Neuroendocrinology and Pituitary

MON-019 - Impact of CRH Shortage on the Work-Up of ACTH-Dependent Cushing'S Syndrome and Usefulness of Desmopressin-Based Diagnostic Tests: Insights from 54 European Expert Centres

Monday, June 15, 2026

9:00 AM - 2:00 PM CT

Location: ENDOExpo; Poster Floor

Co-Author(s)

AC

Annamaria Colao, MD, PhD

Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università Federico II di Napoli, Naples, Italy
Naples, Italy
BA

Barbara Altieri, MD (she/her/hers)

Dept. of Medicine, University Hospital, University of Würzburg, Division of Endocrinology and Diabetes, Würzburg, Germany
Wrzburg, Germany
CS

Carla Scaroni, MD, PhD

Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy
Padova, United States
EV

Elena Valassi, MD, PhD

Endocrinology and Nutrition Department, Germans Trias i Pujol Hospital and Research Institute, Badalona, Spain
Barcelona, Spain
EM

Emese Mezősi, MD, PhD, DSc

Clinical Center, University of Pécs Medical School
Pécs, Hungary
FC

Frederic Castinetti, MD, PhD

Professor (Assistant)
Aix Marseille University
Marseille, France
LS

Leonard Saiegh, MD

Department of Endocrinology, Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
Haifa, Israel
MP

Manel Puig-Domingo, MD, PhD

Department of Endocrinology & Nutrition CIBERER group 747. Germans Trias Research Institute and University Hospital. Universitat Autònoma de Barcelona
Barcelona, Spain

Abstract Poster Presenter(s)

Pedro Marques, MD, PhD (he/him/his)

Endocrinology
Hospital CUF Descobertas
Voorburg, Netherlands

Co-Author(s)

TD

Timo Deutschbein, MD, PhD

Medicover Oldenburg MVZ
Oldenburg, United States

Introduction: The main supplier of corticotropin-releasing hormone (CRH) is no longer manufacturing this drug. The European Society of Endocrinology (ESE) provided recommendations on how to deal with this issue (PMID: 39005054). The diagnostic work-up of adrenocorticotropic hormone (ACTH)-dependent Cushing’s syndrome (CS) is now more reliant on desmopressin. We aimed to evaluate the impact of CRH shortage and usefulness of desmopressin-based alternative diagnostic tests across expert centres in Europe.

Methods: A standardized survey (SurveyMonkey®) with 25 questions was created by an ESE Task Force and sent to European expert pituitary centres. Answers were counted as absolute numbers and percentages.

Results: Forty-four of 54 centres (82%) from 17 countries that answered the survey currently have no CRH. The main CRH utilisation was the diagnostic work-up of ACTH-dependent CS (98%), but CRH was also commonly used to distinguish between CS and pseudo-Cushing states (31%). Top investigations for ACTH-dependent CS before and after CRH shortage were pituitary MRI and IPSS (>90%), and there was an expected drop in the use of CRH stimulation tests across centres from 80% to 8%, while desmopressin test use increased from 25% to 73%. After CRH shortage there was an increased use of whole-body CT scan (from 41% to 49%) and functioning imaging (from 35% to 41%). Based on their experience, 47% of centres consider the desmopressin test performance worse than CRH stimulation test, while 36% consider these similar. Since CRH shortage, 70% of centres are using desmopressin during IPSS (contrasting with 4% before CRH shortage), and 4% stopped performing IPSS because of CRH shortage. Overall, 57% of centres consider CRH shortage has low impact on the ACTH-dependent CS diagnostic work-up, while 28% and 15% of centres describe CRH shortage as having no and high impact, respectively; 85% of centres agreed that a revised CS diagnostic algorithm without CRH is necessary.

Conclusions: CRH is not available in most European centres, which led to a shift towards desmopressin-based diagnostic tests. In general, CRH shortage seems to have low or no impact on ACTH-dependent CS work-up, but it can create additional diagnostic challenges due to the limited experience with desmopressin and need for more expensive and time-consuming alternative investigations. The performance of desmopressin is regarded as inferior to CRH by most centres, perception that may reflect the lack of data and experience with desmopressin. Further studies to assess the desmopressin diagnostic accuracy, and a revised CS diagnostic algorithm without CRH, are needed.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*