ESPEYB17 15. Editors’ choice (1) (18 abstracts)
15.8. Arginine-stimulated copeptin measurements in the differential diagnosis of diabetes insipidus: A prospective diagnostic study
Winzeler B , Cesana-Nigro N , Refardt J , Vogt DR , Imber C , Morin B , Popovic M , Steinmetz M , Sailer CO , Szinnai G , Chifu I , Fassnacht M & Christ-Crain M
To read the full abstract: Lancet. 2019 Aug 17;394(10198):587–595. doi: 10.1016/S0140-6736(19)31255-3.
These authors previously described that the measurement of copeptin, a peptide cleaved in the posterior pituitary from the protein precursor of vasopressin and stable in circulation, is an accurate tool to diagnose diabetes insipidus (DI; vasopressin insufficiency). However, they acknowledged that their original protocol using hypertonic saline as a stimulus is challenging and requires close monitoring of hypernatraemia.
Here, they describe good diagnostic discrimination by plasma copeptin on arginine stimulation in adult patients (age 18+ years), 12 with complete DI, 9 with partial DI, 31 with primary polydipsia, and 20 healthy controls; they included similar numbers in a separate validation cohort. Optimal accuracy was reached at a cutoff of 3ñ8 pM copeptin at 60 min (sensitivity 93%; specificity 92%).
Unfortunately, for paediatric endocrinologist and our patients, they did not include children with DI and, as they found differences in plasma copeptin levels between healthy children and healthy adults, the robustness of these thresholds to diagnose children with DI needs to be assessed.
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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