ECE2014 Oral Communications Neuroendocrinology & Signalling (5 abstracts)
Copeptin in the diagnosis and differential diagnosis of diabetes dnsipidus – the ‘CoSIP-study’
Katharina Timper 1 , Wiebke Fenske 2 , Mira Katan 3 , Felix Kuehn 4 , Birsen Arici 5 , Nica Frech 1 , Jonas Rutishauser 6 , Peter Kopp 7 , Bruno Allolio 2 , Christoph Stettler 4 , Beat Mueller 8 & Mirjam Christ-Crain 1
1Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, 4031 Basel, Switzerland; 2Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, 97080 Würzburg, Germany; 3Department of Neurology, University Hospital Zürich, 8091 Zurich, Switzerland; 4Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Bern, 3010 Bern, Switzerland; 5Department of Internal Medicine, Hospital Rheinfelden, 4310 Rheinfelden, Switzerland; 6Clinic of Internal Medicine, Hospital Bruderholz, 4101 Bruderholz, Switzerland; 7Division of Endocrinology, Metabolism and Molecular Medicine and Center for Genetic Medicine, Northwestern University, Chicago, Illinois 60611, USA; 8Department of Internal Medicine Kantonsspital Aarau, 5001 Aarau, Switzerland.
Introduction: The correct differential diagnosis of the disorders related to polyuria–polydipsia syndrome (PPS) is mandatory since inadequate treatment may lead to serious complications. The diagnostic gold standard is the water deprivation test (WDT) with direct or indirect measurement of plasma vasopressin (AVP). But test interpretation is problematic, and direct measurement of AVP is hampered by methodological difficulties. The aim of this study was to evaluate the diagnostic accuracy of copeptin in the differential diagnosis of DI.
Methods: In a prospective multicenter study, patients with a history of PPS and indication for a WDT were consecutively included. The WDT started at 0800 h with a baseline blood and urine sampling and was terminated once S-Na+ levels increased >147 mmol/l. If this cutoff was not reached by fluid deprivation alone, a 3% saline infusion was administered. Serum samples were obtained hourly for measurement of copeptin and AVP.
Results: We present results of the first 52 patients with full data available: 13 with complete, 12 with partial central DI, 17 with PP, and 10 with nephrogenic DI. Twenty-nine were women, 23 were men. Mean (S.D.) age was 45 (16) years. Baseline copeptin levels ranged from 21–117 pmol/L in patients with nephrogenic DI, from 0.7–5.1 pmol/Llin patients with central DI (complete: 0.7–4.1 pmol/l; partial: 0.8–5.1 pmol/l) and from 0.9–13.5 pmol/l in patients with primary polydipsia. Without prior thirsting, a single baseline copeptin level of >20 pmol/l perfectly differentiated nephrogenic DI from all other etiologies with a sensitivity and specificity of 100%, rendering a WDT unnecessary. Furthermore, a delta copeptin increase under osmotic stimulation of <2 pmol/l differentiated patients with central DI from patients with primary polydipsia with a specificity of 95.8%, a sensitivity of 94.1% and a positive likelihood ratio of 22.6.
Conclusion: Copeptin is a promising new tool in the complex diagnosis of polyuria–polydipsia syndrome
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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