Affiliation:
1. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
2. Department of Endocrinology Sahlgrenska University Hospital Gothenburg Sweden
3. Department of Clinical Chemistry Sahlgrenska University Hospital Gothenburg Sweden
4. Wallenberg Center for Molecular and Translational Medicine, Institution of Medicine at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
Abstract
AbstractObjectivePlasma copeptin is a relatively new biomarker for evaluation of arginine vasopressin (AVP) secretion. The aim of this study was to test the diagnostic performance of copeptin in patients with polyuria‐polydipsia syndrome.Design, Patients and MeasurementsThis was a prospective study where 88 patients with polyuria‐polydipsia syndrome were evaluated with a water deprivation test (WDT). Weight, urine osmolality, urine specific gravity, and plasma copeptin were collected at baseline, after 8 h, and at termination of the WDT when one of the following had been reached: (i) >3% weight reduction, (ii) urine specific gravity >1.017 or urine osmolality >600 mOsm/kg, or (iii) intolerable adverse symptoms.ResultsOf 88 patients (57 women), 21 (24%) were diagnosed with central diabetes insipidus (cDI), 5 (6%) with nephrogenic DI (nDI), and 62 (71%) with primary polydipsia (PP). Median (interquartile range) copeptin at baseline was 1.7 (1.4–2.5) pmol/L in cDI, 22 (18–65) pmol/L in nDI, and 2.7 (2–4) pmol/L in PP. After 8 h of WDT, the highest copeptin in patients with cDI was 4.0 pmol/L. In patients with PP: (i) 41 had urine osmolality <600 mOsm/kg, 7 (17%) of these had copeptin >4.0 pmol/L, (ii) 21 had urine osmolality ≥600 mOsm/kg, 14 (67%) of these had copeptin >4.0 pmol/L.ConclusionsCopeptin >4.0 pmol/L after an overnight WDT can be used to rule out cDI and copeptin ≥21 pmol/L at baseline to diagnose nDI. The diagnostic performance of copeptin in the context of the WDT is otherwise limited in the diagnostic work‐up of patients with polyuria‐polydipsia syndrome.
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