A Copeptin-Based Approach in the Diagnosis of Diabetes Insipidus

Fenske, Wiebke; Refardt, Julie; Chifu, Irina; Schnyder, Ingeborg; Winzeler, Bettina; Drummond, Juliana; Ribeiro‐Oliveira, Antônio; Drescher, Tilman; Bilz, Stefan; Vogt, Deborah R; Malzahn, Uwe; Kroiß, Matthias; Christ, Emanuel; Henzen, Christoph; Fischli, Stefan; Tönjes, Anke; Müeller, Beat; Schopohl, Jochen; Flitsch, Jörg; Brabant, Georg; Fassnacht, Martin; Christ‐Crain, Mirjam

doi:10.1056/nejmoa1803760

Cited by 192 publications

(189 citation statements)

References 33 publications

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“…Anyway, it should be considered that all patients classified as permanent forms showed a good hydro-electrolytic balance at the post-discharge revaluation during dDAVP therapy. Moreover, p-CDI presented still a lower median copeptin with respect to non-CDI patients, very close to the copeptin cut-off indicated in literature for CDI diagnosis after an overnight dehydration test [14,15]. About this, it must be underlined that the dDAVP treatment may be able to partially inhibit AVP and copeptin release, thus representing an important potential confounding factor.…”

Section: Discussionsupporting

confidence: 76%

“…Copeptin offers other several advantages compared to AVP, such as reduced pre-analytical variability, a reliable assay for its determination [12], short turnaround time for obtaining results and no significant circadian rhythm [11,13]. In the last years, several authors suggested the evaluation of stimulated copeptin as a new suitable tool in the differential diagnosis of polyuric-polydipsic syndrome [14,15]; further, a recent multicentre study demonstrated that copeptin is a promising predictor of post-surgical CDI [16]. Nevertheless, an important limitation in the cited study was the lack of standardization, which did not allow the authors to identify accurate time points for copeptin determination.…”

Section: Introductionmentioning

confidence: 99%

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Early Copeptin Determination Allows Prompt Diagnosis of Post-Neurosurgical Central Diabetes Insipidus

et al. 2019

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Introduction: Central diabetes insipidus (CDI) is a frequent complication of pituitary surgery, but its diagnosis lacks standardized criteria. Copeptin, a surrogate marker of arginine vasopressin release, is triggered by psycho-physical stresses such as pituitary surgery. Low postoperative copeptin could predict CDI onset. The aims of this study were the validation of copeptin as a predictor of post-neurosurgical CDI and the identification of the optimal timing for its determination. Methods: Sixty-six consecutive patients operated for a hypothalamic-pituitary lesion were evaluated. Copeptin was determined preoperatively and at 1, 6, 12, 24 and 48 h post-extubation. Fifty-eight patients were reassessed after 3-6 months post-surgery to confirm transient (3 cases) or permanent CDI (5 cases) diagnosis. Results: A marked copeptin peak was identified at 1 h after extubation, when a value below or equal to 12.8 pmol/L had a good accuracy in identifying CDI cases (AUC 0.866, 95% CI 0.751-0.941). Moreover, a copeptin peak above 4.2 pmol/L exclud-ed permanent forms (AUC 1, 95% CI 0.629-1). Regression analysis identified copeptin as the only significant predictor of CDI (OR 0.86, 95% CI 0.75-0.98, p = 0.02). A copeptin T1/ T0 ratio below or equal to 1.47 identified patients at risk of isolated biochemical alterations even in the absence of an overt CDI. Conclusions: A prompt increase of copeptin is expected at 1 h after extubation. The absence of this peak is a reliable predictor of post-neurosurgical CDI.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Early Copeptin Determination Allows Prompt Diagnosis of Post-Neurosurgical Central Diabetes Insipidus

et al. 2019

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“…33 The addition of copeptin to the standard WDT did not improve its diagnostic accuracy. The overall diagnostic accuracy of the hypertonic saline test was 96%, far superior to that of the WDT, 77%, the main caveat being a higher rate of reported adverse events related to the hypertonic saline test.…”

Section: Measurement Of Copeptinmentioning

confidence: 94%

“…The overall diagnostic accuracy of the hypertonic saline test was 96%, far superior to that of the WDT, 77%, the main caveat being a higher rate of reported adverse events related to the hypertonic saline test. 33 The addition of copeptin to the standard WDT did not improve its diagnostic accuracy.…”

Section: Measurement Of Copeptinmentioning

confidence: 94%

Diagnosis and management of central diabetes insipidus in adults

Garrahy

Moran

Thompson

2018

Clinical Endocrinology

107

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Central diabetes insipidus (CDI) is characterized by hypotonic polyuria due to impairment of AVP secretion from the posterior pituitary. In clinical practice, it needs to be distinguished from renal resistance to the antidiuretic effects of AVP (nephrogenic DI), and abnormalities of thirst appreciation (primary polydipsia). As nephrogenic diabetes insipidus is rare in adults, unless they are treated with lithium salts, the practical challenge is how to differentiate between CDI and clinical disorders of excess thirst. The differential diagnosis is usually straight forward, but the recommended gold standard test, the water deprivation test, is not without interpretative pitfalls. The addition of the measurement of plasma AVP concentrations improves diagnostic accuracy, but the radioimmunoassay for AVP is technically difficult, and is only available in a few specialized centres. More recently, the measurement of plasma copeptin concentrations has been claimed to provide a reliable alternative to measurement of plasma AVP, without the sampling handling challenges. In addition, the measurement of thirst ratings can help the differentiation between CDI and primary polydipsia. Once the diagnosis of CDI is biochemically certain, investigations to determine the cause of AVP deficiency are needed. In this review, we will outline the diagnostic approach to polyuria, revisit the caveats of the water deprivation test and review recent data on value of adding AVP/copeptin measurement. We will also discuss treatment strategies for CDI, with analysis of potential complications of treatment.

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“…Further research is needed to determine (a) the frequency of disordered osmoregulation in this patient population, (b) factors correlating with these impairments such as duration of illness, the use of antidepressants, or the differences within the DSM-5-defined subtypes of AN (restrictive vs. binge purging, which is present with distinct electrolyte challenges at baseline), and (c) the role of newer techniques to improve the diagnostic accuracy in the cases of hypotonic polyuria, such as use of plasma copeptin levels(Fenske et al, 2018). In the inpatient refeeding setting, fluid and calorie intake are controlled by protocol, and fluids are generally restricted.…”

mentioning

confidence: 99%

Central diabetes insipidus associated with refeeding in anorexia nervosa: A case report

Rosen

Thambundit

Mehler

et al. 2019

Intl J Eating Disorders

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Anorexia nervosa (AN) has been associated with a multitude of hypothalamic pituitary abnormalities, although it is unknown which aberrations reflect disease causation and which are the consequences of severe malnutrition. Among these endocrinopathies, hypothalamic-posterior pituitary aberrations have been described, including disorders of osmoregulation. We report the case of an adolescent female with a history of severe AN, restricting subtype, treated aggressively with multiple hospitalizations. During hospitalization for severe weakness and lethargy, her course of medical stabilization was complicated by significant polyuria, ultimately diagnosed as central diabetes insipidus (DI). This is the first reported case, to our knowledge, of a severely malnourished adolescent with AN-restricting subtype developing central DI during the refeeding process for medical stabilization, thus adding to the small body of existing literature on

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A Copeptin-Based Approach in the Diagnosis of Diabetes Insipidus

Abstract: The direct measurement of hypertonic saline-stimulated plasma copeptin had greater diagnostic accuracy than the water-deprivation test in patients with hypotonic polyuria. (Funded by the Swiss National Foundation and others; ClinicalTrials.gov number, NCT01940614 .).

Cited by 192 publications

References 33 publications

Early Copeptin Determination Allows Prompt Diagnosis of Post-Neurosurgical Central Diabetes Insipidus

Early Copeptin Determination Allows Prompt Diagnosis of Post-Neurosurgical Central Diabetes Insipidus

Diagnosis and management of central diabetes insipidus in adults

Central diabetes insipidus associated with refeeding in anorexia nervosa: A case report

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