Inferior Petrosal Sinus Sampling with DDAVP Stimulation in Adults with Cushing Disease: Coping with a Global CRH Analog Shortage

Introduction: There are various methodologies to diagnose Cushing disease, with the recent gold standard being inferior petrosal sinus sampling (IPSS) after corticotropin-releasing hormone (CRH) analog stimulation. Given recent global supply chain issues, CRH analogs have been widely unavailable in many regions. Desmopressin (DDAVP) is widely available, more cost-effective, and had been proposed previously as an alternative to CRH analogs for IPSS testing purposes. While there is significant literature on the ability of CRH analogs to correctly diagnose Cushing disease and predict tumor lateralization, the literature is lacking in recent descriptions of the similar use of DDAVP. In this study the authors aim to compare the usage of DDAVP to the historical usage of CRH analogs.