Changes in copeptin levels before and 3 months after transsphenoidal surgery according to the presence of postoperative central diabetes insipidus

AbstractCopeptin levels reflect arginine vasopressin (AVP) release from the hypothalamus. Pituitary surgery often impairs AVP release and results in central diabetes insipidus (CDI). Here, we aimed to investigate how serum copeptin level changes 3 months after pituitary surgery and whether it has a diagnostic value for postoperative permanent CDI. Consecutive patients who underwent endoscopic transsphenoidal surgery at a single tertiary hospital were recruited. Serum copeptin levels were measured preoperatively and 3 months postoperatively. Among 88 patients, transient and permanent CDI occurred in 17 (19.3%) and 23 (26.1%), respectively. Three-month postoperative copeptin levels significantly declined from preoperative levels in permanent CDI group (P < 0.001, percentage difference = − 42.2%) and also in the transient CDI group (P = 0.002, − 27.2%). Three months postoperative copeptin level < 1.9 pmol/L under normal serum sodium levels was the optimal cutoff value for diagnosing permanent CDI with an accuracy of 81.8%, while 3-month postoperative copeptin level ≥ 3.5 pmol/L excluded the CDI with a negative predictive value of 100%. Conclusively, 3 months postoperative copeptin levels significantly decreased from preoperative levels in the transient CDI group as well as the permanent CDI group. Three-month postoperative copeptin levels ≥ 3.5 pmol/L under normal serum sodium levels may be diagnostic for excluding postoperative CDI.

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Oxcarbazepine Therapy for Complete Central Diabetes Insipidus

Case Reports in Nephrology and Dialysis ◽

10.1159/000485244 ◽

2018 ◽

Vol 8 (1) ◽

pp. 20-24 ◽

Cited By ~ 2

Author(s):

Basmah Abdallah ◽

Spencer Hodgins ◽

Daniel Landry ◽

Michael O’Shea ◽

Gregory Braden

Keyword(s):

Diabetes Insipidus ◽

Serum Sodium Level ◽

Alternative Therapy ◽

Normal Serum ◽

Central Diabetes Insipidus ◽

Water Reabsorption ◽

Collecting Tubule ◽

V2 Receptor ◽

Renal Tubular ◽

Normal Serum Sodium

Oxcarbazepine and carbamazepine cause hyponatremia by unknown mechanisms. We describe a patient with complete central diabetes insipidus and seizures who developed worsening hyponatremia when her dose of oxcarbazepine was increased. The patient maintained a normal serum sodium level and has had appropriately concentrated urine for 5 years on just oxcarbazepine, despite undetectable antidiuretic hormone (ADH) levels. This suggests that oxcarbazepine (or one of its metabolites) may stimulate collecting tubule V2 receptor-G protein complex independent of ADH, resulting in increased renal tubular water reabsorption. Oxcarbazepine may be useful as an alternative therapy for patients with central diabetes insipidus.

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MON-270 Diagnostic Value of Copeptin in Central Diabetes Insipidus

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.761 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Emma Boehm ◽

Julie Sherfan ◽

Joel Smith ◽

James King ◽

John Wentworth ◽

...

Keyword(s):

Diabetes Insipidus ◽

Serum Sodium ◽

Area Under The Curve ◽

Clinical Endocrinology ◽

Urine Osmolality ◽

Pituitary Surgery ◽

Sodium Concentration ◽

Diagnostic Value ◽

Serum Samples ◽

Control Subjects

Abstract Background: The diagnosis of diabetes insipidus (DI) relies on indirect measurement of serum and urine sodium and osmolality. Since the diagnosis can only be made when an inappropriately dilute urine is paired with a significantly concentrated serum, the process is tedious for the clinician and uncomfortable for the patient. Copeptin is the C-terminal portion of the anti-diuretic hormone (ADH) prohormone which correlates with the less stable ADH, therefore providing a direct measurement of posterior pituitary response to hyperosmolar stress. (1,2) Aim: This study aims to assess the diagnostic accuracy of copeptin in patients with central DI compared with subjects who underwent pituitary surgery without developing DI. Methods: Serum samples from subjects with central DI, control subjects post pituitary surgery with no DI (NDI) and control subjects with SIADH were collected and analysed on the BRAHMS KRYPTOR copeptin assay. Groups were compared using unpaired T-test and Levene’s test for equal variance. Results: 56 samples from 22 subjects (13 females, 9 males, mean age 53.9 ± 15.5 y.o.) were analysed. Two subjects had resolved DI (RDI) after copeptin analysis and were successfully weaned off DDAVP and reclassified as NDI. Of the DI subjects, 1 had acute and 5 had chronic DI. Copeptin was lower in DI compared to NDI group (p = 0.013), while serum sodium, osmolality, urine osmolality were similar. Copeptin did not differentiate between the SIADH and NDI groups. After exclusion of NDI samples with serum sodium ≤ 140 mmol/L, the area under the curve was 0.97 (95% CI 0.9 to 1.0), a copeptin cut-off of 2.9 pmol/L predicts DI with a sensitivity of 92% and a specificity of 90%. Conclusion: Copeptin concentration of < 3.0 pmol/L concurrently with serum sodium concentration of > 140mmol/L predicted central DI when using post pituitary surgery subjects without DI as controls. 1. Winzeler, B., Zweifel, C., Nigro, N., Arici, B., Bally, M., Schuetz, P., Blum, C., Kelly, C., Berkmann, S., Huber, A., Gentili, F., Zadeh, G., Landolt, H., Mariani, L., Müller, B. and Christ-Crain, M. (2015). Postoperative Copeptin Concentration Predicts Diabetes Insipidus After Pituitary Surgery. The Journal of Clinical Endocrinology & Metabolism, 100(6), pp.2275-2282. 2. Fenske, J., Refardt, I., SchnyderI., Winzeler, B., Drummond J., Ribeiro-Oliveira, Jr. A., Drescher, T., Bilz S., Vogt, D.R., Malzahn, U., Kroiss, M., Christ, E., Henzen, C., Fischli S., Tönjes, A., Mueller, B., Schopohl, J., Flitsch, J., Brabant, G., Fassnacht M., Christ-Crain, M. (2018). Copeptin in the Diagnosis of Diabetes Insipidus. New England Journal of Medicine, 379(18), pp.1784-1786.

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Gambaran elektrolit serum pada anak dengan diare akut

e-CliniC ◽

10.35790/ecl.4.1.2016.12105 ◽

2016 ◽

Vol 4 (1) ◽

Author(s):

Christin V. Wololi ◽

Jeanette I.Ch. Manoppo

Keyword(s):

Serum Sodium ◽

Acute Diarrhea ◽

Sudden Onset ◽

Normal Serum ◽

Normal Range ◽

Serum Electrolyte ◽

Medical Record Data ◽

Electrolyte Disturbance ◽

Record Data ◽

Normal Serum Sodium

Abstract: Acute diarrhea is defined as the sudden onset of 3 or more loose stools per day and lasts no longer than 14 days; chronic or persistent diarrhea lasts more than 14 days. Loss of fluid in large quantitiy such as diarrhea results in imbalance of fluid and electrolyte. The first influenced electrolytes are sodium and chloride since both are extracellular electrolytes. This study aimed to obtain the profile of serum electrolytes in children with acute diarrhea. Thus was a descriptive retrospective study using medical record data of patients hospitalized in the Paediatrics Department of Prof. Dr. R. D. Kandou Manado Hospital in the period of January 2015 - December 2015. The results showed that the highest incidence was among males (30 cases; 65.21%). Most cases were aged 1 - < 5 years (23 cases; 50%). Most serum sodium values were in the normal range (36 cases; 78.26%). Most cases had diarrhea without dehydration and had normal serum sodium (20 cases; 43.47%). Most cases had normal serum potassium levels (33 cases; 71.73%). Most inpatients were without dehydration (17 cases; 36.95%). Most cases had normal serum electrolyte levels (39 cases; 84.78%). Most of the diarrhea without dehydration ( 21 cases; 45.65%). Diarrhea was most often in those who were formula-fed (29 cases; 63.04%). Keywords: acute diarrhea, dehydration, electrolyte disturbance Abstrak: Diare akut didefinisikan sebagai onset mendadak 3 atau lebih mencret per hari dan berlangsung tidak lebih dari 14 hari sedangkan diare kronis atau persisten berlangsung lebih dari 14 hari. Bila terjadi kehilangan cairan dalam jumlah banyak secara terus menerus seperti pada diare maka keseimbangan cairan dan elektrolit dalam tubuh tidak dapat dipertahankan. Elektrolit yang pertama terpengaruh ialah natrium dan klorida karena keduanya merupakan elektrolit ekstrasel. Penelitian ini bertujuan untuk mendapatkan gambaran elektrolit serum pada anak dengan diare akut. Jenis penelitian retrospektif deskriptif menggunakan data rekam medik pasien rawat inap di Bagian Pediatri RSUP Prof. Dr. R.D. Kandou Manado periode Januari 2015 - Desember 2015. Hasil penelitian memperlihatkan bahwa insiden tertinggi pada laki-laki sebanyak 30 kasus (65,21%). Usia terbanyak antara 1 tahun - < 5 tahun yaitu 23 kasus (50%). Nilai natrium serum paling banyak pada kisaran normal yaitu 36 kasus (78,26%), paling banyak didapatkan pada penderita tanpa dehidrasi dengan natrium serum normal 20 kasus (43,47%). Kadar kalium serum normal secara keseluruhan berjumlah 33 kasus (71,73%), paling banyak pada penderita tanpa dehidrasi yaitu 17 kasus (36,95%). Kadar serum paling banyak pada kisaran normal yaitu 39 kasus (84,78%), dan paling banyak pada penderita tanpa dehidrasi yaitu 21 kasus (45,65%). Diare paling banyak pada yang diberi susu formula sebanyak 29 kasus (63,04 %).Kata kunci: diare akut, dehidrasi, gangguan elektrolit

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Early Copeptin Determination Allows Prompt Diagnosis of Post-Neurosurgical Central Diabetes Insipidus

Neuroendocrinology ◽

10.1159/000503145 ◽

2019 ◽

Vol 110 (6) ◽

pp. 525-534 ◽

Cited By ~ 5

Author(s):

Alessandro Maria Berton ◽

Filippo Gatti ◽

Federica Penner ◽

Emanuele Varaldo ◽

Nunzia Prencipe ◽

...

Keyword(s):

Diabetes Insipidus ◽

Surrogate Marker ◽

Pituitary Surgery ◽

Central Diabetes Insipidus ◽

Optimal Timing ◽

Vasopressin Release ◽

Biochemical Alterations ◽

Post Surgery ◽

Patients At Risk ◽

Pituitary Lesion

Introduction: Central diabetes insipidus (CDI) is a frequent complication of pituitary surgery, but its diagnosis lacks standardized criteria. Copeptin, a surrogate marker of arginine vasopressin release, is triggered by psycho-physical stresses such as pituitary surgery. Low postoperative copeptin could predict CDI onset. The aims of this study were the validation of copeptin as a predictor of post-neurosurgical CDI and the identification of the optimal timing for its determination. Methods: Sixty-six consecutive patients operated for a hypothalamic-pituitary lesion were evaluated. Copeptin was determined preoperatively and at 1, 6, 12, 24 and 48 h post-extubation. Fifty-eight patients were reassessed after 3–6 months post-surgery to confirm transient (3 cases) or permanent CDI (5 cases) diagnosis. Results: A marked copeptin peak was identified at 1 h after extubation, when a value below or equal to 12.8 pmol/L had a good accuracy in identifying CDI cases (AUC 0.866, 95% CI 0.751–0.941). Moreover, a copeptin peak above 4.2 pmol/L excluded permanent forms (AUC 1, 95% CI 0.629–1). Regression analysis identified copeptin as the only significant predictor of CDI (OR 0.86, 95% CI 0.75–0.98, p = 0.02). A copeptin T1/T0 ratio below or equal to 1.47 identified patients at risk of isolated biochemical alterations even in the absence of an overt CDI. Conclusions: A prompt increase of copeptin is expected at 1 h after extubation. The absence of this peak is a reliable predictor of post-neurosurgical CDI.

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PREDICTORS AND INCIDENCE OF CENTRAL DIABETES INSIPIDUS AFTER ENDOSCOPIC PITUITARY SURGERY

Neurosurgery ◽

10.1227/01.neu.0000311063.10745.d8 ◽

2008 ◽

Vol 62 (1) ◽

pp. 71-79 ◽

Cited By ~ 38

Author(s):

Dimitri G. Sigounas ◽

Julie L. Sharpless ◽

D. Ming L. Cheng ◽

Tiffany G. Johnson ◽

Brent A. Senior ◽

...

Keyword(s):

Minimally Invasive ◽

Diabetes Insipidus ◽

Serum Sodium ◽

Elevated Serum ◽

High Sensitivity ◽

Cerebrospinal Fluid Leak ◽

Pituitary Surgery ◽

Minimal Risk ◽

Low Incidence ◽

Traditional Approaches

Abstract OBJECTIVE With the advent of minimally invasive endoscopic pituitary surgery, there has been concern that the technique may be associated with higher rates of complications such as diabetes insipidus (DI) than traditional approaches, particularly early in a center's experience. We report the incidence and predictors of diabetes insipidus in patients after endoscopic transnasal resection (minimally invasive pituitary surgery) of pituitary lesions. METHODS Data were collected from hospital and clinic records on the first 119 consecutive patients undergoing endoscopic pituitary surgery at our center. RESULTS The rate of postoperative diabetes insipidus is low in patients undergoing minimally invasive pituitary surgery (permanent, 2.7%; transient, 13.6%). Factors associated with development of DI after minimally invasive pituitary surgery include Rathke's cleft cyst histology, intraoperative cerebrospinal fluid leak, and previous nonendoscopic lesion resection. Elevated serum sodium (>145 mmol/L) within the first 5 days postoperatively has a high sensitivity (87.5%), specificity (83.5%), and negative predictive value (99.5%) for permanent postoperative DI development. CONCLUSION Transitioning from microscopic to endoscopic pituitary surgery can be achieved with a low incidence of DI. An elevated serum sodium level in the first 5 postoperative days using standard monitoring can predict the chance of developing permanent DI. Patients having no elevated serum sodium measurements, defined as >145 mmol/L, in the first 5 days postoperatively will rarely, if ever, develop permanent DI, thereby validating short postoperative inpatient stays with minimal risk of readmission for DI management. Those with a single serum sodium measurement greater than 145 mmol/L have a 15% risk of developing permanent DI.

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Successful Treatment of Transient Central Diabetes Insipidus following Traumatic Brain Injury in a Dog

Case Reports in Veterinary Medicine ◽

10.1155/2019/3563675 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Catriona Croton ◽

Sarah Purcell ◽

Andrea Schoep ◽

Mark Haworth

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Diabetes Insipidus ◽

Successful Treatment ◽

Serum Sodium ◽

Rapid Onset ◽

Central Diabetes Insipidus ◽

The Other ◽

Clinical Progression ◽

First Report

An 11-year-old female spayed Maltese presented comatose, half an hour after vehicular trauma, and was treated for traumatic brain injury and pulmonary contusions. The dog developed severe hypernatremia within six hours of presentation, which responded poorly to the administration of five percent dextrose in water. As central diabetes insipidus was suspected, desmopressin was trialled and resolution of hypernatremia was achieved six days later. Transient trauma-induced central diabetes insipidus has been described previously in two dogs; in the first, serum sodium concentrations were evaluated three days after injury and the other developed hypernatremia seven days after injury. To the authors’ knowledge, this is the first report of rapid onset, transient, and trauma-induced central diabetes insipidus in a dog that encompasses the complete clinical progression of the syndrome from shortly after injury through to resolution.

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Vasopressin Bolus Protocol Compared to Desmopressin (DDAVP) for Managing Acute, Postoperative Central Diabetes Insipidus and Hypovolemic Shock

Case Reports in Endocrinology ◽

10.1155/2017/3052102 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Anukrati Shukla ◽

Syeda Alqadri ◽

Ashley Ausmus ◽

Robert Bell ◽

Premkumar Nattanmai ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Case Report ◽

Specific Gravity ◽

Diabetes Insipidus ◽

Serum Sodium ◽

Urine Output ◽

Hypovolemic Shock ◽

Central Diabetes Insipidus ◽

Intravenous Fluids ◽

Decompressive Craniotomy

Introduction. Management of postoperative central diabetes insipidus (DI) can be challenging from changes in volume status and serum sodium levels. We report a case successfully using a dilute vasopressin bolus protocol in managing hypovolemic shock in acute, postoperative, central DI. Case Report. Patient presented after bifrontal decompressive craniotomy for severe traumatic brain injury. He developed increased urine output resulting in hypovolemia and hypernatremia. He was resuscitated with intravenous fluids including a dilute vasopressin bolus protocol. This protocol consisted of 1 unit of vasopressin in 1 liter of 0.45% normal saline. This protocol was given in boluses based on the formula: urine output minus one hundred. Initial serum sodium was 148 mmol/L, and one-hour urine output was 1 liter. After 48 hours, he transitioned to 1-desamino-8-D-arginine vasopressin (DDAVP). Pre-DDAVP serum sodium was 149 mmol/L and one-hour urine output 320 cc. Comparing the bolus protocol to the DDAVP protocol, the average sodium was 143.8 ± 3.2 and 149.6 ± 3.2 mmol/L (p=0.0001), average urine output was 433.2 ± 354.4 and 422.3 ± 276.0 cc/hr (p=0.90), and average specific gravity was 1.019 ± 0.009 and 1.016 ± 0.01 (p=0.42), respectively. Conclusion. A protocol using dilute vasopressin bolus can be an alternative for managing acute, central DI postoperatively, particularly in setting of hypovolemic shock resulting in a consistent control of serum sodium.

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Effect of Histamine on Electrocardiograms and Serum Electrolytes of Intact, Cortisone-Treated and Adrenalectomized Hamsters

American Journal of Physiology-Legacy Content ◽

10.1152/ajplegacy.1958.194.1.53 ◽

1958 ◽

Vol 194 (1) ◽

pp. 53-56 ◽

Cited By ~ 2

Author(s):

Frederick N. Sudak ◽

Leland C. Wyman ◽

George P. Fulton

Keyword(s):

Serum Sodium ◽

Serum Potassium ◽

Normal Serum ◽

P Wave ◽

Serum Electrolyte ◽

S Waves ◽

T Wave ◽

Small Doses ◽

Sodium And Potassium ◽

Normal Serum Sodium

Following toxic doses of histamine in golden hamsters there was progressively increasing bradycardia in those which died and a compensatory tachycardia in survivors. The T wave of the EKG increased, especially in those animals which succumbed, and decreased as terminus approached. Except for terminal lowering there were no striking changes in the P wave. Other changes were occasional Q waves, lowered R waves and deeper S waves, and impaired conduction. Pretreatment of intact hamsters with 12 daily doses of cortisone acetate lowered both serum sodium and potassium. Hyponatremia and hyperpotassemia were present terminally in intact hamsters dying from histamine intoxication. Pretreatment with cortisone tended to alleviate these changes but did not entirely prevent the terminal rise in serum potassium. Adrenalectomized hamsters exhibited hyponatremia and hyperpotassemia, both becoming greater as death approached. Maintenance therapy with cortisone did not restore a normal serum sodium but did reduce serum potassium to normal or below. Adrenalectomized hamsters poisoned by small doses of histamine had EKG and serum electrolyte changes similar to those dying from adrenal insufficiency. Replacement therapy prevented these changes.

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Clinical Characterization of Gastroenteritis-Related Seizures in Children

Journal of Child Neurology ◽

10.1177/0883073811409222 ◽

2011 ◽

Vol 26 (11) ◽

pp. 1397-1400 ◽

Cited By ~ 15

Author(s):

Eyal Zifman ◽

Füsun Alehan ◽

Shay Menascu ◽

Miki Har-Gil ◽

Peter Miller ◽

...

Keyword(s):

Body Temperature ◽

Serum Sodium ◽

Normal Serum ◽

Seizure Recurrence ◽

Seizure Duration ◽

The Impact ◽

Gastroenteritis Episode ◽

Normal Serum Sodium ◽

Benign Course

Gastroenteritis-related seizures have increasingly gained attention in recent years. Most cases follow a brief, benign course with very few episodes of seizure recurrence and without development of epilepsy. Published reports usually do not make a distinction between febrile and afebrile patients, and most authors include only nonfebrile convulsions in their reported series. This study evaluated the impact of fever in children presenting with seizures during a mild gastroenteritis episode and found that the presence or absence of fever did not affect seizure characteristics or duration. However, mild hyponatremia affected some seizure features, particularly seizure duration, as hyponatremic children sustained more prolonged seizures than patients with normal serum sodium levels, irrespective of body temperature.

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