ECE2015 Eposter Presentations Pituitary: clinical (121 abstracts)
Changes in mid-regional pro-atrial natriuretic peptide during thirsting separate patients with diabetes insipidus from those with primary polydipsia
Sandrine Urwyler 1 , Katharina Timper 1, , Wiebke Fenske 3 , Felix Kühn 4 , Nica Frech 1 , Birsen Arici 5 , Jonas Rutishauser 6 , Peter Kopp 7 , Bruno Allolio 8 , Christoph Stettler 4 , Beat Müller 9 , Mira Katan 10 & Mirjam Christ-Crain 1
1Clinic of Endocrinology, Diabetes and Metabolism, Department of Clinical Research, University Hospital Basel, Basel, Switzerland; 2Max-Planck-Institute for Metabolism Research, Cologne, Germany; 3Integrated Research and Treatment Center for Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany; 4Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Bern – Inselspital, Bern, Switzerland; 5Department of Internal Medicine, Spital Rheinfelden, Rheinfelden, Switzerland; 6University Clinic of Internal Medicine, Kantonsspital Baselland, Bruderholz, Switzerland; 7Division of Endocrinology, Metabolism and Molecular Medicine and Center for Genetic Medicine, Northwestern University, Chicago, Illinois, USA; 8Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany; 9Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland; 10Department of Neurology, University Hospital Zurich, Zürich, Switzerland.
Background: The water deprivation test as the accepted gold standard in the differential diagnosis of polyuria polydipsia syndrome can be associated with a decrease in extracellular fluid volume in patients with diabetes insipidus (DI). We herein evaluated mid-regional pro-atrial natriuretic peptide (MR-proANP) as marker of extracellular body volume in patients with diabetes insipidus compared to primary polydipsia (PP), at baseline and after water deprivation.
Methods: Patients >18 years old with a history of polyuria and polydipsia were prospectively included. Participants underwent a standardized combined water deprivation and 3% saline infusion test that was terminated when serum sodium levels exceeded 147 mmol/l. MR-proANP levels were determined at baseline and when serum sodium exceeded 147 mmol/l.
Results: 55 patients with polyuria polydipsia syndrome were enrolled: 37 had complete or partial DI and 18 had PP. At baseline median MR-proANP levels in patients with DI were similar as compared to patients with PP (median (IQR) 51.2 pmol/l (31.9; 74.4) vs 42.6 pmol/l (28.4; 63.6); P=0.23). Upon the water deprivation test, in patients with DI MR-proANP levels decreased to 46.9 pmol/l (29; 64.1) (P=0.004), whereas there was no change in patients with PP (45.8 pmol/l (26.1; 61.3), P=0.28). The change of MR-proANP was significantly more pronounced in patients with DI compared to patients with PP (P=0.009). A delta-ANP of >0.9 had an AUC of 0.77 (95% CI, 0.63–0.90) with a sensitivity of 75.7% and a specificity of 72.2% to differentiate patients with DI from patients with PP.
Conclusion: MR-proANP levels decrease upon a water deprivation test in patients with DI, without a change in PP. Changes in MR-proANP during thirsting may separate patients with diabetes insipidus from those with PP.
Disclosure: This work was supported by the Swiss National Foundation (grant number PP00P3-123346) and Thermo Scientific Biomarkers, Henningsdorf, Germany, the developer and manufacturer of the MR-proANP-Assay, who provided all the kits for measurement of MR-proANP levels.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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