Utility of the desmopressin test in diagnosing silent corticotroph adenomas

Abstract Purpose: Silent corticotroph adenomas (SCAs) are difficult to diagnose in patients with non-functioning pituitary adenomas (NFPAs). This study investigated the diagnostic performance of the desmopressin test (DT) for SCA in patients with NFPAs.Methods: This prospective study was conducted at a single referral center. 37 patients with NFPAs were recruited, including 13 patients with SCA and 24 without SCA. All patients underwent corticotropin-releasing hormone (CRH) testing and preoperative DT. Early postoperative CRH tests and DT were performed in patients with SCA. Radiological and endocrinological characteristics, surgical outcomes, and results of the CRH test and DT were compared between the SCA and non-SCA groups.Results: Preoperative DT showed a higher absolute adrenocorticotropic hormone (ACTH) increment (ΔACTH), absolute cortisol increment (ΔCort), percentage ACTH change (% ΔACTH), and percentage absolute cortisol change (% ΔCort) in patients with SCAs than in those without SCAs. ΔACTH greater than 9.9 pg/mL led to 100% sensitivity and 92% specificity. Total resection was achieved in 31% (4/13) of patients with SCA. When postoperative DT data were compared according to SCA remnant status, ΔACTH ≧ 5.2 pg/mL showed 100% sensitivity and 75% specificity with an accuracy rate of 91%.Conclusion: DT can be used to diagnose and detect tumor remnants in patients with SCA.