1
|
Trimpou P, Bounias I, Ehn O, Hammarsten O, Ragnarsson O. The influence of insulin-induced hypoglycemia on copeptin concentrations. Peptides 2024; 176:171185. [PMID: 38462093 DOI: 10.1016/j.peptides.2024.171185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/12/2024]
Abstract
Plasma copeptin is a biomarker that reflects arginine vasopressin (AVP) secretion. In this study we measured copeptin during insulin tolerance test (ITT) in 65 patients referred to our department for evaluation of anterior pituitary function. Plasma for measurements of copeptin were collected at the start of the test and regurarly up to 120 minutes thereafter. Of 60 patients who developed significant hypoglycemia and were included in the analyses, 13 (22%) had corticotropic deficiency, 11 (18%) had thyreotropic deficiency, 33 (55%) had growth hormone deficiency and 4 (6%) had AVP deficieny (AVPD). Thirty-seven (62%) patients had at least one anterior pituitary deficiency. In patients without AVPD, median (range) copeptin increased from 4.5 pmol/L (1.3-33.0) to a maximum of 6.2 pmol/L (2.0-34.4; p<0.001). Baseline copeptin was similar in men and women, but maximal copeptin during ITT was higher in men. Copeptin concentrations were not affected by age, BMI, somatotropic, or corticotropic function. Copeptin concentrations were lower in patients with AVPD than patiets without AVPD, and in patients with thyrotropic deficiency, compared to patients with intact thyrotropic function, both at baseline and during ITT. In conclusion, copeptin increases significantly during insulin induced hypoglycemia but is of limited value in predicting anterior pituitary hormonal function.
Collapse
Affiliation(s)
- Penelope Trimpou
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Ioannis Bounias
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olof Ehn
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ola Hammarsten
- Department of Clinical Chemistry Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Ragnarsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
2
|
March CA, Sastry S, McPhaul MJ, Wheeler SE, Garibaldi L. Copeptin Stimulation by Combined Intravenous Arginine and Oral LevoDopa/Carbidopa in Healthy Short Children and Children with the Polyuria-Polydipsia Syndrome. Horm Res Paediatr 2024:1-11. [PMID: 38705144 DOI: 10.1159/000539208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024] Open
Abstract
INTRODUCTION Stimulated copeptin may provide an alternative to water deprivation testing (WDT) in the evaluation of polyuria-polydipsia syndrome (PPS). Though best studied, arginine stimulation alone produces a modest copeptin response in children. We investigated the effectiveness of the arginine + LevoDopa/Carbidopa stimulation test (ALD-ST) for copeptin. METHODS 47 healthy short children (controls), 10 children with primary polydipsia, and 10 children with AVP deficiency received arginine hydrochloride (500 mg/kg intravenously over 30 min) and Levodopa/carbidopa (10:1 ratio; 175 mg of l-Dopa/m2 BSA) orally. Serum copeptin was measured at 0, 60, 90, and 120 min. RESULTS In controls, ALD-ST increased copeptin from a median of 7.0 pmol/L (IQR 5.0-10.0) to a peak of 44.0 pmol/L (IQR 21.4-181.0) between 60 and 120 min (p < 0.001). Copeptin peak was higher in subjects who experienced nausea or vomiting (57%) than in those who did not (131.0 pmol/L [IQR 42.5-193.8] vs. 22.7 pmol/L [IQR 16.0-33.7], p < 0.001). While subjects with primary polydipsia had similar baseline (8.5 pmol/L [IQR 8.0-11.0]) and stimulated (125.2 pmol/L [IQR 87.6-174.0]) copeptin levels as controls, subjects with AVP deficiency had lower baseline (2.5 pmol/L [IQR 2.0-3.1]) and peak levels (4.6 pmol/L [IQR 2.4-6.0]). A peak copeptin of ≥9.3 pmol/L best predicted absence of complete or partial AVP deficiency with a sensitivity of 100% and specificity of 80%. CONCLUSIONS ALD-ST induced a robust peak copeptin in healthy short children and children with primary polydipsia. Nausea/vomiting, a side effect of ALD-ST, amplified the copeptin response. The ALD-ST may be a suitable initial screening test in children with PPS.
Collapse
Affiliation(s)
- Christine A March
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shruti Sastry
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael J McPhaul
- Quest Diagnostics Nichols Institute, San Juan Capistrano, California, USA
| | - Sarah E Wheeler
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Luigi Garibaldi
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
3
|
Boot C. The laboratory investigation of diabetes insipidus: A review. Ann Clin Biochem 2024; 61:19-31. [PMID: 36650746 DOI: 10.1177/00045632231154391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
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.
Collapse
Affiliation(s)
- Christopher Boot
- Blood Sciences, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| |
Collapse
|
4
|
Mu D, Ma Y, Cheng J, Qiu L, Chen S, Cheng X. Diagnostic Accuracy of Copeptin in the Differential Diagnosis of patients with Diabetes Insipidus: A Systematic Review and Meta-analysis. Endocr Pract 2023:S1530-891X(23)00413-5. [PMID: 37225043 DOI: 10.1016/j.eprac.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/26/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Accurate diagnosis of diabetes insipidus (DI) is of significant importance for correct management. We aimed to evaluate the diagnostic accuracy of copeptin measurements in the differential diagnosis between DI and primary polydipsia (PP). METHODS A literature search of electronic databases from Jan. 1st, 2005 to July 13th, 2022 was performed. Primary studies that evaluated the diagnostic accuracy of copeptin in patients with DI and PP were eligible. Two reviewers independently screened relevant articles and extracted data. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool was used to assess the quality of the included studies. The hierarchical summary receiver operating characteristic model and bivariate method were used. RESULTS Seven studies including 422 patients with polydipsia-polyuria syndrome (PPS), 189 (44.79%) of whom with arginine vasopressin-deficiency (AVP-D, cranial DI) and 212 (50.24%) with PP, were included. The summary estimates of the diagnostic performance of stimulated copeptin to differentiate between PP and AVP-D were 0.93 (95% confidence interval [CI] 0.89-0.97) for sensitivity, 0.96 (95% CI 0.88-1.00) for specificity, respectively. Baseline copeptin level had high performance to identify AVP- resistance (AVP-R, nephrogenic DI), with pooled sensitivity of 1.00 (95% CI 0.82-1.00) and specificity of 1.00 (95% CI 0.98-1.00); however, it showed little value in the differentiation between PP and AVP-D. CONCLUSION Copeptin measurement is a useful tool for the differential diagnosis of patients with DI and PP. Stimulation before copeptin measurement is necessary in the diagnosis of AVP-D.
Collapse
Affiliation(s)
- Danni Mu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Yichen Ma
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Jin Cheng
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Ling Qiu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| | - Shi Chen
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
| | - Xinqi Cheng
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
| |
Collapse
|
5
|
Binder G, Weber K, Peter A, Schweizer R. Arginine-stimulated copeptin in children and adolescents. Clin Endocrinol (Oxf) 2023; 98:548-553. [PMID: 36710502 DOI: 10.1111/cen.14880] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/16/2022] [Accepted: 01/09/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Copeptin is secreted in isomolar amounts along with arginine vasopressin peptide (AVP) from the neurohypophysis. Its stability makes it a perfect candidate for the endocrine approach in the diagnosis of AVP deficiency (AVPD; cranial diabetes insipidus; CDI). However, pediatric reference values are lacking. DESIGN AND PATIENTS This is a monocentric retrospective analysis of donated residual serum samples from 72 children and adolescents who underwent arginine or growth hormone-releasing hormone-arginine stimulation to test GH secretory capacity from 2018 to 2022. MEASUREMENTS Copeptin was measured in baseline, 30-, and 60-min samples by BRAHMS Copeptin proAVP Kryptor immunofluorescence assay. RESULTS Of the 72 patients, 4 suffered from complete AVPD (CDI). The baseline level of copeptin in the 68 non-AVPD (non-CDI) patients was highly variable (range: 1.3-44.4 pmol/L). The increase after arginine was moderate (30 min range: 1.6-40.4 pmol/L). The median baseline and peak copeptin levels were 5.6 and 8.0 pmol/L, respectively. The 2.5th percentile of the baseline and peak values of copeptin were 2.1 and 3.3 pmol/L, respectively. The increase and peak value of copeptin were inversely related to age (R = -.405; p = .011, and R = -.335; p = .0072, respectively) but not to gender, body mass index (standard deviation score) or GH secretion. In the four patients with AVPD (CDI), baseline or stimulated copeptin was below the 2.5th percentile of non-AVPD (non-CDI) patients. CONCLUSIONS Stimulated copeptin is a promising parameter for the differential diagnosis of polyuria-polydipsia syndrome. However, the low copeptin increase after arginine and the high limit of quantification of the assay are problematic for use in paediatrics.
Collapse
Affiliation(s)
- Gerhard Binder
- Pediatric Endocrinology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Karin Weber
- Pediatric Endocrinology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Andreas Peter
- Department for Diagnostic Laboratory Medicine, Institute for Clinical Chemistry and Pathobiochemistry, University Hospital Tübingen, Tübingen, Germany
| | - Roland Schweizer
- Pediatric Endocrinology, University Children's Hospital Tübingen, Tübingen, Germany
| |
Collapse
|
6
|
March CA, Sastry S, McPhaul MJ, Wheeler SE, Garibaldi L. Combined Arginine and Insulin Stimulation Elicits a Robust and Consistent Copeptin Response in Short Children. Horm Res Paediatr 2022; 96:395-403. [PMID: 36513057 PMCID: PMC10261513 DOI: 10.1159/000528661] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Copeptin, co-secreted with arginine vasopressin, is regulated by osmotic and volume stimuli but also responds to intravenous arginine and insulin-induced hypoglycemia. The serum copeptin response to the latter agents has been studied in adults but only to a limited extent in children. The objective of this study was to describe the copeptin response to combined arginine and insulin in children with normal posterior pituitary function. METHODS We conducted a prospective, single-arm assessment of serum copeptin concentrations in children (age 7-16 years, n = 38) undergoing growth hormone stimulation testing with an arginine-insulin tolerance test (AITT) for short stature or growth deceleration in a tertiary referral center. After overnight fasting, arginine (500 mg/kg) was administered between 0 and 30 min intravenously (IV) followed by insulin (0.1 units/kg IV) at 60 min. Copeptin serum concentrations were measured at baseline (0 min), at the post-arginine peak (60 min), and at the post-insulin peak (90 min; 30 min post-insulin), respectively. The main outcome was the peak copeptin concentration. RESULTS Mean ± SD copeptin concentrations increased from 9.9 ± 5.0 pmol/L at 0 min to 13.2 ± 5.8 pmol/L at 60 min (p < 0.0001 vs. 0 min) and 27.7 ± 14.2 pmol/L at 90 min (p < 0.0001 vs. 0 and 60 min). There was no significant correlation between copeptin concentrations and age, BMI, pubertal status, cortisol, growth hormone, or glucose concentrations. DISCUSSION/CONCLUSION Arginine and insulin appear to have an additive and consistent effect resulting in significant stimulation of copeptin secretion in children. The AITT may be a useful tool to evaluate for normal posterior pituitary function in this age-group, with potential implications for the evaluation of polyuria-polydipsia syndrome.
Collapse
Affiliation(s)
- Christine A March
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shruti Sastry
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Sarah E Wheeler
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Luigi Garibaldi
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
7
|
Banerjee A, Biswas D, Barpanda A, Halder A, Sibal S, Kattimani R, Shah A, Mahadevan A, Goel A, Srivastava S. The First Pituitary Proteome Landscape From Matched Anterior and Posterior Lobes for a Better Understanding of the Pituitary Gland. Mol Cell Proteomics 2022; 22:100478. [PMID: 36470533 PMCID: PMC9877467 DOI: 10.1016/j.mcpro.2022.100478] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
To date, very few mass spectrometry (MS)-based proteomics studies are available on the anterior and posterior lobes of the pituitary. In the past, MS-based investigations have focused exclusively on the whole pituitary gland or anterior pituitary lobe. In this study, for the first time, we performed a deep MS-based analysis of five anterior and five posterior matched lobes to build the first lobe-specific pituitary proteome map, which documented 4090 proteins with isoforms, mostly mapped into chromosomes 1, 2, and 11. About 1446 differentially expressed significant proteins were identified, which were studied for lobe specificity, biological pathway enrichment, protein-protein interaction, regions specific to comparison of human brain and other neuroendocrine glands from Human Protein Atlas to identify pituitary-enriched proteins. Hormones specific to each lobe were also identified and validated with parallel reaction monitoring-based target verification. The study identified and validated hormones, growth hormone and thyroid-stimulating hormone subunit beta, exclusively to the anterior lobe whereas oxytocin-neurophysin 1 and arginine vasopressin to the posterior lobe. The study also identified proteins POU1F1 (pituitary-specific positive transcription factor 1), POMC (pro-opiomelanocortin), PCOLCE2 (procollagen C-endopeptidase enhancer 2), and NPTX2 (neuronal pentraxin-2) as pituitary-enriched proteins and was validated for their lobe specificity using parallel reaction monitoring. In addition, three uPE1 proteins, namely THEM6 (mesenchymal stem cell protein DSCD75), FSD1L (coiled-coil domain-containing protein 10), and METTL26 (methyltransferase-like 26), were identified using the NeXtProt database, and depicted tumor markers S100 proteins having high expression in the posterior lobe. In summary, the study documents the first matched anterior and posterior pituitary proteome map acting as a reference control for a better understanding of functional and nonfunctional pituitary adenomas and extrapolating the aim of the Human Proteome Project towards the investigation of the proteome of life.
Collapse
Affiliation(s)
- Arghya Banerjee
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, India
| | - Deepatarup Biswas
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, India
| | - Abhilash Barpanda
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, India
| | - Ankit Halder
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, India
| | - Shamira Sibal
- Lokmanya Tilak Municipal Medical College, Mumbai, India
| | | | - Abhidha Shah
- Department of Neurosurgery at King Edward Memorial Hospital and Seth G. S. Medical College, Mumbai, India
| | - Anita Mahadevan
- Human Brain Bank, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Atul Goel
- Department of Neurosurgery at King Edward Memorial Hospital and Seth G. S. Medical College, Mumbai, India
| | - Sanjeeva Srivastava
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, India.
| |
Collapse
|
8
|
Tomkins M, Lawless S, Martin-Grace J, Sherlock M, Thompson CJ. Diagnosis and Management of Central Diabetes Insipidus in Adults. J Clin Endocrinol Metab 2022; 107:2701-2715. [PMID: 35771962 PMCID: PMC9516129 DOI: 10.1210/clinem/dgac381] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Indexed: 11/19/2022]
Abstract
Central diabetes insipidus (CDI) is a clinical syndrome which results from loss or impaired function of vasopressinergic neurons in the hypothalamus/posterior pituitary, resulting in impaired synthesis and/or secretion of arginine vasopressin (AVP). AVP deficiency leads to the inability to concentrate urine and excessive renal water losses, resulting in a clinical syndrome of hypotonic polyuria with compensatory thirst. CDI is caused by diverse etiologies, although it typically develops due to neoplastic, traumatic, or autoimmune destruction of AVP-synthesizing/secreting neurons. This review focuses on the diagnosis and management of CDI, providing insights into the physiological disturbances underpinning the syndrome. Recent developments in diagnostic techniques, particularly the development of the copeptin assay, have improved accuracy and acceptability of the diagnostic approach to the hypotonic polyuria syndrome. We discuss the management of CDI with particular emphasis on management of fluid intake and pharmacological replacement of AVP. Specific clinical syndromes such as adipsic diabetes insipidus and diabetes insipidus in pregnancy as well as management of the perioperative patient with diabetes insipidus are also discussed.
Collapse
Affiliation(s)
- Maria Tomkins
- Academic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sarah Lawless
- Academic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Julie Martin-Grace
- Academic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mark Sherlock
- Academic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chris J Thompson
- Correspondence: Chris Thompson, Academic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland.
| |
Collapse
|
9
|
Atila C, Monnerat S, Urwyler SA, Refardt J, Winzeler B, Christ-Crain M. The effect of glucose dynamics on plasma copeptin levels upon glucagon, arginine, and macimorelin stimulation in healthy adults : Data from: Glucacop, Macicop, and CARGO study. Pituitary 2022; 25:636-644. [PMID: 35723775 PMCID: PMC9345811 DOI: 10.1007/s11102-022-01240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Non-osmotic stimulation tests using glucagon, arginine, or macimorelin were recently evaluated for their ability to assess posterior pituitary function. Glucagon and arginine, but not macimorelin, stimulated copeptin secretion (a surrogate marker of vasopressin) and, therefore, provide novel tests to assess the posterior pituitary. The exact underlying mechanism behind their stimulatory effect remains elusive. METHODS This analysis combined data from three diagnostic studies conducted at the University Hospital Basel, Switzerland. In total, 80 healthy adults underwent the glucagon (n = 22), arginine (n = 30), or macimorelin (n = 28) stimulation tests. The primary objective was to investigate glucose course upon glucagon, arginine, and macimorelin stimulation tests and its effect on plasma copeptin release. RESULTS Upon glucagon stimulation, the median [IQR] glucose level at baseline was 5.0 [4.6, 5.2] mmol/l, peaked at 8.1 [7.2, 9.4] mmol/l after 30 min and decreased to a minimum of 3.8 [3.5, 4.5] mmol/l after 120 min. The median copeptin increase upon glucagon stimulation was 7.7 [2.6, 28.0] pmol/l. Upon arginine, the glucose level at baseline was 4.9 [4.8, 5.5] mmol/l, peaked at 6.0 [5.2, 6.4] mmol/l after 30 min and decreased to a minimum of 4.3 [3.8, 4.8] mmol/l after 60 min. The median copeptin increase upon arginine stimulation was 4.5 [2.9, 7.5] pmol/l. Upon macimorelin, glucose levels showed no notable dynamics over the 120 min, and no major change in copeptin was observed. In the pooled dataset, a decrease in glucose levels was significantly correlated with copeptin increase (ρ = 0.53, p < 0.01). CONCLUSION A similar course in plasma glucose was observed in the copeptin-stimulating test, i.e., after glucagon and arginine, while macimorelin had no effect on glucose and copeptin levels. We hypothesize that a drop in glucose levels observed upon glucagon and arginine might stimulate copeptin.
Collapse
Affiliation(s)
- Cihan Atila
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Sophie Monnerat
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Sandrine Andrea Urwyler
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Julie Refardt
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Bettina Winzeler
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Mirjam Christ-Crain
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Department of Clinical Research, University of Basel, Basel, Switzerland.
| |
Collapse
|
10
|
Christ-Crain M, Refardt J, Winzeler B. Approach to the Patient: "Utility of the Copeptin Assay". J Clin Endocrinol Metab 2022; 107:1727-1738. [PMID: 35137148 PMCID: PMC9113794 DOI: 10.1210/clinem/dgac070] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Indexed: 11/19/2022]
Abstract
Copeptin derives from the same precursor peptide preprovasopressin as arginine vasopressin (AVP). The secretion of both peptides is stimulated by similar physiological processes, such as osmotic stimulation, hypovolemia, or stress. AVP is difficult to measure due to complex preanalytical requirements and due to technical difficulties. In the last years, copeptin was found to be a stable, sensitive, and simple to measure surrogate marker of AVP release. Different immunoassays exist to measure copeptin. The 2 assays which have most often be used in clinical studies are the original sandwich immunoluminometric assay and its automated immunofluorescent successor. In addition, various enzyme-linked immunosorbent assay have been developed. With the availability of the copeptin assay, the differential diagnosis of diabetes insipidus was recently revisited. The goal for this article is therefore to first review the physiology of copeptin, and second to describe its use as marker for the differential diagnosis of vasopressin-dependent fluid disorders, mainly diabetes insipidus but also hyper- and hyponatremia. Furthermore, we highlight the role of copeptin as prognostic marker in other acute and chronic diseases.
Collapse
Affiliation(s)
- Mirjam Christ-Crain
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, 4031 Basel, Switzerland
- Correspondence: Mirjam Christ-Crain, MD, PhD, Department of Endocrinology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Julie Refardt
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, 4031 Basel, Switzerland
| | - Bettina Winzeler
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, 4031 Basel, Switzerland
| |
Collapse
|
11
|
Atila C, Gaisl O, Vogt DR, Werlen L, Szinnai G, Christ-Crain M. Glucagon-stimulated copeptin measurements in the differential diagnosis of diabetes insipidus: a double-blind, randomized, placebo-controlled study. Eur J Endocrinol 2022; 187:65-74. [PMID: 35521789 DOI: 10.1530/eje-22-0033] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/25/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The differential diagnosis of diabetes insipidus is challenging. The most reliable approaches are copeptin measurements after hypertonic saline infusion or arginine, which is a known growth hormone secretagogue but has recently also been shown to stimulate the neurohypophysis. Similar to arginine, glucagon stimulates growth hormone release, but its effect on the neurohypophysis is poorly studied. DESIGN Double-blind, randomized, placebo-controlled trial including 22 healthy participants, 10 patients with central diabetes insipidus, and 10 patients with primary polydipsia at the University Hospital Basel, Switzerland. METHODS Each participant underwent the glucagon test (s.c. injection of 1 mg glucagon) and placebo test. The primary objective was to determine whether glucagon stimulates copeptin and to explore whether the copeptin response differentiates between diabetes insipidus and primary polydipsia. Copeptin levels were measured at baseline, 30, 60, 90, 120, 150, and 180 min after injection. RESULTS In healthy participants, glucagon stimulated copeptin with a median increase of 7.56 (2.38; 28.03) pmol/L, while placebo had no effect (0.10 pmol/L (-0.70; 0.68); P < 0.001). In patients with diabetes insipidus, copeptin showed no relevant increase upon glucagon, with an increase of 0.55 (0.21; 1.65) pmol/L, whereas copeptin was stimulated in patients with primary polydipsia with an increase of 15.70 (5.99; 24.39) pmol/L. Using a copeptin cut-off level of 4.6pmol/L had a sensitivity of 100% (95% CI: 100-100) and a specificity of 90% (95% CI: 70-100) to discriminate between diabetes insipidus and primary polydipsia. CONCLUSION Glucagon stimulates the neurohypophysis, and glucagon-stimulated copeptin has the potential for a safe, novel, and precise test in the differential diagnosis of diabetes insipidus.
Collapse
Affiliation(s)
- Cihan Atila
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Odile Gaisl
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Deborah R Vogt
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Laura Werlen
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gabor Szinnai
- Department of Paediatric Endocrinology and Diabetology, University Children's Hospital Basel, Basel, Switzerland
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| |
Collapse
|
12
|
Flippo C, Tatsi C, Sinaii N, Sierra MDLL, Belyavskaya E, Lyssikatos C, Keil M, Spanakis E, Stratakis CA. Copeptin Levels Before and After Transsphenoidal Surgery for Cushing Disease: A Potential Early Marker of Remission. J Endocr Soc 2022; 6:bvac053. [DOI: 10.1210/jendso/bvac053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Indexed: 11/19/2022] Open
Abstract
Abstract
Context
Arginine-vasopressin (AVP) and corticotropin-releasing hormone (CRH) act synergistically to stimulate secretion of adrenocorticotropic hormone (ACTH). There is evidence that glucocorticoids act via negative feedback to suppress AVP secretion.
Objective
Our hypothesis was that a post-operative increase in plasma copeptin may serve as a marker of remission of Cushing Disease (CD).
Design
Plasma copeptin was obtained in patients with CD before and daily on post-operative days 1-8 after transsphenoidal surgery. Peak post-operative copeptin levels and Δcopeptin values were compared among those in remission versus no remission.
Results
Forty-four patients (64% female, 7-55 years old) were included, and 19 developed neither DI nor SIADH. Thirty-three had follow-up at least 3 months post-operatively. There was no difference in peak post-operative copeptin in remission [6.1 pmol/L (4.3-12.1)] versus no remission [7.3 pmol/L (5.4-8.4), p=0.88].. Excluding those who developed DI or SIADH, there was no difference in peak post-operative copeptin in remission [10.2 pmol/L (6.9-21.0)] versus no remission [5.4 pmol/L (4.6-7.3), p= 0.20]. However, a higher peak post-operative copeptin was found in those in remission [14.6 pmol/L (±10.9) vs. 5.8 (±1.4), p=0.03]] with parametric testing. There was no difference in the Δcopeptin by remission status.
Conclusions
A difference in peak post-operative plasma copeptin as an early marker to predict remission of CD was not consistently present, although the data point to the need for a larger sample size to further evaluate this. However, the utility of this test may be limited to those who develop neither DI nor SIADH post-operatively.
Collapse
Affiliation(s)
- Chelsi Flippo
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD
| | - Christina Tatsi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD
| | - Ninet Sinaii
- Biostatistics and Clinical Epidemiology Service, National Institutes of Health Clinical Center, Bethesda, MD
| | - Maria De La Luz Sierra
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD
| | - Elena Belyavskaya
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD
| | - Charalampos Lyssikatos
- Indiana Center for Musculoskeletal Health, Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Meg Keil
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD
| | - Elias Spanakis
- Division of Endocrinology, Diabetes, and Nutrition, University of Maryland, Baltimore, MD
| | - Constantine A Stratakis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD
- Foundation for Research & Technology (FORTH), Greece & Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
13
|
Mu D, Ma C, Cheng J, Zou Y, Qiu L, Cheng X. Copeptin in fluid disorders and stress. Clin Chim Acta 2022; 529:46-60. [PMID: 35143773 DOI: 10.1016/j.cca.2022.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 12/16/2022]
Abstract
Copeptin, a glycosylated peptide of 39 amino acids, is the C-terminal segment of arginine vasopressin (AVP) precursor peptide, which is consisted of two other fragments, vasopressin and neurophysin Ⅱ. The main physiological functions of AVP are fluid and osmotic balance, cardiovascular homeostasis and regulation of the endocrine stress response. Numerous studies have demonstrated that the endogenous AVP in plasma is a meaningful biomarker to guide diagnosis and therapy of diseases associated with fluids disorders and stress. However, due to its instability, short half-time life in circulation and lack of readily available AVP assays, clinical measurement of AVP is restricted. In contrast to AVP, copeptin which is released in an equimolar mode with AVP from the pituitary, has emerged as a stable and simple-to-measure surrogate marker of AVP and displays excellent potential in diagnosis, differentiation and prognosis of various diseases. This review will discuss the studies on the clinical value of copeptin in different diseases, especially in AVP-dependent fluids disorders, as well as issues and prospects of the application of this potential biomarker.
Collapse
Affiliation(s)
- Danni Mu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Chaochao Ma
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Jin Cheng
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Yutong Zou
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Ling Qiu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xinqi Cheng
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China.
| |
Collapse
|
14
|
Abstract
Vasopressin (AVP) and copeptin are released in equimolar amounts from the same precursor. Due to its molecular stability and countless advantages as compared with AVP, copeptin perfectly mirrors AVP presence and has progressively emerged as a reliable marker of vasopressinergic activation in response to osmotic and hemodynamic stimuli in clinical practice. Moreover, evidence highlighting the prognostic potential of copeptin in several acute diseases, where the activation of the AVP system is primarily linked to stress, as well as in psychologically stressful conditions, has progressively emerged. Furthermore, organic stressors induce a rise in copeptin levels which, although non-specific, is unrelated to plasma osmolality but proportional to their magnitude: suggesting disease severity, copeptin proved to be a reliable prognostic biomarker in acute conditions, such as sepsis, early post-surgical period, cardiovascular, cerebrovascular or pulmonary diseases, and even in critical settings. Evidence on this topic will be briefly discussed in this article.
Collapse
|
15
|
Ferrante E, Cremaschi A, Serban AL, Indirli R, Grassi G, Locatelli M, Arosio M, Mantovani G. Usefulness of non-stimulated copeptin in the diagnosis of diabetes insipidus after pituitary surgery. J Endocrinol Invest 2021; 44:2315-2317. [PMID: 33609279 DOI: 10.1007/s40618-021-01530-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Affiliation(s)
- E Ferrante
- Department: Endocrinology Unit, Institute: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20143, Milan, Italy.
| | - A Cremaschi
- Department: Endocrinology Unit, Institute: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20143, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - A L Serban
- Department: Endocrinology Unit, Institute: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20143, Milan, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - R Indirli
- Department: Endocrinology Unit, Institute: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20143, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Grassi
- Department: Endocrinology Unit, Institute: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20143, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - M Locatelli
- Neurosurgery Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Di Milano, Milano, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - M Arosio
- Department: Endocrinology Unit, Institute: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20143, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Mantovani
- Department: Endocrinology Unit, Institute: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20143, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| |
Collapse
|
16
|
Almalki MH, Ahmad MM, Brema I, Almehthel M, AlDahmani KM, Mahzari M, Beshyah SA. Management of Diabetes Insipidus following Surgery for Pituitary and Suprasellar Tumours. Sultan Qaboos Univ Med J 2021; 21:354-364. [PMID: 34522399 PMCID: PMC8407907 DOI: 10.18295/squmj.4.2021.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/14/2020] [Accepted: 08/09/2020] [Indexed: 12/03/2022] Open
Abstract
Central diabetes insipidus (CDI) is a common complication after pituitary surgery. However, it is most frequently transient. It is defined by the excretion of an abnormally large volume of dilute urine with increasing serum osmolality. The reported incidence of CDI after pituitary surgery ranges from 0–90%. Large tumour size, gross total resection and intraoperative cerebrospinal fluid leak usually pose an increased risk of CDI as observed with craniopharyngioma and Rathke’s cleft cysts. CDI can be associated with high morbidity and mortality if not promptly recognised and treated on time. It is also essential to rule out other causes of postoperative polyuria to avoid unnecessary pharmacotherapy and iatrogenic hyponatremia. Once the diagnosis of CDI is established, close monitoring is required to evaluate the response to treatment and to determine whether the CDI is transient or permanent. This review outlines the evaluation and management of patients with CDI following pituitary and suprasellar tumour surgery to help recognise the diagnosis, consider the differential diagnosis, initiate therapeutic interventions and guide monitoring and long-term management.
Collapse
Affiliation(s)
- Mussa H Almalki
- Obesity, Endocrine and Metabolism Centre, King Fahad Medical City, Riyadh, Saudi Arabia.,Faculty of Medicine, King Saud Bin Abdul Aziz University of Health Sciences, Riyadh, Saudi Arabia
| | - Maswood M Ahmad
- Obesity, Endocrine and Metabolism Centre, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Imad Brema
- Obesity, Endocrine and Metabolism Centre, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Almehthel
- Obesity, Endocrine and Metabolism Centre, King Fahad Medical City, Riyadh, Saudi Arabia.,Division of Endocrinology, University of British Columbia, Vancouver, Canada
| | - Khaled M AlDahmani
- Division of Endocrinology, Tawam Hospital, Al Ain, United Arab Emirates.,Department of Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Moeber Mahzari
- Faculty of Medicine, King Saud Bin Abdul Aziz University of Health Sciences, Riyadh, Saudi Arabia.,Department of Medicine, Ministry of National Guard Health Affair, Riyadh, Saudi Arabia
| | - Salem A Beshyah
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates.,Department of Endocrinology, Mediclinic Airport Road, Abu Dhabi, United Arab Emirates
| |
Collapse
|
17
|
Changes in copeptin levels before and 3 months after transsphenoidal surgery according to the presence of postoperative central diabetes insipidus. Sci Rep 2021; 11:17240. [PMID: 34446748 PMCID: PMC8390481 DOI: 10.1038/s41598-021-95500-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/26/2021] [Indexed: 11/09/2022] Open
Abstract
Copeptin levels reflect arginine vasopressin (AVP) release from the hypothalamus. Pituitary surgery often impairs AVP release and results in central diabetes insipidus (CDI). Here, we aimed to investigate how serum copeptin level changes 3 months after pituitary surgery and whether it has a diagnostic value for postoperative permanent CDI. Consecutive patients who underwent endoscopic transsphenoidal surgery at a single tertiary hospital were recruited. Serum copeptin levels were measured preoperatively and 3 months postoperatively. Among 88 patients, transient and permanent CDI occurred in 17 (19.3%) and 23 (26.1%), respectively. Three-month postoperative copeptin levels significantly declined from preoperative levels in permanent CDI group (P < 0.001, percentage difference = - 42.2%) and also in the transient CDI group (P = 0.002, - 27.2%). Three months postoperative copeptin level < 1.9 pmol/L under normal serum sodium levels was the optimal cutoff value for diagnosing permanent CDI with an accuracy of 81.8%, while 3-month postoperative copeptin level ≥ 3.5 pmol/L excluded the CDI with a negative predictive value of 100%. Conclusively, 3 months postoperative copeptin levels significantly decreased from preoperative levels in the transient CDI group as well as the permanent CDI group. Three-month postoperative copeptin levels ≥ 3.5 pmol/L under normal serum sodium levels may be diagnostic for excluding postoperative CDI.
Collapse
|
18
|
Rhim JK, Youn DH, Kim BJ, Kim Y, Kim S, Kim HC, Jeon JP. The Role of Consecutive Plasma Copeptin Levels in the Screening of Delayed Cerebral Ischemia in Poor-Grade Subarachnoid Hemorrhage. Life (Basel) 2021; 11:life11040274. [PMID: 33806226 PMCID: PMC8066417 DOI: 10.3390/life11040274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 12/12/2022] Open
Abstract
The prognostic value of copeptin in subarachnoid hemorrhage (SAH) has been reported, but the prognosis was largely affected by the initial clinical severity. Thus, the previous studies are not very useful in predicting delayed cerebral ischemia (DCI) in poor-grade SAH patients. Here, we first investigated the feasibility of predicting DCI in poor-grade SAH based on consecutive measurements of plasma copeptin. We measured copeptin levels of 86 patients on days 1, 3, 5, 7, 9, 11, and 13 using ELISA. The primary outcome was the association between consecutive copeptin levels and DCI development. The secondary outcomes were comparison of copeptin with C-reactive protein (CRP) in predicting DCI. Additionally, we compared the prognostic value of transcranial Doppler ultrasonography (TCD) with copeptin using TCD alone to predict DCI. Increased copeptin (OR = 1.022, 95% CI: 1.008–1.037) and modified Fisher scale IV (OR = 2.841; 95% CI: 0.998–8.084) were closely related to DCI. Consecutive plasma copeptin measurements showed significant differences between DCI and non-DCI groups (p < 0.001). Higher CRP and DCI appeared to show a correlation, but it was not statistically significant. Analysis of copeptin changes with TCD appeared to predict DCI better than TCD alone with AUCROC differences of 0.072. Consecutive measurements of plasma copeptin levels facilitate the screening of DCI in poor-grade SAH patients.
Collapse
Affiliation(s)
- Jong Kook Rhim
- Department of Neurosurgery, Jeju National University College of Medicine, Jeju 63243, Korea;
| | - Dong Hyuk Youn
- Institute of New Frontier Stroke Research, Hallym University College of Medicine, Chuncheon 24252, Korea; (D.H.Y.); (B.J.K.); (Y.K.)
| | - Bong Jun Kim
- Institute of New Frontier Stroke Research, Hallym University College of Medicine, Chuncheon 24252, Korea; (D.H.Y.); (B.J.K.); (Y.K.)
| | - Youngmi Kim
- Institute of New Frontier Stroke Research, Hallym University College of Medicine, Chuncheon 24252, Korea; (D.H.Y.); (B.J.K.); (Y.K.)
| | - Sungeun Kim
- EMS Situation Management Center, Seoul Emergency Operation Center, Seoul Metropolitan Fire & Disaster Headquarters, Seoul 04628, Korea;
| | - Heung Cheol Kim
- Department of Radioilogy, Hallym University College of Medicine, Chuncheon 24252, Korea;
| | - Jin Pyeong Jeon
- Genetic and Research Inc., Chuncheon 24252, Korea
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon 24252, Korea
- Correspondence: ; Tel.: +82-33-240-5171; Fax: +82-33-240-9970
| |
Collapse
|
19
|
Postoperative Copeptin as a Biomarker for Development of Diabetes Insipidus Following Hypothalamic-Pituitary Surgery. Endocr Pract 2020; 27:463-470. [PMID: 33645512 DOI: 10.1016/j.eprac.2020.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/29/2020] [Accepted: 11/07/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Copeptin is a surrogate marker of arginine vasopressin release with better stability and simplicity of measurement. Postoperative copeptin levels may guide clinicians in stratifying patients who need close monitoring of fluid balance. The objective is to determine whether copeptin is a predictive marker of postoperative diabetes insipidus (DI). METHODS This is a prospective diagnostic study. Patients who underwent neurosurgical intervention of the sellar-suprasellar regions were recruited. Serum copeptin levels were measured before and after surgery, within 24 hours. Logistic regression analysis and diagnostic performance measures were calculated to determine the relationship between postoperative copeptin levels and DI. RESULTS Of 82 patients, 26 (31.7%) developed postoperative DI, with 7 patients (8.5%) having permanent DI. The samples for copeptin measurement were taken at 13 ± 2.1 hours postoperatively. From the receiver operating characteristic analysis, low postoperative copeptin levels (<2.5 pmol/L) demonstrated an acceptable ability to predict DI (area under the curve, 0.72; 95% CI, 0.60-0.84). Discriminative power was stronger in the permanent DI group (area under the curve, 0.82; 95% CI, 0.64-1.00). Postoperative copeptin levels <2.5 pmol/L were associated with DI (specificity > 91%). However, postoperative copeptin levels >20 pmol/L were rarely associated with DI, with a negative predictive value of 100%. CONCLUSIONS In patients undergoing sellar-suprasellar interventions, low postoperative copeptin levels within the first postoperative day predict postoperative DI, whereas high levels exclude it. Copeptin measurement should be applied in the clinical practice of postoperative care in patients following hypothalamic-pituitary surgery. This study may expand the potential use of copeptin, including in the Asian population.
Collapse
|
20
|
Drummond JB, Soares BS, Pedrosa W, Vieira ELM, Teixeira AL, Christ-Crain M, Ribeiro-Oliveira A. Copeptin response to hypoglycemic stress is linked to prolactin activation in children. Pituitary 2020; 23:681-690. [PMID: 32851504 DOI: 10.1007/s11102-020-01076-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE The physiological role of arginine vasopressin (AVP) in the acute stress response in humans and especially in children is unclear. The aim of this study was to explore the interaction between copeptin, a well-established surrogate marker of AVP release, and anterior pituitary hormone activation in response to acute hypoglycemic stress in children and adolescents. METHODS We conducted an exploratory single center study involving 77 children and adolescents undergoing insulin-induced hypoglycemia. Blood levels of copeptin, ACTH, cortisol, GH, prolactin, interleukin-6 (IL-6), adrenaline and noradrenaline were determined at baseline and after insulin-induced hypoglycemia. RESULTS Basal plasma levels of copeptin (median: 5.2 pmol/L) increased significantly after hypoglycemia (median 9.7 pmol/L; P < 0.0001). Subjects with insufficient HPA axis response or severe GH deficiency had lower hypoglycemia-induced copeptin increase (median: 2.3 pmol/L) compared with individuals with intact pituitary response (median: 5.2 pmol/L, P = 0.02). Copeptin increase correlated significantly with the maximal increase of ACTH (rs = 0.30; P = 0.010), cortisol (rs = 0.33; P = 0.003), prolactin (rs = 0.25; P = 0.03), IL-6 (rs = 0.35; P = 0.008) and with BMI-SDS (rs = - 0.28, P = 0.01). In multivariate regression analysis, prolactin increase was the only independent variable associated with copeptin increase (P = 0.0004). CONCLUSION Our data indicate that: (1) hypoglycemic stress elicits a marked copeptin response in children and adolescents, pointing out its role as an acute stress marker in this population; (2) stress-induced AVP/copeptin release is associated with anterior pituitary activation, mainly a prolactin response.
Collapse
Affiliation(s)
- Juliana B Drummond
- Laboratory of Endocrinology, Federal University of Minas Gerais, Av. Alfredo Balena, 190, Belo Horizonte, Minas Gerais, Brazil
| | - Beatriz S Soares
- Laboratory of Endocrinology, Federal University of Minas Gerais, Av. Alfredo Balena, 190, Belo Horizonte, Minas Gerais, Brazil
| | - William Pedrosa
- Hermes Pardini Institute, Belo Horizonte, Minas Gerais, Brazil
| | - Erica L M Vieira
- Interdisciplinary Laboratory of Medical Investigation, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Antonio L Teixeira
- Interdisciplinary Laboratory of Medical Investigation, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Immunopsychiatry Laboratory & Neuropsychiatry Program, Department of Psychiatry & Behavioral Science, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, USA
| | | | - Antonio Ribeiro-Oliveira
- Laboratory of Endocrinology, Federal University of Minas Gerais, Av. Alfredo Balena, 190, Belo Horizonte, Minas Gerais, Brazil.
| |
Collapse
|
21
|
Ebrahimi F, Kutz A, Wagner U, Illigens B, Siepmann T, Schuetz P, Christ-Crain M, Mueller B, Christ ER. Excess Mortality Among Hospitalized Patients With Hypopituitarism-A Population-Based, Matched-Cohort Study. J Clin Endocrinol Metab 2020; 105:5891746. [PMID: 32785679 DOI: 10.1210/clinem/dgaa517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/09/2020] [Indexed: 02/07/2023]
Abstract
CONTEXT Patients with hypopituitarism face excess mortality in the long-term outpatient setting. However, associations of pituitary dysfunction with outcomes in acutely hospitalized patients are lacking. OBJECTIVE The objective of this work is to assess clinical outcomes of hospitalized patients with hypopituitarism with or without diabetes insipidus (DI). DESIGN, SETTING, AND PATIENTS In this population-based, matched-cohort study from 2012 to 2017, hospitalized adult patients with a history of hypopituitarism were 1:1 propensity score-matched with a general medical inpatient cohort. MAIN OUTCOME MEASURES The primary outcome was in-hospital mortality. Secondary outcomes included all-cause readmission rates within 30 days and 1 year, intensive care unit (ICU) admission rates, and length of hospital stay. RESULTS After matching, 6764 cases were included in the study. In total, 3382 patients had hypopituitarism and of those 807 (24%) suffered from DI. All-cause in-hospital mortality occurred in 198 (5.9%) of patients with hypopituitarism and in 164 (4.9%) of matched controls (odds ratio [OR] 1.32, [95% CI, 1.06-1.65], P = .013). Increased mortality was primarily observed in patients with DI (OR 3.69 [95% CI, 2.44-5.58], P < .001). Patients with hypopituitarism had higher ICU admissions (OR 1.50 [95% CI, 1.30-1.74], P < .001), and faced a 2.4-day prolonged length of hospitalization (95% CI, 1.94-2.95, P < .001) compared to matched controls. Risk of 30-day (OR 1.31 [95% CI, 1.13-1.51], P < .001) and 1-year readmission (OR 1.29 [95% CI, 1.17-1.42], P < .001) was higher among patients with hypopituitarism as compared with medical controls. CONCLUSIONS Patients with hypopituitarism are highly vulnerable once hospitalized for acute medical conditions with increased risk of mortality and adverse clinical outcomes. This was most pronounced among those with DI.
Collapse
Affiliation(s)
- Fahim Ebrahimi
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
| | - Alexander Kutz
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Ulrich Wagner
- Foundation National Institute for Cancer Epidemiology and Registration (NICER) University of Zurich, Zurich, Switzerland
| | - Ben Illigens
- Division of Health Care Sciences Center for Clinical Research and Management Education Dresden, Dresden International University, Dresden, Germany
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Timo Siepmann
- Division of Health Care Sciences Center for Clinical Research and Management Education Dresden, Dresden International University, Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - Philipp Schuetz
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Mirjam Christ-Crain
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Beat Mueller
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Emanuel R Christ
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| |
Collapse
|
22
|
Patti G, Ibba A, Morana G, Napoli F, Fava D, di Iorgi N, Maghnie M. Central diabetes insipidus in children: Diagnosis and management. Best Pract Res Clin Endocrinol Metab 2020; 34:101440. [PMID: 32646670 DOI: 10.1016/j.beem.2020.101440] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Central diabetes insipidus (CDI) is a complex disorder in which large volumes of dilute urine are excreted due to arginine-vasopressin deficiency, and it is caused by a variety of conditions (genetic, congenital, inflammatory, neoplastic, traumatic) that arise mainly from the hypothalamus. The differential diagnosis between diseases presenting with polyuria and polydipsia is challenging and requires a detailed medical history, physical examination, biochemical approach, imaging studies and, in some cases, histological confirmation. Magnetic resonance imaging is the gold standard method for evaluating the sellar-suprasellar region in CDI. Pituitary stalk size at presentation is variable and can change over time, depending on the underlying condition, and other brain areas or other organs - in specific diseases - may become involved during follow up. An early diagnosis and treatment are preferable in order to avoid central nervous system damage and the risk of dissemination of germ cell tumor, or progression of Langerhans Cell Histiocytosis, and in order to start treatment of additional pituitary defects without further delay. This review focuses on current diagnostic work-up and on the role of neuroimaging in the differential diagnosis of CDI in children and adolescents. It provides an update on the best approach for diagnosis - including novel biochemical markers such as copeptin - treatment and follow up of children and adolescents with CDI; it also describes the best approach to challenging situations such as post-surgical patients, adipsic patients, patients undergoing chemotherapy and/or in critical care.
Collapse
MESH Headings
- Adolescent
- Age of Onset
- Biomarkers/analysis
- Brain/diagnostic imaging
- Brain/pathology
- Child
- Diabetes Insipidus, Neurogenic/diagnosis
- Diabetes Insipidus, Neurogenic/epidemiology
- Diabetes Insipidus, Neurogenic/etiology
- Diabetes Insipidus, Neurogenic/therapy
- Diagnosis, Differential
- Diagnostic Imaging/methods
- Diagnostic Imaging/trends
- Diagnostic Techniques, Endocrine/trends
- Histiocytosis, Langerhans-Cell/complications
- Histiocytosis, Langerhans-Cell/diagnosis
- Histiocytosis, Langerhans-Cell/epidemiology
- Histiocytosis, Langerhans-Cell/therapy
- Humans
- Magnetic Resonance Imaging
- Polydipsia/diagnosis
- Polydipsia/epidemiology
- Polydipsia/etiology
- Polydipsia/therapy
- Polyuria/diagnosis
- Polyuria/epidemiology
- Polyuria/etiology
- Polyuria/therapy
Collapse
Affiliation(s)
- Giuseppa Patti
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Anastasia Ibba
- SSD Endocrinologia Pediatrica, Ospedale Pediatrico Microcitemico "A. Cao", AO Brotzu, Cagliari, Italy
| | - Giovanni Morana
- Department of Neurosciences, University of Turin, Turin, Italy; Department of Neuroradiology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Flavia Napoli
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Daniela Fava
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Natascia di Iorgi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.
| |
Collapse
|
23
|
Abstract
The two main differential diagnoses of central diabetes insipidus are nephrogenic diabetes insipidus and primary polydipsia. Reliable distinction between those entities is essential as treatment differs substantially with the wrong treatment potentially leading to serious complications. Past diagnostic measures using the indirect water deprivation test had several pitfalls, resulting in a low diagnostic accuracy. With the introduction of copeptin, a stable and reliable surrogate marker for arginine vasopressin, diagnosis of diabetes insipidus was new evaluated. While unstimulated basal copeptin measurement reliably diagnoses nephrogenic diabetes insipidus, a stimulation test is needed to differentiate patients with central diabetes insipidus from patients with primary polydipsia. Stimulation can either be achieved through hypertonic saline infusion or arginine infusion. While the former showed high diagnostic accuracy and superiority over the indirect water deprivation test in a recent validation study, the diagnostic accuracy for arginine-stimulated copeptin was slightly lower, but superior in test tolerance. In summary of the recent findings, a new copeptin based diagnostic algorithm is proposed for the reliable diagnosis of diabetes insipidus.
Collapse
Affiliation(s)
- Julie Refardt
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Switzerland; University of Basel, Basel, Switzerland.
| |
Collapse
|
24
|
Christ-Crain M, Fenske WK. Copeptin in the differential diagnosis of hypotonic polyuria. J Endocrinol Invest 2020; 43:21-30. [PMID: 31368050 DOI: 10.1007/s40618-019-01087-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/17/2019] [Indexed: 11/26/2022]
Abstract
COPEPTIN Copeptin is secreted in equimolar amount to Arginine Vasopressin (AVP) but can easily be measured with a sandwich immunoassay. Both peptides, copeptin and AVP, show a high correlation. Accordingly, copeptin mirrors the amount of AVP in the circulation and its measurement provides an attractive marker in the differential diagnosis of diabetes insipidus. THE POLYURIA POLYDIPSIA SYNDROME Diabetes insipidus-either central or nephrogenic-has to be differentiated from primary polydipsia. Differentiation is crucial since wrong treatment can have deleterious consequences. Since many decades, the "gold standard" for differential diagnosis has been the classical water deprivation test, which has several limitations leading to an overall limited diagnostic accuracy. In addition, the test has a long duration of 17 hours and is cumbersome for patients. Clinical signs and symptoms as well as MRI characteristics overlap between patients with diabetes insipidus and primary polydipsia. Direct measurement of AVP upon osmotic stimulation was first shown to overcome these limitations, but failed to enter clinical practice mainly due to technical limitations of the AVP assay. COPEPTIN AS DIAGNOSTIC TOOL IN THE POLYURIA POLYDIPSIA SYNDROME We have recently shown that copeptin, without prior water deprivation, identifies patients with nephrogenic diabetes insipidus. On the other hand, for the more difficult differentiation between central diabetes insipidus and primary polydipsia, a copeptin level of 4.9 pmol/L stimulated with hypertonic saline infusion differentiates between these two entities with a high diagnostic accuracy, and is superior to the water deprivation test. It is important to note that close sodium monitoring during the hypertonic saline test is a prerequisite. CONCLUSION Therefore, we propose that copeptin upon hypertonic saline infusion should become the new standard test in the differential diagnosis of diabetes insipidus.
Collapse
Affiliation(s)
- M Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital of Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Medical Department III-Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, University Hospital Leipzig, Leipzig, Germany.
| | - W K Fenske
- Department of Endocrinology, Diabetology and Metabolism, University Hospital of Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Medical Department III-Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, University Hospital Leipzig, Leipzig, Germany.
| |
Collapse
|
25
|
Christ-Crain M. Diabetes Insipidus: New Concepts for Diagnosis. Neuroendocrinology 2020; 110:859-867. [PMID: 31986514 DOI: 10.1159/000505548] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/18/2019] [Indexed: 11/19/2022]
Abstract
Diabetes insipidus (DI), be it from central or from nephrogenic origin, has to be differentiated from primary polydipsia. This differentiation is crucial since wrong treatment can have dangerous consequences. For decades, the "gold standard" for differential diagnosis has been the standard water deprivation test. However, this test has several limitations leading to an overall limited diagnostic accuracy. In addition, the test has a long duration of 17 h and is cumbersome for patients. Also clinical signs and symptoms and MRI characteristics overlap between patients with DI and primary polydipsia. Direct measurement of arginine vasopressin (AVP) upon osmotic stimulation was first shown to overcome these limitations, but failed to enter clinical practice mainly due to technical limitations of the AVP assay. Copeptin is secreted in equimolar ratio to AVP, mirroring AVP concentrations in the circulation. We have shown that copeptin, without prior fluid deprivation, identifies patients with nephrogenic DI. For the more difficult differentiation between central DI and primary polydipsia, a copeptin level of 4.9 pmol/L stimulated with hypertonic saline infusion differentiates between these 2 entities with a high diagnostic accuracy and is superior to the water deprivation test. However, it is important to note that close and regular sodium monitoring every 30 min during the hypertonic saline test is a prerequisite, which is not possible in all hospitals. Furthermore, side effects are common. Therefore, a nonosmotic stimulation test would be advantageous. Arginine significantly stimulates copeptin and therefore is a novel, so far unknown stimulus of this peptide. Consequently, infusion of arginine with subsequent copeptin measurement was shown to be an even simpler and better tolerated test, but head to head comparison is still lacking.
Collapse
Affiliation(s)
- Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism University Hospital Basel, Basel, Switzerland,
- Department of Clinical Research, University of Basel, Basel, Switzerland,
| |
Collapse
|
26
|
Abstract
Arginine Vasopressin (AVP) and copeptin derive from the same precursor molecule. Due to the equimolar secretion, copeptin responds as rapidly as AVP to osmotic, hemodynamic and unspecific stress-related stimuli and both peptides show a very strong correlation. The physiological functions of AVP are homeostasis of fluid balance, vascular tonus and regulation of the endocrine stress response. In contrast, the exact function of copeptin remains unknown. Since copeptin, in contrast to AVP, can easily be measured with a sandwich immunoassay, its main function so far that it indirectly indicates the amount of AVP in the circulation. Copeptin has emerged as a useful measure in different diseases. On one hand, through its characteristics as a marker of stress, it provides a unique measure of the individual stress burden. As such, it is a prognostic marker in different acute diseases such as ischemic stroke or myocardial infarction. On the other side, it has emerged as a promising marker in the diagnosis of AVP-dependent fluid disorders. Copeptin reliably differentiates various entities of the polyuria polydipsia syndrome; baseline levels >20 pmol/L without prior fluid deprivation identify patients with nephrogenic diabetes insipidus, whereas levels measured upon osmotic stimulation with hypertonic saline or upon non-osmotic stimulation with arginine differentiate primary polydipsia from central diabetes insipidus. In patients with hyponatremia, low levels of copeptin together with low urine osmolality identify patients with primary polydipsia, but copeptin levels overlap in all other causes of hyponatremia, limiting its diagnostic use in hyponatremia. Copeptin has also been put forward as predictive marker for autosomal dominant polycystic kidney disease and for diabetes mellitus, but more studies are needed to confirm these findings.
Collapse
Affiliation(s)
- Mirjam Christ-Crain
- Department of Endocrinology, University hospital Basel, University of Basel, Basel, Switzerland.
| |
Collapse
|
27
|
Refardt J, Winzeler B, Christ-Crain M. Copeptin and its role in the diagnosis of diabetes insipidus and the syndrome of inappropriate antidiuresis. Clin Endocrinol (Oxf) 2019; 91:22-32. [PMID: 31004513 PMCID: PMC6850413 DOI: 10.1111/cen.13991] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/08/2019] [Accepted: 04/15/2019] [Indexed: 01/14/2023]
Abstract
Copeptin is secreted in an equimolar amount to arginine vasopressin (AVP) but can easily be measured in plasma or serum with a sandwich immunoassay. The main stimuli for copeptin are similar to AVP, that is an increase in osmolality and a decrease in arterial blood volume and pressure. A high correlation between copeptin and AVP has been shown. Accordingly, copeptin mirrors the amount of AVP in the circulation. Copeptin has, therefore, been evaluated as diagnostic biomarker in vasopressin-dependent disorders of body fluid homeostasis. Disorders of body fluid homeostasis are common and can be divided into hyper- and hypoosmolar circumstances: the classical hyperosmolar disorder is diabetes insipidus, while the most common hypoosmolar disorder is the syndrome of inappropriate antidiuresis (SIAD). Copeptin measurement has led to a "revival" of the direct test in the differential diagnosis of diabetes insipidus. Baseline copeptin levels, without prior thirsting, unequivocally identify patients with nephrogenic diabetes insipidus. In contrast, for the difficult differentiation between central diabetes insipidus and primary polydipsia, a stimulated copeptin level of 4.9 pmol/L upon hypertonic saline infusion differentiates these two entities with a high diagnostic accuracy and is clearly superior to the classical water deprivation test. On the contrary, in the SIAD, copeptin measurement is of only little diagnostic value. Copeptin levels widely overlap in patients with hyponatraemia and emphasize the heterogeneity of the disease. Additionally, a variety of factors lead to unspecific copeptin elevations in the acute setting further complicating its interpretation. The broad use of copeptin as diagnostic marker in hyponatraemia and specifically to detect cancer-related disease in SIADH patients can, therefore, not be recommended.
Collapse
Affiliation(s)
- Julie Refardt
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Bettina Winzeler
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
28
|
Turkson S, Kloster A, Hamilton PJ, Neigh GN. Neuroendocrine drivers of risk and resilience: The influence of metabolism & mitochondria. Front Neuroendocrinol 2019; 54:100770. [PMID: 31288042 PMCID: PMC6886586 DOI: 10.1016/j.yfrne.2019.100770] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/20/2019] [Accepted: 07/03/2019] [Indexed: 02/07/2023]
Abstract
The manifestation of risk versus resilience has been considered from varying perspectives including genetics, epigenetics, early life experiences, and type and intensity of the challenge with which the organism is faced. Although all of these factors are central to determining risk and resilience, the current review focuses on what may be a final common pathway: metabolism. When an organism is faced with a perturbation to the environment, whether internal or external, appropriate energy allocation is essential to resolving the divergence from equilibrium. This review examines the potential role of metabolism in the manifestation of stress-induced neural compromise. In addition, this review details the current state of knowledge on neuroendocrine factors which are poised to set the tone of the metabolic response to a systemic challenge. The goal is to provide an essential framework for understanding stress in a metabolic context and appreciation for key neuroendocrine signals.
Collapse
Affiliation(s)
- Susie Turkson
- Department of Anatomy & Neurobiology, Virginia Commonwealth University, Richmond, VA, United States
| | - Alix Kloster
- Department of Anatomy & Neurobiology, Virginia Commonwealth University, Richmond, VA, United States
| | - Peter J Hamilton
- Department of Anatomy & Neurobiology, Virginia Commonwealth University, Richmond, VA, United States
| | - Gretchen N Neigh
- Department of Anatomy & Neurobiology, Virginia Commonwealth University, Richmond, VA, United States.
| |
Collapse
|
29
|
Christ-Crain M. EJE AWARD 2019: New diagnostic approaches for patients with polyuria polydipsia syndrome. Eur J Endocrinol 2019; 181:R11-R21. [PMID: 31067508 PMCID: PMC6598864 DOI: 10.1530/eje-19-0163] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/08/2019] [Indexed: 02/02/2023]
Abstract
Diabetes insipidus (DI), be it from central or nephrogenic origin, must be differentiated from secondary forms of hypotonic polyuria such as primary polydipsia. Differentiation is crucial since wrong treatment can have deleterious consequences. Since decades, the gold standard for differentiation has been the water deprivation test, which has limitations leading to an overall unsatisfying diagnostic accuracy. Furthermore, it is cumbersome for patients with a long test duration. Clinical signs and symptoms and MRI characteristics overlap between patients with DI and primary polydipsia. The direct test including vasopressin (AVP) measurement upon osmotic stimulation was meant to overcome these limitations, but failed to enter clinical practice mainly due to technical constraints of the AVP assay. Copeptin is secreted in equimolar amount to AVP but can easily be measured with a sandwich immunoassay. A high correlation between copeptin and AVP has been shown. Accordingly, copeptin mirrors the amount of AVP in the circulation and has led to a 'revival' of the direct test in the differential diagnosis of DI. We have shown that a baseline copeptin, without prior thirsting, unequivocally identifies patients with nephrogenic DI. In contrast, for the differentiation between central DI and primary polydipsia, a stimulated copeptin level of 4.9 pmol/L upon hypertonic saline infusion differentiates these two entities with a high diagnostic accuracy and is superior to the water deprivation test. Close sodium monitoring during the test is a prerequisite. Further new test methods are currently evaluated and might provide an even simpler way of differential diagnosis in the future.
Collapse
Affiliation(s)
- Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism and Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Correspondence should be addressed to M Christ-Crain;
| |
Collapse
|
30
|
Garrahy A, Moran C, Thompson CJ. Diagnosis and management of central diabetes insipidus in adults. Clin Endocrinol (Oxf) 2019; 90:23-30. [PMID: 30269342 DOI: 10.1111/cen.13866] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 02/05/2023]
Abstract
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.
Collapse
Affiliation(s)
- Aoife Garrahy
- Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland
| | - Carla Moran
- Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland
| | - Christopher J Thompson
- Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland
| |
Collapse
|
31
|
Association between Serum Copeptin and Stroke in Rural Areas of Northern China: A Matched Case-Control Study. DISEASE MARKERS 2018; 2018:9316162. [PMID: 30402171 PMCID: PMC6193346 DOI: 10.1155/2018/9316162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/10/2018] [Accepted: 07/26/2018] [Indexed: 02/07/2023]
Abstract
Background Copeptin has been implicated as an effective prognostic biomarker of stroke outcome; however, few studies have investigated whether copeptin could be used as an etiological factor for stroke or not. The aim of our study was to evaluate the association of serum copeptin with stroke. Methods In total, 238 participants including 119 cases (87 ischemic stroke and 32 hemorrhagic stroke) and 119 controls were included in this 1 : 1 matched case-control study. Conditional multivariate logistic regression was conducted to assess the Odds Ratios (ORs) and 95% confidence intervals (CI); restricted cubic spline in logistic regression model was used to evaluate the dose-response association between serum copeptin and total stroke, ischemic stroke, and hemorrhagic stroke. Results The median serum copeptin was 20.90 pmol/L, 20.90 pmol/L, 6.53 pmol/L, and 8.42 pmol/L for total stroke, ischemic stroke, hemorrhagic stroke, and healthy subjects, respectively. The corresponding ORs (95% CIs) for the highest compared with the lowest quartile were 1.23 (0.62–2.44) for total stroke, 4.01 (1.47–10.96) for ischemic stroke, and 0.13 (0.22–0.69) for hemorrhagic stroke. No nonlinear dose-response relationship was found between serum copeptin and total stroke (Pnonlinear = 0.278), ischemic stroke (Pnonlinear = 0.362), and hemorrhagic stroke (Pnonlinear = 0.314). Compared with the reference copeptin level, a significantly increasing trend was found between serum copeptin and ischemic stroke (Poverall = 0.002), and a decreasing trend was found between serum copeptin and hemorrhagic stroke (Poverall = 0.007). Conclusions Elevated serum copeptin levels were positively associated with ischemic stroke and adversely associated with hemorrhagic stroke. Additional prospective studies with larger sample size are needed to confirm the present findings.
Collapse
|
32
|
Fenske WK, Schnyder I, Koch G, Walti C, Pfister M, Kopp P, Fassnacht M, Strauss K, Christ-Crain M. Release and Decay Kinetics of Copeptin vs AVP in Response to Osmotic Alterations in Healthy Volunteers. J Clin Endocrinol Metab 2018; 103:505-513. [PMID: 29267966 DOI: 10.1210/jc.2017-01891] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 12/12/2017] [Indexed: 12/29/2022]
Abstract
CONTEXT Copeptin is the C-terminal fragment of the arginine vasopressin (AVP) prohormone whose measurement is more robust than that of AVP. Similar release and clearance characteristics have been suggested promoting copeptin as a surrogate marker. OBJECTIVE To characterize the physiology of osmotically regulated copeptin release and its half-life in direct comparison with plasma AVP. DESIGN Ninety-one healthy volunteers underwent a standardized three-phase test protocol including (1) osmotic stimulation into the hypertonic range by hypertonic-saline infusion followed by osmotic suppression via (2) oral water load and (3) subsequent glucose infusion. Plasma copeptin, AVP, serum sodium, and osmolality levels were measured in regular intervals. RESULTS In phase 1, an increase in median osmotic pressure [289 (286; 291) to 311 (309; 314) mOsm/kg H2O] caused similar release kinetics of plasma copeptin [4 (3.1; 6) to 29.3 (18.6; 48.2) pmol/L] and AVP [1 (0.7; 1.6) to 10.3 (6.8; 18.8) pg/mL]. Subsequent osmotic suppression to 298 (295; 301) mOsm/kg at the end of phase 3 revealed markedly different decay kinetics between both peptides-an estimated initial half-life of copeptin being approximately 2 times longer than that of AVP (26 vs 12 minutes). CONCLUSION Copeptin is released in equimolar amounts with AVP in response to osmotic stimulation, suggesting its high potential as an AVP surrogate for differentiation of osmotic disorders. Furthermore, we here describe the decay kinetics of copeptin in response to osmotic depression enabling to identify a half-life for copeptin in direct comparison with AVP.
Collapse
Affiliation(s)
- Wiebke K Fenske
- Leipzig University Medical Center, Integrated Center for Research and Treatment Adiposity Diseases, Leipzig, Germany
- Internal Medicine (Endocrinology and Nephrology), University of Leipzig, Germany, Leipzig, Germany
| | - Ingeborg Schnyder
- Department of Endocrinology, Diabetology, and Metabolism, University Hospital of Basel, Basel, Switzerland
| | - Gilbert Koch
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital of Basel, Basel, Switzerland
| | - Carla Walti
- Department of Endocrinology, Diabetology, and Metabolism, University Hospital of Basel, Basel, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital of Basel, Basel, Switzerland
| | - Peter Kopp
- Division of Endocrinology, Metabolism, and Molecular Medicine and Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Konrad Strauss
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology, and Metabolism, University Hospital of Basel, Basel, Switzerland
| |
Collapse
|
33
|
Lewandowski KC, Lewiński A, Skowrońska-Jóźwiak E, Malicka K, Horzelski W, Brabant G. Copeptin as a marker of an altered CRH axis in pituitary disease. Endocrine 2017; 57:474-480. [PMID: 28795329 PMCID: PMC5573756 DOI: 10.1007/s12020-017-1366-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/27/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Copeptin (pre-proAVP) secreted in equimolar amounts with vasopressin closely reflects vasopressin release. Copeptin has been shown to subtly mirror stress potentially mediated via corticotrophin-releasing hormone. To further test a potential direct interaction of corticotrophin-releasing hormone with copeptin release, which could augment vasopressin effects on pituitary function, we investigated copeptin response to corticotrophin-releasing hormone. PATIENTS AND METHODS Cortisol, adrenocorticotropin and copeptin were measured in 18 healthy controls and 29 subjects with a history of pituitary disease during standard corticotrophin-releasing hormone test. RESULTS Patients with previous pituitary disease were subdivided in a group passing the test (P1, n = 20) and failing (P2, n = 9). The overall copeptin response was higher in controls than in subjects with pituitary disease (area under the curve, p = 0.04 for P1 + P2) with a maximum increase in controls from 3.84 ± 2.86 to 12.65 ± 24.87 pmol/L at 30 min, p < 0.05. In contrast, both groups of pituitary patients lacked a significant copeptin response to corticotrophin-releasing hormone, and even in P1, where adrenocorticotropin concentrations increased fourfold (mean, 21.48 vs. 91.53 pg/mL, p < 0.01), copeptin did not respond (e.g., 4.35 ± 5.81 vs. 5.36 ± 6.79 pmol/L, at 30 min, p = ns). CONCLUSIONS Corticotrophin-releasing hormone is able to stimulate copeptin release in healthy controls suggesting a direct interaction of corticotrophin-releasing hormone and vasopressin/vasopressin. Interestingly, this relation is altered already in the group of pituitary patients who pass the standard corticotrophin-releasing hormone test indicating (1) the corticotrophin-releasing hormone-adrenocorticotropin-cortisol response is largely independent from the vasopressin system, but (2) the corticotrophin-releasing hormone-vasopressin interaction reflected by copeptin may be much more sensitive to reveal subtle alterations in the regulation of pituitary function.
Collapse
Affiliation(s)
- Krzysztof C Lewandowski
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
- Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
- Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland
| | - Elżbieta Skowrońska-Jóźwiak
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
- Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland
| | | | - Wojciech Horzelski
- Faculty of Mathematics and Computer Science, University of Lodz, Lodz, Poland
| | - Georg Brabant
- Experimental and Clinical Endocrinology Med Clinic I, University of Luebeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| |
Collapse
|
34
|
Tang WZ, Wang XB, Li HT, Dong M, Ji X. Serum Copeptin Predicts Severity and Recurrent Stroke in Ischemic Stroke Patients. Neurotox Res 2017; 32:420-425. [PMID: 28555260 DOI: 10.1007/s12640-017-9754-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/09/2017] [Accepted: 05/16/2017] [Indexed: 11/25/2022]
Abstract
Several studies investigated the prognostic role of copeptin in stroke. The aim of this study is to assess copeptin levels in serum, and investigate their associations with risk of recurrent stroke in a 1-year follow-up study in patients with ischemic stroke. In this post hoc analysis, serum levels of copeptin and NIH stroke scale (NIHSS) were measured at the time of admission in a cohort of 316 patients with ischemic stroke. The end point was stroke recurrence after 1-year follow-up. We used logistic regression model to assess the relationship between copeptin levels and risk recurrent stroke. Logistic regression analysis considering traditional risk factors showed a relationship between serum copeptin levels and moderate-to-high clinical severity when serum copeptin was used as a continuous variable (OR, 1.05; 95% CI, 1.03-1.09). In the follow-up, 54 patients (17.1%) had a stroke recurrence. The stroke recurrence events distribution across the copeptin quartiles ranged between 5.1% (first quartile) to 23.1% (fourth quartile). In multivariate models comparing the third (OR = 2.78; 95% CI 1.85-3.53) and fourth quartiles (OR = 4.00; 95% CI 2.86-6.50) against the first quartile of the copeptin, levels of copeptin were associated with stroke recurrence events. A higher serum copeptin level is a predictor of both severity at admission and stroke recurrence at 1-year in stroke patients.
Collapse
Affiliation(s)
- Wan-Zhong Tang
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiao-Bo Wang
- Department of Geriatrics and Shandong Key Laboratory of Proteomics, Qilu Hospital of Shandong University, 107 Wenhuaxi, Road, Jinan, Shandong Province, 250012, China
| | - Huan-Ting Li
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mei Dong
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Xiang Ji
- Department of Geriatrics and Shandong Key Laboratory of Proteomics, Qilu Hospital of Shandong University, 107 Wenhuaxi, Road, Jinan, Shandong Province, 250012, China.
| |
Collapse
|
35
|
Salt Ö, Durukan P, Ozkan S, Saraymen R, Sen A, Yurci MA. Plasma copeptin levels in the patients with gastrointestinal bleeding. Am J Emerg Med 2017; 35:1440-1443. [PMID: 28431872 DOI: 10.1016/j.ajem.2017.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/10/2017] [Accepted: 04/13/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Gastrointestinal bleeding is a significant cause of morbidity and mortality worldwide. In addition, it constitutes an important part of health expenditures. In this study, we aimed to determine whether there is a relationship between plasma copeptin levels and the etiology, location and severity of gastrointestinal bleeding. MATERIALS AND METHODS This study was performed prospectively in 104 consecutive patients who were admitted to an emergency department with complaints of bloody vomiting or bloody or black stool. To evaluate the level of biochemical parameters such as Full Blood Count (FBC), serum biochemistry, bleeding parameters and copeptin, blood samples were obtained at admission. For the copeptin levels, 2 more blood samples were obtained at the 12th and 24th hours after admission. The values obtained were compared using statistical methods. RESULTS In terms of the etiology of bleeding, the copeptin levels in the patients with peptic ulcer were higher than the levels in patients with other gastrointestinal bleeding. However, the difference was not statistically significant. There were no significant differences among all groups' 0th, 12th and 24th hour levels of copeptin. DISCUSSION We conclude that copeptin cannot be effectively used as a biochemical parameter in an emergency department to determine the etiology and location of gastrointestinal bleeding. It can, however, be used to make decisions on endoscopy and the hospitalization of patients with suspected gastrointestinal bleeding.
Collapse
Affiliation(s)
- Ömer Salt
- Trakya University, Medical Faculty Hospital Department of Emergency Medicine, Edirne, Turkey.
| | - Polat Durukan
- Erciyes University, Medical Faculty Department of Emergency Medicine, Kayseri, Turkey
| | - S Ozkan
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Emergency Medicine, Ankara, Turkey
| | - R Saraymen
- Erciyes University, Medical Faculty Department of Biochemistry, Kayseri, Turkey
| | - A Sen
- Yuksekova State Hospital, Department of Biochemistry, Hakkari, Turkey
| | - M A Yurci
- Erciyes University, Medical Faculty Department of Gastroenterology, Kayseri, Turkey
| |
Collapse
|
36
|
Lewandowski KC, Lewiński A, Skowrońska-Jóźwiak E, Stasiak M, Horzelski W, Brabant G. Copeptin under glucagon stimulation. Endocrine 2016; 52:344-51. [PMID: 26578365 PMCID: PMC4824796 DOI: 10.1007/s12020-015-0783-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 10/20/2015] [Indexed: 12/05/2022]
Abstract
Stimulation of growth hormone (GH) and adrenocorticotropic hormone (ACTH) secretion by glucagon is a standard procedure to assess pituitary dysfunction but the pathomechanism of glucagon action remains unclear. As arginine vasopressin (AVP) may act on the release of both, GH and ACTH, we tested here the role of AVP in GST by measuring a stable precursor fragment, copeptin, which is stoichiometrically secreted with AVP in a 1:1 ratio. ACTH, cortisol, GH, and copeptin were measured at 0, 60, 90, 120, 150, and 180 min during GST in 79 subjects: healthy controls (Group 1, n = 32), subjects with pituitary disease, but with adequate cortisol and GH responses during GST (Group 2, n = 29), and those with overt hypopituitarism (Group 3, n = 18). Copeptin concentrations significantly increased over baseline 150 and 180 min following glucagon stimulation in controls and patients with intact pituitary function but not in hypopituitarism. Copeptin concentrations were stimulated over time and the maximal increment correlated with ACTH, while correlations between copeptin and GH were weaker. Interestingly, copeptin as well as GH secretion was significantly attenuated when comparing subjects within the highest to those in the lowest BMI quartile (p < 0.05). Copeptin is significantly released following glucagon stimulation. As this release is BMI-dependent, the time-dependent relation between copeptin and GH may be obscured, whereas the close relation to ACTH suggests that AVP/copeptin release might be linked to the activation of the adrenal axis.
Collapse
Affiliation(s)
- Krzysztof C Lewandowski
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
| | | | - Magdalena Stasiak
- Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland
| | - Wojciech Horzelski
- Faculty of Mathematics and Computer Science, University of Lodz, Lodz, Poland
| | - Georg Brabant
- Experimental and Clinical Endocrinology Med Clinic I, University of Luebeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
- Department of Endocrinology, The Christie Manchester Academic Health Science Centre, Wilmslow Rd, Manchester, M20 4BX, UK.
| |
Collapse
|
37
|
Christ-Crain M, Morgenthaler NG, Fenske W. Copeptin as a biomarker and a diagnostic tool in the evaluation of patients with polyuria-polydipsia and hyponatremia. Best Pract Res Clin Endocrinol Metab 2016; 30:235-47. [PMID: 27156761 DOI: 10.1016/j.beem.2016.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Copeptin is part of the 164 amino acid precursor protein preprovasopressin together with vasopressin and neurophysin II. During precursor processing, copeptin is released together with vasopressin. Copeptin concentrations respond as rapidly as vasopressin to changes in osmolality, a decrease in blood pressure or stress and there is a close correlation of vasopressin and copeptin concentrations. For these reasons, copeptin is propagated as a surrogate marker for vasopressin in the differential diagnosis of the polyuria-polydipsia syndromes and hyponatremia. Results of prospective studies show that a baseline copeptin level without prior fluid deprivation >20 pmol/L is able to identify patients with nephrogenic diabetes insipidus, whereas osmotically stimulated copeptin levels differentiate between patients with partial central diabetes insipidus and primary polydipsia with a high sensitivity and specificity >94%. In hyponatremia, low copeptin levels point to primary polydipsia and high levels to hypovolemic hyponatremia. The copeptin to urinary sodium ratio differentiates accurately between volume-depleted and normovolemic disorders.
Collapse
Affiliation(s)
- M Christ-Crain
- Department of Endocrinology, University Hospital Basel, University of Basel, Switzerland.
| | - N G Morgenthaler
- Institut für Experimentelle Endokrinologie, Charité-Universitätsmedizin-Berlin, Berlin, Germany.
| | - W Fenske
- Leipzig University Medical Center, Integrated Research and Treatment Center for Adiposity Diseases, Germany.
| |
Collapse
|
38
|
Christ-Crain M, Fenske W. Copeptin in the diagnosis of vasopressin-dependent disorders of fluid homeostasis. Nat Rev Endocrinol 2016; 12:168-76. [PMID: 26794439 DOI: 10.1038/nrendo.2015.224] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Copeptin and arginine vasopressin (AVP) are derived from a common precursor molecule and have equimolar secretion and response to osmotic, haemodynamic and stress-related stimuli. Plasma concentrations of copeptin and AVP in relation to serum osmolality are highly correlated. The physiological functions of AVP with respect to homeostasis of fluid balance, vascular tonus and regulation of the endocrine stress response are well known, but the exact function of copeptin is undetermined. Quantification of AVP can be difficult, but copeptin is stable in plasma and can be easily measured with a sandwich immunoassay. For this reason, copeptin has emerged as a promising marker for the diagnosis of AVP-dependent fluid disorders. Copeptin measurements can enable differentiation between various conditions within the polyuria-polydipsia syndrome. In the absence of prior fluid deprivation, baseline copeptin levels >20 pmol/l identify patients with nephrogenic diabetes insipidus. Conversely, copeptin levels measured upon osmotic stimulation differentiate primary polydipsia from partial central diabetes insipidus. In patients with hyponatraemia, low levels of copeptin together with low urine osmolality identify patients with primary polydipsia, and the ratio of copeptin to urinary sodium can distinguish the syndrome of inappropriate antidiuretic hormone secretion from other AVP-dependent forms of hyponatraemia.
Collapse
Affiliation(s)
- Mirjam Christ-Crain
- Department of Endocrinology, University Hospital Basel, University of Basel, Petersgraben 4, Basel CH-4031, Switzerland
| | - Wiebke Fenske
- Leipzig University Medical Center, Integrated Research and Treatment Center for Adiposity Diseases, Liebigstrasse 21, 04103 Leipzig, Germany
| |
Collapse
|
39
|
Association of HPA axis hormones with copeptin after psychological stress differs by sex. Psychoneuroendocrinology 2016; 63:254-61. [PMID: 26520685 PMCID: PMC4695232 DOI: 10.1016/j.psyneuen.2015.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/24/2015] [Accepted: 10/13/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Copeptin levels are elevated in severe medical conditions, an effect that is attributed to elevated arginine vasopressin (AVP) levels in response to physiological stress, resulting in activation of hypothalamus-pituitary-adrenal (HPA) axis. In the current study, we wanted to determine if copeptin is responsive to psychological stress, correlates with cortisol and adrenocorticotropin hormone (ACTH), and if associations differed by sex. MATERIALS AND METHODS In a cross-sectional study that included 100 healthy men (41%) and women (59%) (aged 18-30 years; mean 24.6 ± 3 years), who underwent the Trier Social Stress Test (TSST), we examined the association between percent change (peak-baseline/baseline) in copeptin levels and percent change in log ACTH and cortisol. Three baselines samples were drawn followed by blood sampling at 20, 35, 50, 65 and 85 min after TSST. RESULTS There was a significant positive association between the percent change in copeptin and the percent change in log-transformed salivary cortisol (β-coefficient=0.95; p=0.02). The association between percent change in copeptin and log-transformed serum cortisol was not statistically significant in the overall population. There was a trend for a non-significant association between percent change in copeptin and percent change in log-transformed ACTH (β-coefficient=1.14; p=0.06). In males, there was a significant positive association between the percent change in copeptin levels and log-transformed salivary (β-coefficient=1.33, p=0.016) and serum cortisol (β-coefficient=0.69, p=0.01), whereas in women there was no statistically significant association. CONCLUSIONS We found a significant positive association between percent change in copeptin and percent change in salivary and serum cortisol among males only.
Collapse
|
40
|
Greisenegger S, Segal HC, Burgess AI, Poole DL, Mehta Z, Rothwell PM. Copeptin and Long-Term Risk of Recurrent Vascular Events After Transient Ischemic Attack and Ischemic Stroke: Population-Based Study. Stroke 2015; 46:3117-23. [PMID: 26451023 DOI: 10.1161/strokeaha.115.011021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 09/15/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Copeptin, the c-terminal portion of provasopressin, is a useful prognostic marker in patients after myocardial infarction and heart failure. More recently, high levels of copeptin have also been associated with worse functional outcome and increased mortality within the first year after ischemic stroke and transient ischemic attack (TIA). However, to date, there are no published data on whether copeptin predicts long-term risk of vascular events after TIA and stroke. METHODS We measured copeptin levels in consecutive patients with TIA or ischemic stroke in a population-based study (Oxford Vascular Study) recruited from 2002 to 2007 and followed up to 2014. Associations with risk of recurrent vascular events were determined by Cox-regression. RESULTS During ≈6000 patient-years in 1076 patients, there were 357 recurrent vascular events, including 174 ischemic strokes. After adjustment for age, sex, and risk factors, copeptin was predictive of recurrent vascular events (adjusted hazard ratio per SD, 1.47; 95% confidence interval, 1.31-1.64; P=0.0001), vascular death (1.85; 1.60-2.14; P<0.0001), all-cause death (1.75; 1.58-1.93; P<0.0001), and recurrent ischemic stroke (1.22; 1.04-1.44; P=0.017); and improved model-discrimination significantly: net reclassification improvement for recurrent vascular events (32%; P<0.0001), vascular death (55%; P<0.0001), death (66%; P<0.0001), and recurrent stroke (16%; P=0.044). The predictive value of copeptin was largest in patients with cardioembolic index events (adjusted hazard ratio, 1.84; 95% confidence interval, 1.53-2.20 versus 1.31, 1.14-1.50 in noncardioembolic stroke; P=0.0025). In patients with cardioembolic stroke, high copeptin levels were associated with a 4-fold increased risk of vascular events within the first year of follow-up (adjusted hazard ratio, 4.02; 95% confidence interval, 2.13-7.70). CONCLUSIONS In patients with TIA and ischemic stroke, copeptin predicted recurrent vascular events and death, particularly after cardioembolic TIA/stroke. Further validation is required, in particular, in studies using more extensive cardiac evaluation.
Collapse
Affiliation(s)
- Stefan Greisenegger
- From the Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom (S.G., H.C.S., A.I.B., D.L.P., Z.M., .M.R.); and Department of Neurology, Medical University of Vienna, Vienna, Austria (S.G.)
| | - Helen C Segal
- From the Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom (S.G., H.C.S., A.I.B., D.L.P., Z.M., .M.R.); and Department of Neurology, Medical University of Vienna, Vienna, Austria (S.G.)
| | - Annette I Burgess
- From the Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom (S.G., H.C.S., A.I.B., D.L.P., Z.M., .M.R.); and Department of Neurology, Medical University of Vienna, Vienna, Austria (S.G.)
| | - Debbie L Poole
- From the Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom (S.G., H.C.S., A.I.B., D.L.P., Z.M., .M.R.); and Department of Neurology, Medical University of Vienna, Vienna, Austria (S.G.)
| | - Ziyah Mehta
- From the Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom (S.G., H.C.S., A.I.B., D.L.P., Z.M., .M.R.); and Department of Neurology, Medical University of Vienna, Vienna, Austria (S.G.)
| | - Peter M Rothwell
- From the Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom (S.G., H.C.S., A.I.B., D.L.P., Z.M., .M.R.); and Department of Neurology, Medical University of Vienna, Vienna, Austria (S.G.).
| |
Collapse
|
41
|
Łukaszyk E, Małyszko J. Copeptin: Pathophysiology and potential clinical impact. Adv Med Sci 2015; 60:335-41. [PMID: 26233637 DOI: 10.1016/j.advms.2015.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/29/2015] [Accepted: 07/02/2015] [Indexed: 12/24/2022]
Abstract
Copeptin, a C-terminal part of the precursor pre-provasopressin is a novel biomarker of arginine-vasopressin (AVP) system. Measurements of AVP concentration are not used in clinical practice because of technical difficulties. Copeptin is synthesized in stoichiometric ratio with AVP, hence it reflects vasopressin concentration in human plasma and serum. This review outlines current research concerning the role of copeptin as a prognostic marker in different diseases and its potential clinical value.
Collapse
|
42
|
Diabetes Insipidus after Traumatic Brain Injury. J Clin Med 2015; 4:1448-62. [PMID: 26239685 PMCID: PMC4519799 DOI: 10.3390/jcm4071448] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/14/2015] [Accepted: 06/19/2015] [Indexed: 02/03/2023] Open
Abstract
Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in many age groups. Neuroendocrine dysfunction has been recognized as a consequence of TBI and consists of both anterior and posterior pituitary insufficiency; water and electrolyte abnormalities (diabetes insipidus (DI) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH)) are amongst the most challenging sequelae. The acute head trauma can lead (directly or indirectly) to dysfunction of the hypothalamic neurons secreting antidiuretic hormone (ADH) or of the posterior pituitary gland causing post-traumatic DI (PTDI). PTDI is usually diagnosed in the first days after the trauma presenting with hypotonic polyuria. Frequently, the poor general status of most patients prevents adequate fluid intake to compensate the losses and severe dehydration and hypernatremia occur. Management consists of careful monitoring of fluid balance and hormonal replacement. PTDI is associated with high mortality, particularly when presenting very early following the injury. In many surviving patients, the PTDI is transient, lasting a few days to a few weeks and in a minority of cases, it is permanent requiring management similar to that offered to patients with non-traumatic central DI.
Collapse
|
43
|
Sleep apnea and night-time hypertension: a role for the vasopressin system? J Hypertens 2015; 33:1524-7. [PMID: 26132756 DOI: 10.1097/hjh.0000000000000676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
44
|
Sun H, Sun T, Ma B, Yang BW, Zhang Y, Huang DH, Shi JP. Prediction of all-cause mortality with copeptin in cardio-cerebrovascular patients: A meta-analysis of prospective studies. Peptides 2015; 69:9-18. [PMID: 25849342 DOI: 10.1016/j.peptides.2015.03.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/08/2015] [Accepted: 03/12/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Measurement of the biomarker copeptin may help identify disease severity and risk of mortality for a various diseases. This study sought to determine the relationship between copeptin and all-cause mortality of patients with cardio-cerebrovascular disease. METHODS Database of Medline and Web of Science were searched for studies with data involving the baseline copeptin levels and subsequent all-cause mortality outcomes. The pooled HRs of all-cause mortality were calculated and presented with 95%CIs. Subgroup analysis and sensitivity analysis were conducted to explore the possible sources of heterogeneity. RESULTS Data from 14,395 participants were derived from 28 prospective studies. Higher copeptin significantly increased the risk of all-cause mortality (per unit copeptin: HR=1.020, 95%CI=1.004-1.036; log unit copeptin: HR=2.884, 95%CI=1.844-4.512; categorical copeptin: HR=3.371, 95%CI=2.077-5.472). Subgroup analysis indicated that the risk of all-cause death was higher in cerebrovascular patients (per unit copeptin: HR=2.537, 95%CI=0.956-6.731; log unit copeptin: HR=3.419, 95%CI=2.391-4.888) than cardiovascular patients (per unit copeptin: HR=1.011, 95%CI=1.002-1.020; log unit copeptin: HR=2.009, 95%CI=1.119-3.608). CONCLUSION Copeptin is associated with all-cause mortality of patients with cardiovascular and cerebrovascular disease. Our study suggests that copeptin seems to be a promising novel biomarker for prediction of mortality in cardio-cerebrovascular patients, especially for cerebrovascular patients.
Collapse
Affiliation(s)
- Hao Sun
- Department of Clinical Epidemiology and Evidence-based Medicine, First Affiliated Hospital, China Medical University, Shenyang 110001, China; Institute of Cardiovascular Diseases, First Affiliated Hospital, China Medical University, Shenyang 110001, China; Center of Evidence Based Medicine, Liaoning Province & China Medical University, Shenyang 110001, China.
| | - Ting Sun
- Department of Clinical Epidemiology and Evidence-based Medicine, First Affiliated Hospital, China Medical University, Shenyang 110001, China; Institute of Cardiovascular Diseases, First Affiliated Hospital, China Medical University, Shenyang 110001, China; Center of Evidence Based Medicine, Liaoning Province & China Medical University, Shenyang 110001, China.
| | - Bing Ma
- Department of Clinical Epidemiology and Evidence-based Medicine, First Affiliated Hospital, China Medical University, Shenyang 110001, China; Institute of Cardiovascular Diseases, First Affiliated Hospital, China Medical University, Shenyang 110001, China; Center of Evidence Based Medicine, Liaoning Province & China Medical University, Shenyang 110001, China.
| | - Bo-wen Yang
- Department of Clinical Epidemiology and Evidence-based Medicine, First Affiliated Hospital, China Medical University, Shenyang 110001, China; Institute of Cardiovascular Diseases, First Affiliated Hospital, China Medical University, Shenyang 110001, China; Center of Evidence Based Medicine, Liaoning Province & China Medical University, Shenyang 110001, China.
| | - Yao Zhang
- Department of Clinical Epidemiology and Evidence-based Medicine, First Affiliated Hospital, China Medical University, Shenyang 110001, China; Institute of Cardiovascular Diseases, First Affiliated Hospital, China Medical University, Shenyang 110001, China; Center of Evidence Based Medicine, Liaoning Province & China Medical University, Shenyang 110001, China.
| | - Dong-hui Huang
- Department of Clinical Epidemiology and Evidence-based Medicine, First Affiliated Hospital, China Medical University, Shenyang 110001, China; Institute of Cardiovascular Diseases, First Affiliated Hospital, China Medical University, Shenyang 110001, China; Center of Evidence Based Medicine, Liaoning Province & China Medical University, Shenyang 110001, China.
| | - Jing-pu Shi
- Department of Clinical Epidemiology and Evidence-based Medicine, First Affiliated Hospital, China Medical University, Shenyang 110001, China; Institute of Cardiovascular Diseases, First Affiliated Hospital, China Medical University, Shenyang 110001, China; Center of Evidence Based Medicine, Liaoning Province & China Medical University, Shenyang 110001, China.
| |
Collapse
|
45
|
Timper K, Fenske W, Kühn F, Frech N, Arici B, Rutishauser J, Kopp P, Allolio B, Stettler C, Müller B, Katan M, Christ-Crain M. Diagnostic Accuracy of Copeptin in the Differential Diagnosis of the Polyuria-polydipsia Syndrome: A Prospective Multicenter Study. J Clin Endocrinol Metab 2015; 100:2268-74. [PMID: 25768671 DOI: 10.1210/jc.2014-4507] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT The polyuria-polydipsia syndrome comprises primary polydipsia (PP) and central and nephrogenic diabetes insipidus (DI). Correctly discriminating these entities is mandatory, given that inadequate treatment causes serious complications. The diagnostic "gold standard" is the water deprivation test with assessment of arginine vasopressin (AVP) activity. However, test interpretation and AVP measurement are challenging. OBJECTIVE The objective was to evaluate the accuracy of copeptin, a stable peptide stoichiometrically cosecreted with AVP, in the differential diagnosis of polyuria-polydipsia syndrome. DESIGN, SETTING, AND PATIENTS This was a prospective multicenter observational cohort study from four Swiss or German tertiary referral centers of adults >18 years old with the history of polyuria and polydipsia. MEASUREMENTS A standardized combined water deprivation/3% saline infusion test was performed and terminated when serum sodium exceeded 147 mmol/L. Circulating copeptin and AVP levels were measured regularly throughout the test. Final diagnosis was based on the water deprivation/saline infusion test results, clinical information, and the treatment response. RESULTS Fifty-five patients were enrolled (11 with complete central DI, 16 with partial central DI, 18 with PP, and 10 with nephrogenic DI). Without prior thirsting, a single baseline copeptin level >21.4 pmol/L differentiated nephrogenic DI from other etiologies with a 100% sensitivity and specificity, rendering a water deprivation testing unnecessary in such cases. A stimulated copeptin >4.9 pmol/L (at sodium levels >147 mmol/L) differentiated between patients with PP and patients with partial central DI with a 94.0% specificity and a 94.4% sensitivity. A stimulated AVP >1.8 pg/mL differentiated between the same categories with a 93.0% specificity and a 83.0% sensitivity. LIMITATION This study was limited by incorporation bias from including AVP levels as a diagnostic criterion. CONCLUSION Copeptin is a promising new tool in the differential diagnosis of the polyuria-polydipsia syndrome, and a valid surrogate marker for AVP. Primary Funding Sources: Swiss National Science Foundation, University of Basel.
Collapse
Affiliation(s)
- Katharina Timper
- Clinic of Endocrinology, Diabetes and Metabolism, Department of Clinical Research (K.T., N.F., M.C.-C.), University Hospital Basel, CH-4031 Basel, Switzerland; Integrated Research and Treatment Center for Adiposity Diseases (W.F.), Leipzig University Medical Center, 04103 Leipzig, Germany; Division of Endocrinology, Diabetes and Clinical Nutrition (F.K., C.S.), University Hospital Bern-Inselspital, CH-3010 Bern, Switzerland; Department of Internal Medicine (B.Ar.), Spital Rheinfelden, CH-4310 Rheinfelden, Switzerland; University Clinic of Internal Medicine (J.R.), Kantonsspital Baselland, CH-4101 Binningen, Switzerland; Division of Endocrinology, Metabolism and Molecular Medicine and Center for Genetic Medicine (P.K.), Northwestern University, Chicago, Illinois 60611; Department of Internal Medicine I, Endocrine and Diabetes Unit (B.Al.), University Hospital Würzburg, 97080 Würzburg, Germany; Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic (B.M.), Kantonsspital Aarau, CH-5001 Aarau, Switzerland; and Department of Neurology (M.K.), University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Wiebke Fenske
- Clinic of Endocrinology, Diabetes and Metabolism, Department of Clinical Research (K.T., N.F., M.C.-C.), University Hospital Basel, CH-4031 Basel, Switzerland; Integrated Research and Treatment Center for Adiposity Diseases (W.F.), Leipzig University Medical Center, 04103 Leipzig, Germany; Division of Endocrinology, Diabetes and Clinical Nutrition (F.K., C.S.), University Hospital Bern-Inselspital, CH-3010 Bern, Switzerland; Department of Internal Medicine (B.Ar.), Spital Rheinfelden, CH-4310 Rheinfelden, Switzerland; University Clinic of Internal Medicine (J.R.), Kantonsspital Baselland, CH-4101 Binningen, Switzerland; Division of Endocrinology, Metabolism and Molecular Medicine and Center for Genetic Medicine (P.K.), Northwestern University, Chicago, Illinois 60611; Department of Internal Medicine I, Endocrine and Diabetes Unit (B.Al.), University Hospital Würzburg, 97080 Würzburg, Germany; Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic (B.M.), Kantonsspital Aarau, CH-5001 Aarau, Switzerland; and Department of Neurology (M.K.), University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Felix Kühn
- Clinic of Endocrinology, Diabetes and Metabolism, Department of Clinical Research (K.T., N.F., M.C.-C.), University Hospital Basel, CH-4031 Basel, Switzerland; Integrated Research and Treatment Center for Adiposity Diseases (W.F.), Leipzig University Medical Center, 04103 Leipzig, Germany; Division of Endocrinology, Diabetes and Clinical Nutrition (F.K., C.S.), University Hospital Bern-Inselspital, CH-3010 Bern, Switzerland; Department of Internal Medicine (B.Ar.), Spital Rheinfelden, CH-4310 Rheinfelden, Switzerland; University Clinic of Internal Medicine (J.R.), Kantonsspital Baselland, CH-4101 Binningen, Switzerland; Division of Endocrinology, Metabolism and Molecular Medicine and Center for Genetic Medicine (P.K.), Northwestern University, Chicago, Illinois 60611; Department of Internal Medicine I, Endocrine and Diabetes Unit (B.Al.), University Hospital Würzburg, 97080 Würzburg, Germany; Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic (B.M.), Kantonsspital Aarau, CH-5001 Aarau, Switzerland; and Department of Neurology (M.K.), University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Nica Frech
- Clinic of Endocrinology, Diabetes and Metabolism, Department of Clinical Research (K.T., N.F., M.C.-C.), University Hospital Basel, CH-4031 Basel, Switzerland; Integrated Research and Treatment Center for Adiposity Diseases (W.F.), Leipzig University Medical Center, 04103 Leipzig, Germany; Division of Endocrinology, Diabetes and Clinical Nutrition (F.K., C.S.), University Hospital Bern-Inselspital, CH-3010 Bern, Switzerland; Department of Internal Medicine (B.Ar.), Spital Rheinfelden, CH-4310 Rheinfelden, Switzerland; University Clinic of Internal Medicine (J.R.), Kantonsspital Baselland, CH-4101 Binningen, Switzerland; Division of Endocrinology, Metabolism and Molecular Medicine and Center for Genetic Medicine (P.K.), Northwestern University, Chicago, Illinois 60611; Department of Internal Medicine I, Endocrine and Diabetes Unit (B.Al.), University Hospital Würzburg, 97080 Würzburg, Germany; Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic (B.M.), Kantonsspital Aarau, CH-5001 Aarau, Switzerland; and Department of Neurology (M.K.), University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Birsen Arici
- Clinic of Endocrinology, Diabetes and Metabolism, Department of Clinical Research (K.T., N.F., M.C.-C.), University Hospital Basel, CH-4031 Basel, Switzerland; Integrated Research and Treatment Center for Adiposity Diseases (W.F.), Leipzig University Medical Center, 04103 Leipzig, Germany; Division of Endocrinology, Diabetes and Clinical Nutrition (F.K., C.S.), University Hospital Bern-Inselspital, CH-3010 Bern, Switzerland; Department of Internal Medicine (B.Ar.), Spital Rheinfelden, CH-4310 Rheinfelden, Switzerland; University Clinic of Internal Medicine (J.R.), Kantonsspital Baselland, CH-4101 Binningen, Switzerland; Division of Endocrinology, Metabolism and Molecular Medicine and Center for Genetic Medicine (P.K.), Northwestern University, Chicago, Illinois 60611; Department of Internal Medicine I, Endocrine and Diabetes Unit (B.Al.), University Hospital Würzburg, 97080 Würzburg, Germany; Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic (B.M.), Kantonsspital Aarau, CH-5001 Aarau, Switzerland; and Department of Neurology (M.K.), University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Jonas Rutishauser
- Clinic of Endocrinology, Diabetes and Metabolism, Department of Clinical Research (K.T., N.F., M.C.-C.), University Hospital Basel, CH-4031 Basel, Switzerland; Integrated Research and Treatment Center for Adiposity Diseases (W.F.), Leipzig University Medical Center, 04103 Leipzig, Germany; Division of Endocrinology, Diabetes and Clinical Nutrition (F.K., C.S.), University Hospital Bern-Inselspital, CH-3010 Bern, Switzerland; Department of Internal Medicine (B.Ar.), Spital Rheinfelden, CH-4310 Rheinfelden, Switzerland; University Clinic of Internal Medicine (J.R.), Kantonsspital Baselland, CH-4101 Binningen, Switzerland; Division of Endocrinology, Metabolism and Molecular Medicine and Center for Genetic Medicine (P.K.), Northwestern University, Chicago, Illinois 60611; Department of Internal Medicine I, Endocrine and Diabetes Unit (B.Al.), University Hospital Würzburg, 97080 Würzburg, Germany; Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic (B.M.), Kantonsspital Aarau, CH-5001 Aarau, Switzerland; and Department of Neurology (M.K.), University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Peter Kopp
- Clinic of Endocrinology, Diabetes and Metabolism, Department of Clinical Research (K.T., N.F., M.C.-C.), University Hospital Basel, CH-4031 Basel, Switzerland; Integrated Research and Treatment Center for Adiposity Diseases (W.F.), Leipzig University Medical Center, 04103 Leipzig, Germany; Division of Endocrinology, Diabetes and Clinical Nutrition (F.K., C.S.), University Hospital Bern-Inselspital, CH-3010 Bern, Switzerland; Department of Internal Medicine (B.Ar.), Spital Rheinfelden, CH-4310 Rheinfelden, Switzerland; University Clinic of Internal Medicine (J.R.), Kantonsspital Baselland, CH-4101 Binningen, Switzerland; Division of Endocrinology, Metabolism and Molecular Medicine and Center for Genetic Medicine (P.K.), Northwestern University, Chicago, Illinois 60611; Department of Internal Medicine I, Endocrine and Diabetes Unit (B.Al.), University Hospital Würzburg, 97080 Würzburg, Germany; Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic (B.M.), Kantonsspital Aarau, CH-5001 Aarau, Switzerland; and Department of Neurology (M.K.), University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Bruno Allolio
- Clinic of Endocrinology, Diabetes and Metabolism, Department of Clinical Research (K.T., N.F., M.C.-C.), University Hospital Basel, CH-4031 Basel, Switzerland; Integrated Research and Treatment Center for Adiposity Diseases (W.F.), Leipzig University Medical Center, 04103 Leipzig, Germany; Division of Endocrinology, Diabetes and Clinical Nutrition (F.K., C.S.), University Hospital Bern-Inselspital, CH-3010 Bern, Switzerland; Department of Internal Medicine (B.Ar.), Spital Rheinfelden, CH-4310 Rheinfelden, Switzerland; University Clinic of Internal Medicine (J.R.), Kantonsspital Baselland, CH-4101 Binningen, Switzerland; Division of Endocrinology, Metabolism and Molecular Medicine and Center for Genetic Medicine (P.K.), Northwestern University, Chicago, Illinois 60611; Department of Internal Medicine I, Endocrine and Diabetes Unit (B.Al.), University Hospital Würzburg, 97080 Würzburg, Germany; Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic (B.M.), Kantonsspital Aarau, CH-5001 Aarau, Switzerland; and Department of Neurology (M.K.), University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Christoph Stettler
- Clinic of Endocrinology, Diabetes and Metabolism, Department of Clinical Research (K.T., N.F., M.C.-C.), University Hospital Basel, CH-4031 Basel, Switzerland; Integrated Research and Treatment Center for Adiposity Diseases (W.F.), Leipzig University Medical Center, 04103 Leipzig, Germany; Division of Endocrinology, Diabetes and Clinical Nutrition (F.K., C.S.), University Hospital Bern-Inselspital, CH-3010 Bern, Switzerland; Department of Internal Medicine (B.Ar.), Spital Rheinfelden, CH-4310 Rheinfelden, Switzerland; University Clinic of Internal Medicine (J.R.), Kantonsspital Baselland, CH-4101 Binningen, Switzerland; Division of Endocrinology, Metabolism and Molecular Medicine and Center for Genetic Medicine (P.K.), Northwestern University, Chicago, Illinois 60611; Department of Internal Medicine I, Endocrine and Diabetes Unit (B.Al.), University Hospital Würzburg, 97080 Würzburg, Germany; Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic (B.M.), Kantonsspital Aarau, CH-5001 Aarau, Switzerland; and Department of Neurology (M.K.), University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Beat Müller
- Clinic of Endocrinology, Diabetes and Metabolism, Department of Clinical Research (K.T., N.F., M.C.-C.), University Hospital Basel, CH-4031 Basel, Switzerland; Integrated Research and Treatment Center for Adiposity Diseases (W.F.), Leipzig University Medical Center, 04103 Leipzig, Germany; Division of Endocrinology, Diabetes and Clinical Nutrition (F.K., C.S.), University Hospital Bern-Inselspital, CH-3010 Bern, Switzerland; Department of Internal Medicine (B.Ar.), Spital Rheinfelden, CH-4310 Rheinfelden, Switzerland; University Clinic of Internal Medicine (J.R.), Kantonsspital Baselland, CH-4101 Binningen, Switzerland; Division of Endocrinology, Metabolism and Molecular Medicine and Center for Genetic Medicine (P.K.), Northwestern University, Chicago, Illinois 60611; Department of Internal Medicine I, Endocrine and Diabetes Unit (B.Al.), University Hospital Würzburg, 97080 Würzburg, Germany; Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic (B.M.), Kantonsspital Aarau, CH-5001 Aarau, Switzerland; and Department of Neurology (M.K.), University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Mira Katan
- Clinic of Endocrinology, Diabetes and Metabolism, Department of Clinical Research (K.T., N.F., M.C.-C.), University Hospital Basel, CH-4031 Basel, Switzerland; Integrated Research and Treatment Center for Adiposity Diseases (W.F.), Leipzig University Medical Center, 04103 Leipzig, Germany; Division of Endocrinology, Diabetes and Clinical Nutrition (F.K., C.S.), University Hospital Bern-Inselspital, CH-3010 Bern, Switzerland; Department of Internal Medicine (B.Ar.), Spital Rheinfelden, CH-4310 Rheinfelden, Switzerland; University Clinic of Internal Medicine (J.R.), Kantonsspital Baselland, CH-4101 Binningen, Switzerland; Division of Endocrinology, Metabolism and Molecular Medicine and Center for Genetic Medicine (P.K.), Northwestern University, Chicago, Illinois 60611; Department of Internal Medicine I, Endocrine and Diabetes Unit (B.Al.), University Hospital Würzburg, 97080 Würzburg, Germany; Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic (B.M.), Kantonsspital Aarau, CH-5001 Aarau, Switzerland; and Department of Neurology (M.K.), University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Mirjam Christ-Crain
- Clinic of Endocrinology, Diabetes and Metabolism, Department of Clinical Research (K.T., N.F., M.C.-C.), University Hospital Basel, CH-4031 Basel, Switzerland; Integrated Research and Treatment Center for Adiposity Diseases (W.F.), Leipzig University Medical Center, 04103 Leipzig, Germany; Division of Endocrinology, Diabetes and Clinical Nutrition (F.K., C.S.), University Hospital Bern-Inselspital, CH-3010 Bern, Switzerland; Department of Internal Medicine (B.Ar.), Spital Rheinfelden, CH-4310 Rheinfelden, Switzerland; University Clinic of Internal Medicine (J.R.), Kantonsspital Baselland, CH-4101 Binningen, Switzerland; Division of Endocrinology, Metabolism and Molecular Medicine and Center for Genetic Medicine (P.K.), Northwestern University, Chicago, Illinois 60611; Department of Internal Medicine I, Endocrine and Diabetes Unit (B.Al.), University Hospital Würzburg, 97080 Würzburg, Germany; Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic (B.M.), Kantonsspital Aarau, CH-5001 Aarau, Switzerland; and Department of Neurology (M.K.), University Hospital Zurich, CH-8091 Zurich, Switzerland
| |
Collapse
|
46
|
Bolignano D, Cabassi A, Fiaccadori E, Ghigo E, Pasquali R, Peracino A, Peri A, Plebani M, Santoro A, Settanni F, Zoccali C. Copeptin (CTproAVP), a new tool for understanding the role of vasopressin in pathophysiology. Clin Chem Lab Med 2015; 52:1447-56. [PMID: 24940718 DOI: 10.1515/cclm-2014-0379] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/14/2014] [Indexed: 01/17/2023]
Abstract
Arginine vasopressin (AVP) plays a key role in many physiologic and pathologic processes. The most important stimulus for AVP release is a change in plasma osmolality. AVP is also involved in the response and adaptation to stress. Reliable measurement of AVP is hindered by several factors. Over 90% of AVP is tightly bound to platelets, and its estimation is influenced by the number of platelets, incomplete removal of platelets or pre-analytical processing steps. Copeptin (CTproAVP), a 39-aminoacid glycopeptide, is a C-terminal part of the precursor pre-provasopressin (pre-proAVP). Activation of the AVP system stimulates CTproAVP secretion into the circulation from the posterior pituitary gland in equimolar amounts with AVP. Therefore CTproAVP directly reflects AVP concentration and can be used as a surrogate biomarker of AVP secretion. In many studies CTproAVP represents AVP levels and its behavior represents changes in plasma osmolality, stress and various disease states, and shows some of the various physiologic and pathophysiologic conditions associated with increased or decreased AVP. Increased CTproAVP concentration is described in several studies as a strong predictor of mortality in patients with chronic heart failure and acute heart failure. Autosomal polycystic kidney disease (ADPKD) patients have both central and nephrogenic defects in osmoregulation and CTproAVP balance. A possibility raised by these clinical observations is that CTproAVP may serve to identify patients who could benefit from an intervention aimed at countering AVP.
Collapse
|
47
|
Kacheva S, Kolk K, Morgenthaler NG, Brabant G, Karges W. Gender-specific co-activation of arginine vasopressin and the hypothalamic-pituitary-adrenal axis during stress. Clin Endocrinol (Oxf) 2015; 82:570-6. [PMID: 25200793 DOI: 10.1111/cen.12608] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/21/2014] [Accepted: 09/01/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To study the interaction between copeptin and hypothalamic-pituitary-adrenal (HPA) activation in men and women during hypoglycaemic stress. DESIGN AND PATIENTS A prospective study in 118 patients (mean age 47·7 ± 13·6 years, n = 52 women) undergoing insulin tolerance testing for suspected pituitary dysfunction. MEASUREMENTS Serum copeptin was measured in serially collected blood samples and assessed in relation to ACTH, cortisol and other endocrine parameters. RESULTS Symptomatic hypoglycaemia (mean glucose nadir, 1·6 ± 0·5 mmol/l) resulted in a rapid significant increase of serum copeptin. Individuals with impaired pituitary function had lower stress-induced copeptin levels (median, 6·26 pmol/l) than patients with intact pituitary (8·46 pmol/l, P < 0·001). A weak overall correlation between stress-induced copeptin and cortisol levels was observed (rs = 0·31, P < 0·001). In female individuals, there was a positive correlation between stress-induced copeptin and ACTH (rs = 0·47, P < 0·001) or cortisol levels (rs = 0·42, P = 0·002), while in males, no correlation with ACTH levels (rs = 0·03, P = 0·75) and poor correlation with cortisol levels (rs = 0·24, P = 0·045) was observed. Patients with central diabetes insipidus showed lowest baseline (2·20 pmol/l) and stimulated copeptin levels (3·68 pmol/l). CONCLUSIONS The data from this study indicate that stress-induced release of AVP in women, but not in men, is linked to the co-activation of the hypothalamic-pituitary-adrenal system.
Collapse
Affiliation(s)
- S Kacheva
- Division of Endocrinology and Diabetes, University Hospital, RWTH Aachen University, Aachen, Germany
| | | | | | | | | |
Collapse
|
48
|
Jiang L, Feng B, Gao D, Zhang Y. Plasma concentrations of copeptin, C-reactive protein and procalcitonin are positively correlated with APACHE II scores in patients with sepsis. J Int Med Res 2015; 43:188-95. [PMID: 25691533 DOI: 10.1177/0300060514561136] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To evaluate the correlation between Acute Physiology and Chronic Health Evaluation II (APACHE II) score and plasma concentrations of copeptin, C-reactive protein (CRP) and procalcitonin in patients with sepsis. METHODS Patients with sepsis were prospectively enrolled. APACHE II scores were determined during the first 24 h after admission to the intensive care unit. Plasma copeptin, CRP and procalcitonin were quantified at admission, 24 h, 48 h, and 72 h. Survival at 28 days after admission was recorded. RESULTS APACHE II score was significantly positively correlated with plasma copeptin, CRP and procalcitonin concentrations. Survivors (n = 15) had significantly lower APACHE II scores and copeptin, CRP and procalcitonin concentrations than nonsurvivors (n = 26). APACHE II score, copeptin at 72 h, CRP at 48 h and procalcitonin at 24 h were independent risk factors for death. CONCLUSION Plasma copeptin, CRP and procalcitonin concentrations were positively correlated with APACHE II score in patients with sepsis, and reflected disease severity.
Collapse
Affiliation(s)
- Li Jiang
- Emergency Department, The first affiliated Hospital of DaLian Medical University, DaLian, China
| | - Bing Feng
- Emergency Department, The first affiliated Hospital of DaLian Medical University, DaLian, China
| | - Dongna Gao
- Emergency Department, The first affiliated Hospital of DaLian Medical University, DaLian, China
| | - Yu Zhang
- Emergency Department, The first affiliated Hospital of DaLian Medical University, DaLian, China
| |
Collapse
|
49
|
Siegenthaler J, Walti C, Urwyler SA, Schuetz P, Christ-Crain M. Copeptin concentrations during psychological stress: the PsyCo study. Eur J Endocrinol 2014; 171:737-42. [PMID: 25249697 DOI: 10.1530/eje-14-0405] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The prognostic/diagnostic biomarker copeptin, an arginine vasopressin surrogate, reflects physical stress. Whether copeptin concentration increases upon psychological stress is unknown. We investigated psychological stress effects on copeptin secretion in healthy volunteers and patients with central diabetes insipidus (DI). DESIGN A prospective observational study was conducted to study the relation between copeptin concentration and psychological stress. METHODS A total of 20 healthy adults (ten female) and eight patients with central DI (four female) underwent the Trier Social Stress Test including, in order, 30-min waiting period, 10-min anticipation period, 10-min test period and 40-min recovery. Serum copeptin and cortisol concentrations and self-rated stress component feelings were determined in the pre-/post-anticipation period, post-test period and twice post-recovery. RESULTS In healthy volunteers, the median (25th-75th percentile) copeptin concentration peaked immediately during the post-test period at 5.1 (3.2-7.0) pmol/l, vs 3.7 (2.6-5.4) pmol/l at baseline. Over the measurement course, copeptin concentration significantly elevated (coefficient; 95% CI) (0.14; 0.06-0.23, P=0.002). The important predictors of increase in copeptin concentration were feelings of tension (0.06; 0.04-0.08, P<0.001) and avoidance (0.07; 0.04-0.10; P<0.001). Copeptin and cortisol levels were associated (0.43; 0.13-0.72, P<0.005). Patients with DI had lower baseline concentrations (1.55 (1.2-3.1) pmol/l) when compared with healthy volunteers, P=0.006. Patients with DI showed no increase upon psychological stress (peak 2.15 pmol/l (1.5-2.28), P=0.79). By contrast, cortisol values were similar in patients and volunteers. CONCLUSIONS In healthy volunteers, copeptin levels significantly increased after psychological stress testing; this response was blunted in patients with DI.
Collapse
Affiliation(s)
- Judith Siegenthaler
- Clinic of EndocrinologyDiabetology, and Metabolism, University Hospital Basel, Petersgraben 4, Basel CH-4031, SwitzerlandDepartment of Internal MedicineKantonsspital Aarau, Tellstrasse, Aaraun CH-5001, Switzerland
| | - Carla Walti
- Clinic of EndocrinologyDiabetology, and Metabolism, University Hospital Basel, Petersgraben 4, Basel CH-4031, SwitzerlandDepartment of Internal MedicineKantonsspital Aarau, Tellstrasse, Aaraun CH-5001, Switzerland
| | - Sandrine Andrea Urwyler
- Clinic of EndocrinologyDiabetology, and Metabolism, University Hospital Basel, Petersgraben 4, Basel CH-4031, SwitzerlandDepartment of Internal MedicineKantonsspital Aarau, Tellstrasse, Aaraun CH-5001, Switzerland
| | - Philipp Schuetz
- Clinic of EndocrinologyDiabetology, and Metabolism, University Hospital Basel, Petersgraben 4, Basel CH-4031, SwitzerlandDepartment of Internal MedicineKantonsspital Aarau, Tellstrasse, Aaraun CH-5001, Switzerland
| | - Mirjam Christ-Crain
- Clinic of EndocrinologyDiabetology, and Metabolism, University Hospital Basel, Petersgraben 4, Basel CH-4031, SwitzerlandDepartment of Internal MedicineKantonsspital Aarau, Tellstrasse, Aaraun CH-5001, Switzerland
| |
Collapse
|
50
|
Walti C, Siegenthaler J, Christ-Crain M. Copeptin levels are independent of ingested nutrient type after standardised meal administration--the CoMEAL study. Biomarkers 2014; 19:557-62. [PMID: 25224842 DOI: 10.3109/1354750x.2014.940504] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT/OBJECTIVE To clarify ambiguous published data, we determined whether standardized nutrient intake influences serum copeptin concentrations. MATERIALS/METHODS Thirty healthy volunteers underwent oral glucose tolerance testing (OGTT) and mixed-meal tolerance testing (MMTT), respectively drinking 300 ml/237 ml of glucose-containing or fat/protein/carbohydrate-containing fluid. Copeptin was measured 30 min pre-("baseline")-180 min post-fluid intake. RESULTS Median [25th-75th percentile] copeptin fell from 4.9 [3.6-8.3]/4.9 [3.6-7.1] pmol/l at OGTT/MMTT baselines to 3.2 (2.8-5.9)/4.1 (2.7-6.1) pmol/l at post-OGTT/post-MMTT nadirs (150 min/120 min; p < 0.001, linear mixed-effect modeling). DISCUSSION/CONCLUSIONS Regardless of nutrient type ingested, copeptin did not increase, suggesting values can be interpreted independently of prandial status.
Collapse
Affiliation(s)
- Carla Walti
- Division of Endocrinology, Diabetology, and Metabolism, University Hospital , Basel , Switzerland
| | | | | |
Collapse
|