Document Detail


Copeptin in the Differential Diagnosis of the Polydipsia-Polyuria Syndrome--Revisiting the Direct and Indirect Water Deprivation Tests.
MedLine Citation:
PMID:  21367924     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: 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. Objective: 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. Setting and Design: 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. Results: 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%). Conclusion: Copeptin holds promise as a diagnostic tool in the polyuria-polydipsia syndrome, improving significantly the diagnostic accuracy of the direct WDT.
Authors:
Wiebke Fenske; Marcus Quinkler; Daniela Lorenz; Kathrin Zopf; Ulrike Haagen; Jana Papassotiriou; Andreas F H Pfeiffer; Martin Fassnacht; Stefan Störk; Bruno Allolio
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-2
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  -     ISSN:  1945-7197     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-3-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Internal Medicine I-Endocrine Unit (W.F., D.L., M.F., B.A.), and Comprehensive Heart Failure Center (W.F., M.F., S.S., B.A.), University Hospital Würzburg, D-97080 Würzburg, Germany; Division of Diabetes, Endocrinology, and Metabolism (W.F.), Department of Medicine, Imperial College London, London W12 ONN, United Kingdom; Clinical Endocrinology (M.Q., K.Z.), Charité Campus Mitte, Charité University Medicine Berlin, 10117 Berlin, Germany; B.R.A.H.M.S. GmbH (U.H., J.P.), Research Department, 16761 Berlin, Germany; Division of Endocrinology, Diabetes, and Nutrition (A.F.H.P.), Charité Campus Benjamin Franklin, Charité University Medicine Berlin, 10117 Berlin, Germany; and Department of Internal Medicine I-Cardiology (S.S.), University Hospital Würzburg, D-97080 Würzburg, Germany.
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