Caution during use of DDAVP in IPSS

Francesca Pecori Giraldi, Medical Researcher,
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October 15, 2012

Dear Sir, we have read with great interest the paper by Deipolyi and co-workers on the use of desmopressin during inferior petrosal sinus sampling (IPSS) in alternative to corticotropin-releasing hormone (CRH) for the diagnostic work-up of Cushing's disease (1). As the Authors report, evidence collected in small series suggests that desmopressin achieves an equivalent diagnostic accuracy to CRH, thus appears a tempting and less expensive alternative. It is worth recalling, however, that desmopressin is also a potent haemostatic agent and that patients with Cushing's syndrome are at increased risk for thromboembolic events (2), some even occuring during IPSS performed at expert centers (3). In this context, we have recently observed that endothelial factors are released upon administration of desmopressin to patients with Cushing's disease (4), although the dose used for diagnostic purposes is roughly half the haemostatic dosage. The magnitude of the increase in von Willebrand factor, a promoter of platelet adhesion to the subendothelium in the early phases of haemostasis, was comparable to the one observed in healthy subjects and possibly counterbalanced by increased fibrinolytic factors but to what extent these changes might affect general haemostatic processes remains to be ascertained. As a consequence, as long as no further evidence is available on the safety of this haemostatic agent during endovascular damages, procedures which are per se at risk for vascular events, extreme caution should be exercised when using desmopressin instead of CRH during IPSS.

References 1. Deipolyi AR, Hirsch JA, Oklu R. Bilateral inferior petrosal sinus sampling with desmopressin. J.Neurointervent.Surg. 2012;doi10.1136/neurointsurg-2012-010437. 2. Stuijver DJF, van Zaane B, Feelders RA, Debeij J, Cannegieter SC, Hermus AR et al. Incidence of venous thromboembolism in patients with Cushing's syndrome: a multicenter cohort study. J.Clin.Endocrinol.Metab. 2011;96:3525-32. 3. Doppman JL. There is no simple answer to a rare complicaton of inferior petrosal sinus sampling. Am.J.Neuroradiology 1999;20:191-2. 4. Pecori Giraldi F, Ambrogio AG, Fatti LM, Rubini V, Cozzi G, Scacchi M et al. Von Willebrand factor and fibrinolytic parameters during the desmopressin test in patients with Cushing's disease. Br.J.Pharmacol. 2011;71:132-6.

Conflict of Interest:

None declared

Conflict of Interest

None declared