Copeptin in the Differential Diagnosis of the Polydipsia-Polyuria Syndrome—Revisiting the Direct and Indirect Water Deprivation Tests
| Autor: | Daniela Lorenz, Marcus Quinkler, Andreas Pfeiffer, U Haagen, Stefan Störk, Martin Fassnacht, Kathrin Zopf, Jana Papassotiriou, Bruno Allolio, Wiebke Fenske |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Adult
Male medicine.medical_specialty endocrine system diseases Arginine Endocrinology Diabetes and Metabolism Clinical Biochemistry Radioimmunoassay urologic and male genital diseases Biochemistry Diagnosis Differential Endocrinology Copeptin Polyuria Reference Values Internal medicine medicine Humans Primary polydipsia Water Deprivation urogenital system business.industry Osmolar Concentration Biochemistry (medical) Glycopeptides Reproducibility of Results Syndrome medicine.disease Nephrogenic diabetes insipidus Privation female genital diseases and pregnancy complications Arginine Vasopressin Vasopressin secretion Female medicine.symptom business Polydipsia Diabetes Insipidus hormones hormone substitutes and hormone antagonists |
| Zdroj: | The Journal of Clinical Endocrinology & Metabolism. 96:1506-1515 |
| ISSN: | 1945-7197 0021-972X |
| Popis: | The water deprivation test (WDT) with direct or indirect measurement of plasma arginine vasopressin (AVP) is the method of choice for the differential diagnosis of the polydipsia-polyuria syndrome. In theory, direct measurement of AVP is highly attractive but is hampered by technical difficulties.The aim of the study was to evaluate the utility of copeptin, a surrogate of AVP secretion, in the diagnostic work-up of the polyuria-polydipsia syndrome and to compare its performance with the current diagnostic standard.In two tertiary referral centers, 20 healthy subjects and 50 patients with polydipsia-polyuria syndrome underwent WDT with measurements of both plasma AVP and copeptin levels. The reference diagnosis was based on clinical information and treatment response.Twenty-two patients (44%) were diagnosed with primary polydipsia, 17 (34%) with partial central diabetes insipidus (DI), nine (18%) with complete central DI, and two (4%) with nephrogenic DI. The indirect WDT led to a correct diagnosis in 35 of 50 patients (70%). The direct WDT with AVP or copeptin measurement correctly diagnosed 23 patients (46%) or 36 patients (72%), respectively. Baseline copeptin values greater than 20 pmol/liter identified patients with nephrogenic DI, and concentrations below 2.6 pmol/liter indicated complete central DI. The ratio between Δ copeptin (0800 to 1600 h) and serum sodium concentration at 1600 h yielded optimal diagnostic accuracy, allowing us to also discern partial central DI from primary polydipsia (sensitivity 86%, and specificity 100%).Copeptin holds promise as a diagnostic tool in the polyuria-polydipsia syndrome, improving significantly the diagnostic accuracy of the direct WDT. |
| Databáze: | OpenAIRE |
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