ECE2020 Audio ePoster Presentations Pituitary and Neuroendocrinology (217 abstracts)
Development of a local reference range for hypertonic saline-stimulated copeptin
Emily Brooks 1,1 , Caroline Bachmeier 2 , Juanita Vorster 3 , Jane Sorbello 1 , Faseeha Peer 1 , Viral Chikani 1 , Goce Dimeski 4 , Jacobus Ungerer 2 , Carel Pretorius 2 & Warrick J Inder 1
1Princess Alexandra Hospital, Endocrinology, Woolloongabba, Australia; 2Royal Brisbane and Women’s Hospital, Chemical Pathology, Herston, Australia; 3Princess Alexandra Hospital, Woolloongabba, Australia; 4Princess Alexandra Hospital, Chemical Pathology, Woolloongabba, Australia
Hypertonic saline stimulated copeptin measurements have recently been described for the diagnosis of central DI. A copeptin cut-off of > 4.9 pmol/l has a diagnostic accuracy of 96.5% for distinguishing primary polydipsia from central DI1. A copeptin assay has recently been established in our laboratory. Validation of hypertonic saline-stimulated copeptin concentrations in our local population is needed before this test can be used with confidence in patients presenting to our institution with polyuria-polydipsia syndrome. The aim of this study was to develop a local reference range for hypertonic saline-stimulated copeptin in healthy volunteers. Twenty healthy volunteers (10 male and 10 female) were recruited. Subjects underwent a hypertonic saline test, as previously described (3). Hypertonic saline (3%) was administered as an initial 250 ml bolus followed by 0.15 ml/kg/minute until a target serum sodium of ≥150 mmol/l was reached. At this time, blood was drawn for copeptin measurement.
Median age was 28.5 years (range 25 – 50); median body weight was 75.05 kg (range 50.4 – 106); median baseline plasma sodium was 138 mmol/l (range 135 – 143) and median serum osmolality was 291.5 (range 281 – 297). Median peak sodium was 152 mmol/l (range 150-154) with osmolality 314.5 mmol/kg (range 306 – 320). Median volume of hypertonic saline infused was 1536 ml (1230 – 2220 ml) and median hypertonic saline stimulated copeptin was 33.8 pmol/l (9.6 – 167.4). Overall symptom burden was 6/10 (range 3/10 – 9/10). 10 patients’ experienced nausea and 3 patients experienced vomiting. Copeptin was significantly higher in those who experienced nausea (35.4 pmol/l; range 30.2 – 82.3 pmol/l) and those who experienced vomiting (91.6 pmol/l; range 58.9 – 95.5 pmol/l) compared to those patients who did not experience either (19.7 pmol/l; 13.0 – 30.9 pmol/l) (P = 0.0465 and P = 0.0085 respectively). There were no serious adverse events.
Nausea and/or vomiting were associated with significantly higher copeptin levels. Development of a local reference range for hypertonic saline stimulated copeptin measurements will assist in interpretation of the test in our local population of patients presenting with polyuria-polydipsia syndrome.
Reference
1. Fenske W, Refardt J, Chifu I, Schnyder I, Winzeler B & Drummond J. A copeptin-based approach in the diagnosis of diabetes insipidus. NEJM 2018 379 428–439.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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