Rapid differential diagnosis of diabetes insipidus in a 7-month-old infant: The copeptin approach

Vergier, Julia; Fromonot, Julien; Macedo, A. Alvares De Azevedo; Godefroy, A.; Marquant, E.; Guieu, Régis; Tsimaratos, Michel; Reynaud, Rachel

doi:10.1016/j.arcped.2017.11.010

Cited by 11 publications

(3 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two cases studies have reported very high copeptin concentrations in infants with NDI. 63,64 These cases are consistent with local experience in Newcastle upon Tyne Hospitals, where we have seen several cases of severe CDI in children with inappropriately low copeptin concentrations (usually <5 pmol/L) and several cases of severe NDI associated with high copeptin concentrations, typically greater than 100 pmol/L (unpublished data). In cases of milder DI, where differentiation from PP is more difficult, there is currently little evidence from prospective studies that the approaches to biochemical diagnosis applied in adults can be transferred to paediatrics, although WDT is widely used in practice.…”

Section: Diagnostic Testing For DI In Paediatricssupporting

confidence: 87%

The laboratory investigation of diabetes insipidus: A review

Boot

2023

Ann Clin Biochem

View full text Add to dashboard Cite

Diabetes insipidus (DI) is a group of disorders that lead to inappropriate production of large volumes of dilute urine. The three main forms are central DI (CDI), nephrogenic DI (NDI) and primary polydipsia (PP). Differentiating CDI/NDI from PP is important as patients with true DI are at risk of severe dehydration without treatment. Biochemical testing is key in the diagnosis of DI. The indirect water deprivation test (WDT) is commonly used in the investigation of DI but has drawbacks including being cumbersome and sometimes producing equivocal results. Direct measurement of AVP has theoretical advantages but has generally only been used in specialist centres. Disadvantages include the requirement to measure AVP under hypertonic stimulation and pre-analytical/analytical challenges. Copeptin (CT-proAVP) is a proxy marker for AVP that is more stable, easier to measure and has been studied more widely in recent years. Historically, the evidence supporting the diagnostic performance of these tests has been relatively poor, being based on a few small, usually single-centre studies. However more recent, well-designed prospective studies are improving the evidence base for investigation of DI. These studies have focused on the utility of copeptin measurements during stimulation tests. There is evidence that measurement of copeptin under stimulation offers improved diagnostic performance compared to the WDT. There is currently a lack of systematic, evidence-based guidelines on the diagnosis of DI, but as the quality of the evidence defining the diagnostic performance of tests for DI continues to improve, a clearer consensus on the optimal approach should become achievable.

show abstract

Section: Diagnostic Testing For DI In Paediatricssupporting

confidence: 87%

The laboratory investigation of diabetes insipidus: A review

Boot

2023

Ann Clin Biochem

View full text Add to dashboard Cite

show abstract

“…Median copeptin levels measured at birth in healthy, term, non-stressed infants were 5.5 pmol/L in boys and 4.8 pmol/L in girls [8]. Vergier et al [7] describes a 7-month-old infant with nephrogenic DI who mounted a copeptin of 303 pmol/L in the context of a serum osmolarity of 330 mOsm/L. Tuli et al [3] evaluated copeptin levels in 53 healthy children (mean age 9.9 ± 0.98 years) and 12 with central DI.…”

Section: Discussionmentioning

confidence: 99%

“…Copeptin is likely superior to AVP in the assessment of osmoregulatory disorders as copeptin is stable in plasma, unlike AVP. Recent work describes copeptin in older children with diabetes insipidus (DI) with levels mirroring adult curves [3,7]. In neonates, increased copeptin levels correlate to increased perinatal stress [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Use of Copeptin Levels to Predict the Resolution of Transient Postoperative SIADH

et al. 2020

View full text Add to dashboard Cite

Background: Copeptin levels reflect vasopressin activity and help classify osmoregulatory disorders. There is limited pediatric experience using copeptin to diagnose and manage diabetes insipidus, syndrome of inappropriate antidiuretic hormone secretion (SIADH), and bi- or tri-phasic postsurgical osmoregulatory disorders. In this report, we describe serial copeptin levels in an infant who developed transient SIADH after neurosurgery. Case Description: A 4-month-old infant with no prior pituitary dysfunction underwent endoscopic fenestration of a large arachnoid cyst (3.5 × 4.7 × 3.8 cm). He developed SIADH on postoperative day 4 with seizures, hyponatremia (sodium 121 mmol/L), and concentrated urine (535 mOsm/kg). His initial copeptin level was inappropriately high in the context of his hyponatremia. Copeptin levels decreased as his SIADH resolved. Serial copeptin levels correlated to the infant’s increased ability to dilute urine. Conclusion: Copeptin levels in this infant are consistent with levels described in adults and older children. Obtaining copeptin levels may improve providers’ ability to quickly diagnose and manage SIADH amongst other heterogeneous causes of hyponatremia. Lastly, trending copeptin levels improved providers’ ability to monitor SIADH progression, and may allow preemptive fluid titration for children with bi- or tri-phasic shifts in osmoregulation after neurological procedures.

show abstract

Sodium and Water Disorders: Evaluation and Management

Moritz

2022

Pediatric Nephrology

View full text Add to dashboard Cite

Rapid differential diagnosis of diabetes insipidus in a 7-month-old infant: The copeptin approach

Cited by 11 publications

References 9 publications

The laboratory investigation of diabetes insipidus: A review

The laboratory investigation of diabetes insipidus: A review

Use of Copeptin Levels to Predict the Resolution of Transient Postoperative SIADH

Sodium and Water Disorders: Evaluation and Management

Contact Info

Product

Resources

About