References
Top
  1. Zimmerman EA, Nilaver G, Hou-Yu A, Silverman AJ. Vasopressinergic and oxytocinergic pathways in the central nervous system. Fed Proc 1984; 43:91.
  2. Sugimoto T, Saito M, Mochizuki S, et al. Molecular cloning and functional expression of a cDNA encoding the human V1b vasopressin receptor. J Biol Chem 1994; 269:27088.
  3. Perraudin V, Delarue C, Lefebvre H, et al. Vasopressin stimulates cortisol secretion from human adrenocortical tissue through activation of V1 receptors. J Clin Endocrinol Metab 1993; 76:1522.
  4. Gallo-Payet N, Guillon G. Regulation of adrenocortical function by vasopressin. Horm Metab Res 1998; 30:360.
  5. Raff H. Glucocorticoid inhibition of neurohypophysial vasopressin secretion. Am J Physiol 1987; 252:R635.
  6. Zimmerman EA, Ma LY, Nilaver G. Anatomical basis of thirst and vasopressin secretion. Kidney Int Suppl 1987; 21:S14.
  7. Deen PM, Verdijk MA, Knoers NV, et al. Requirement of human renal water channel aquaporin-2 for vasopressin-dependent concentration of urine. Science 1994; 264:92.
  8. Bichet DG, Razi M, Lonergan M, et al. Hemodynamic and coagulation responses to 1-desamino[8-D-arginine] vasopressin in patients with congenital nephrogenic diabetes insipidus. N Engl J Med 1988; 318:881.
  9. Thibonnier M, Auzan C, Madhun Z, et al. Molecular cloning, sequencing, and functional expression of a cDNA encoding the human V1a vasopressin receptor. J Biol Chem 1994; 269:3304.
  10. de Keyzer Y, Auzan C, Lenne F, et al. Cloning and characterization of the human V3 pituitary vasopressin receptor. FEBS Lett 1994; 356:215.
  11. Birnbaumer M, Seibold A, Gilbert S, et al. Molecular cloning of the receptor for human antidiuretic hormone. Nature 1992; 357:333.
  12. Lolait SJ, O'Carroll AM, McBride OW, et al. Cloning and characterization of a vasopressin V2 receptor and possible link to nephrogenic diabetes insipidus. Nature 1992; 357:336.
  13. Tucci JR, Espiner EA, Jagger PI, et al. Vasopressin in the evaluation of pituitary-adrenal function. Ann Intern Med 1968; 69:191.
  14. Raux MC, Binoux M, Luton JP, et al. Studies of ACTH secretion control in 116 cases of Cushing's syndrome. J Clin Endocrinol Metab 1975; 40:186.
  15. Reznik Y, Lefebvre H, Rohmer V, et al. Aberrant adrenal sensitivity to multiple ligands in unilateral incidentaloma with subclinical autonomous cortisol hypersecretion: a prospective clinical study. Clin Endocrinol (Oxf) 2004; 61:311.
  16. Malerbi DA, Mendonça BB, Liberman B, et al. The desmopressin stimulation test in the differential diagnosis of Cushing's syndrome. Clin Endocrinol (Oxf) 1993; 38:463.
  17. Scott LV, Medbak S, Dinan TG. ACTH and cortisol release following intravenous desmopressin: a dose-response study. Clin Endocrinol (Oxf) 1999; 51:653.
  18. Hensen J, Hader O, Bähr V, Oelkers W. Effects of incremental infusions of arginine vasopressin on adrenocorticotropin and cortisol secretion in man. J Clin Endocrinol Metab 1988; 66:668.
  19. Tabarin A, San Galli F, Dezou S, et al. The corticotropin-releasing factor test in the differential diagnosis of Cushing's syndrome: a comparison with the lysine-vasopressin test. Acta Endocrinol (Copenh) 1990; 123:331.
  20. Malay MB, Ashton JL, Dahl K, et al. Heterogeneity of the vasoconstrictor effect of vasopressin in septic shock. Crit Care Med 2004; 32:1327.
  21. Leather HA, Segers P, Berends N, et al. Effects of vasopressin on right ventricular function in an experimental model of acute pulmonary hypertension. Crit Care Med 2002; 30:2548.
  22. Kahn JM, Kress JP, Hall JB. Skin necrosis after extravasation of low-dose vasopressin administered for septic shock. Crit Care Med 2002; 30:1899.
  23. Nieman LK, Oldfield EH, Wesley R, et al. A simplified morning ovine corticotropin-releasing hormone stimulation test for the differential diagnosis of adrenocorticotropin-dependent Cushing's syndrome. J Clin Endocrinol Metab 1993; 77:1308.
  24. Arai K, Takebe K. Corticotropin response to combined administration of human corticotropin-releasing hormone and small-dose arginine vasopressin in normal subjects. Metabolism 1991; 40:1088.
  25. Favrod-Coune C, Raux-Demay MC, Proeschel MF, et al. Potentiation of the classic ovine corticotrophin releasing hormone stimulation test by the combined administration of small doses of lysine vasopressin. Clin Endocrinol (Oxf) 1993; 38:405.
  26. Michelson D, Galliven E, Hill L, et al. Chronic imipramine is associated with diminished hypothalamic-pituitary-adrenal axis responsivity in healthy humans. J Clin Endocrinol Metab 1997; 82:2601.
  27. Rado JP, Juhos E. Effect of 1-deamino-5-D-arginine vasopressin (DDAVP) on plasma cortisol (hydrocortisone). J Clin Pharmacol 1976; 16:333.
  28. Webb-Peploe MM, Spathis GS, Reed PI. Cushing's syndrome: use of lysine vasopressin to distinguish overproduction of corticotrophin by pituitary from other causes of adrenal cortical hyperfunction. Lancet 1967; 1:195.
  29. Coslovsky R, Wajchenberg BL, Nogueira O. Hyperresponsiveness to lysine-vasopressin in Cushing's disease. Acta Endocrinol (Copenh) 1974; 75:125.
  30. Krieger DT, Luria M. Plasma ACTH and cortisol responses to TRF, vasopressin or hypoglycemia in cushing's disease and nelson's syndrome. J Clin Endocrinol Metab 1977; 44:361.
  31. Catania A, Cantalamessa L, Orsatti A, et al. Plasma ACTH-response to the corticotropin releasing factor in patients with Cushing's disease. Comparison with the lysine-vasopressin test. Metabolism 1984; 33:478.
  32. Gaillard RC, Riondel AM, Ling N, Muller AF. Corticotropin releasing factor activity of CRF 41 in normal man is potentiated by angiotensin II and vasopressin but not by desmopressin. Life Sci 1988; 43:1935.
  33. Scott LV, Medbak S, Dinan TG. Desmopressin augments pituitary-adrenal responsivity to corticotropin-releasing hormone in subjects with chronic fatigue syndrome and in healthy volunteers. Biol Psychiatry 1999; 45:1447.
  34. Colombo P, Passini E, Re T, et al. Effect of desmopressin on ACTH and cortisol secretion in states of ACTH excess. Clin Endocrinol (Oxf) 1997; 46:661.
  35. Terzolo M, Reimondo G, Alì A, et al. The limited value of the desmopressin test in the diagnostic approach to Cushing's syndrome. Clin Endocrinol (Oxf) 2001; 54:609.
  36. Tsagarakis S, Tsigos C, Vasiliou V, et al. The desmopressin and combined CRH-desmopressin tests in the differential diagnosis of ACTH-dependent Cushing's syndrome: constraints imposed by the expression of V2 vasopressin receptors in tumors with ectopic ACTH secretion. J Clin Endocrinol Metab 2002; 87:1646.
  37. Malerbi DA, Fragoso MC, Vieira Filho AH, et al. Cortisol and adrenocorticotropin response to desmopressin in women with Cushing's disease compared with depressive illness. J Clin Endocrinol Metab 1996; 81:2233.
  38. Losa M, Mortini P, Dylgjeri S, et al. Desmopressin stimulation test before and after pituitary surgery in patients with Cushing's disease. Clin Endocrinol (Oxf) 2001; 55:61.
  39. Moro M, Putignano P, Losa M, et al. The desmopressin test in the differential diagnosis between Cushing's disease and pseudo-Cushing states. J Clin Endocrinol Metab 2000; 85:3569.
  40. Sakai Y, Horiba N, Tozawa F, et al. Desmopressin stimulation test for diagnosis of ACTH-dependent Cushing's syndrome. Endocr J 1997; 44:687.
  41. Tsagarakis S, Vasiliou V, Kokkoris P, et al. Assessment of cortisol and ACTH responses to the desmopressin test in patients with Cushing's syndrome and simple obesity. Clin Endocrinol (Oxf) 1999; 51:473.
  42. Newell-Price J, Perry L, Medbak S, et al. A combined test using desmopressin and corticotropin-releasing hormone in the differential diagnosis of Cushing's syndrome. J Clin Endocrinol Metab 1997; 82:176.
  43. Dahia PL, Ahmed-Shuaib A, Jacobs RA, et al. Vasopressin receptor expression and mutation analysis in corticotropin-secreting tumors. J Clin Endocrinol Metab 1996; 81:1768.
  44. Arlt W, Dahia PL, Callies F, et al. Ectopic ACTH production by a bronchial carcinoid tumour responsive to desmopressin in vivo and in vitro. Clin Endocrinol (Oxf) 1997; 47:623.
  45. Antoni FA. Novel ligand specificity of pituitary vasopressin receptors in the rat. Neuroendocrinology 1984; 39:186.
  46. Arnaldi G, de Keyzer Y, Gasc JM, et al. Vasopressin receptors modulate the pharmacological phenotypes of Cushing's syndrome. Endocr Res 1998; 24:807.
  47. Wang FF, Tang KT, Yen YS, et al. Plasma corticotrophin response to desmopressin in patients with Cushing's disease correlates with the expression of vasopressin receptor 2, but not with that of vasopressin receptor 1 or 3, in their pituitary tumours. Clin Endocrinol (Oxf) 2012; 76:253.
  48. Pecori Giraldi F, Marini E, Torchiana E, et al. Corticotrophin-releasing activity of desmopressin in Cushing's disease: lack of correlation between in vivo and in vitro responsiveness. J Endocrinol 2003; 177:373.
  49. Coiro V, Volpi R, Capretti L, et al. Desmopressin and hexarelin tests in alcohol-induced pseudo-Cushing's syndrome. J Intern Med 2000; 247:667.
  50. Pecori Giraldi F, Pivonello R, Ambrogio AG, et al. The dexamethasone-suppressed corticotropin-releasing hormone stimulation test and the desmopressin test to distinguish Cushing's syndrome from pseudo-Cushing's states. Clin Endocrinol (Oxf) 2007; 66:251.
  51. Tirabassi G, Papa R, Faloia E, et al. Corticotrophin-releasing hormone and desmopressin tests in the differential diagnosis between Cushing's disease and pseudo-Cushing state: a comparative study. Clin Endocrinol (Oxf) 2011; 75:666.
  52. Colombo P, Dall'Asta C, Barbetta L, et al. Usefulness of the desmopressin test in the postoperative evaluation of patients with Cushing's disease. Eur J Endocrinol 2000; 143:227.
  53. Dall'asta C, Barbetta L, Bonavina L, et al. Recurrence of Cushing's disease preceded by the reappearance of ACTH and cortisol responses to desmopressin test. Pituitary 2004; 7:183.
  54. Valéro R, Vallette-Kasic S, Conte-Devolx B, et al. The desmopressin test as a predictive factor of outcome after pituitary surgery for Cushing's disease. Eur J Endocrinol 2004; 151:727.
  55. Romanholi DJ, Machado MC, Pereira CC, et al. Role for postoperative cortisol response to desmopressin in predicting the risk for recurrent Cushing's disease. Clin Endocrinol (Oxf) 2008; 69:117.
  56. Castinetti F, Martinie M, Morange I, et al. A combined dexamethasone desmopressin test as an early marker of postsurgical recurrence in Cushing's disease. J Clin Endocrinol Metab 2009; 94:1897.
  57. Dickstein G, DeBold CR, Gaitan D, et al. Plasma corticotropin and cortisol responses to ovine corticotropin-releasing hormone (CRH), arginine vasopressin (AVP), CRH plus AVP, and CRH plus metyrapone in patients with Cushing's disease. J Clin Endocrinol Metab 1996; 81:2934.
  58. Tsagarakis S, Kaskarelis IS, Kokkoris P, et al. The application of a combined stimulation with CRH and desmopressin during bilateral inferior petrosal sinus sampling in patients with Cushing's syndrome. Clin Endocrinol (Oxf) 2000; 52:355.
  59. Pasquali R, Gagliardi L, Vicennati V, et al. ACTH and cortisol response to combined corticotropin releasing hormone-arginine vasopressin stimulation in obese males and its relationship to body weight, fat distribution and parameters of the metabolic syndrome. Int J Obes Relat Metab Disord 1999; 23:419.
  60. Kaltsas GA, Giannulis MG, Newell-Price JD, et al. A critical analysis of the value of simultaneous inferior petrosal sinus sampling in Cushing's disease and the occult ectopic adrenocorticotropin syndrome. J Clin Endocrinol Metab 1999; 84:487.
  61. Booth GL, Redelmeier DA, Grosman H, et al. Improved diagnostic accuracy of inferior petrosal sinus sampling over imaging for localizing pituitary pathology in patients with Cushing's disease. J Clin Endocrinol Metab 1998; 83:2291.
  62. Machado MC, de Sa SV, Domenice S, et al. The role of desmopressin in bilateral and simultaneous inferior petrosal sinus sampling for differential diagnosis of ACTH-dependent Cushing's syndrome. Clin Endocrinol (Oxf) 2007; 66:136.
  63. Tsagarakis S, Vassiliadi D, Kaskarelis IS, et al. The application of the combined corticotropin-releasing hormone plus desmopressin stimulation during petrosal sinus sampling is both sensitive and specific in differentiating patients with Cushing's disease from patients with the occult ectopic adrenocorticotropin syndrome. J Clin Endocrinol Metab 2007; 92:2080.
  64. Findling JW, Raff H. Newer diagnostic techniques and problems in Cushing's disease. Endocrinol Metab Clin North Am 1999; 28:191.
  65. Lacroix A, Ndiaye N, Tremblay J, Hamet P. Ectopic and abnormal hormone receptors in adrenal Cushing's syndrome. Endocr Rev 2001; 22:75.
  66. Mune T, Murase H, Yamakita N, et al. Eutopic overexpression of vasopressin v1a receptor in adrenocorticotropin-independent macronodular adrenal hyperplasia. J Clin Endocrinol Metab 2002; 87:5706.
  67. Lee S, Hwang R, Lee J, et al. Ectopic expression of vasopressin V1b and V2 receptors in the adrenal glands of familial ACTH-independent macronodular adrenal hyperplasia. Clin Endocrinol (Oxf) 2005; 63:625.
  68. Vezzosi D, Cartier D, Régnier C, et al. Familial adrenocorticotropin-independent macronodular adrenal hyperplasia with aberrant serotonin and vasopressin adrenal receptors. Eur J Endocrinol 2007; 156:21.
  69. Bourdeau I, D'Amour P, Hamet P, et al. Aberrant membrane hormone receptors in incidentally discovered bilateral macronodular adrenal hyperplasia with subclinical Cushing's syndrome. J Clin Endocrinol Metab 2001; 86:5534.
  70. Tatsuno I, Uchida D, Tanaka T, et al. Vasopressin responsiveness of subclinical Cushing's syndrome due to ACTH-independent macronodular adrenocortical hyperplasia. Clin Endocrinol (Oxf) 2004; 60:192.
  71. Joubert M, Louiset E, Rego JL, et al. Aberrant adrenal sensitivity to vasopressin in adrenal tumours associated with subclinical or overt autonomous hypercortisolism: is this explained by an overexpression of vasopressin receptors? Clin Endocrinol (Oxf) 2008; 68:692.
  72. Gagliardi L, Hotu C, Casey G, et al. Familial vasopressin-sensitive ACTH-independent macronodular adrenal hyperplasia (VPs-AIMAH): clinical studies of three kindreds. Clin Endocrinol (Oxf) 2009; 70:883.
  73. Lampron A, Bourdeau I, Oble S, et al. Regulation of aldosterone secretion by several aberrant receptors including for glucose-dependent insulinotropic peptide in a patient with an aldosteronoma. J Clin Endocrinol Metab 2009; 94:750.
  74. Zwermann O, Suttmann Y, Bidlingmaier M, et al. Screening for membrane hormone receptor expression in primary aldosteronism. Eur J Endocrinol 2009; 160:443.