Alessandro Maria Berton1, Filippo Gatti2, Federica Penner3, Emanuele Varaldo2, Nunzia Prencipe2, Francesca Rumbolo4, Fabio Settanni4, Valentina Gasco2, Ezio Ghigo2, Francesco Zenga3, Silvia Grottoli2. 1. Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy, alessandro.m.berton@gmail.com. 2. Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy. 3. Division of Neurosurgery, Department of Neuroscience and Mental Health, University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy. 4. Laboratory of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy.
Abstract
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.
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.
Authors: E Ferrante; A Cremaschi; A L Serban; R Indirli; G Grassi; M Locatelli; M Arosio; G Mantovani Journal: J Endocrinol Invest Date: 2021-02-20 Impact factor: 4.256
Authors: M Araujo-Castro; F Mariño-Sánchez; A Acitores Cancela; A García Fernández; S García Duque; V Rodríguez Berrocal Journal: J Endocrinol Invest Date: 2020-10-11 Impact factor: 4.256
Authors: D Pasero; A M Berton; G Motta; R Raffaldi; G Fornaro; A Costamagna; A Toscano; C Filippini; G Mengozzi; N Prencipe; M Zavattaro; F Settanni; E Ghigo; L Brazzi; A S Benso Journal: J Endocrinol Invest Date: 2020-11-27 Impact factor: 4.256
Authors: Friso de Vries; Daniel J Lobatto; Marco J T Verstegen; Wouter R van Furth; Alberto M Pereira; Nienke R Biermasz Journal: Pituitary Date: 2020-09-29 Impact factor: 4.107