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.

1.
Qureshi
S
,
Galiveeti
S
,
Bichet
DG
,
Roth
J
.
Diabetes insipidus: celebrating a century of vasopressin therapy
.
Endocrinology
.
2014
Dec
;
155
(
12
):
4605
21
.
[PubMed]
0013-7227
2.
Rotondo
F
,
Butz
H
,
Syro
LV
,
Yousef
GM
,
Di Ieva
A
,
Restrepo
LM
, et al
Arginine vasopressin (AVP): a review of its historical perspectives, current research and multifunctional role in the hypothalamo-hypophysial system
.
Pituitary
.
2016
Aug
;
19
(
4
):
345
55
.
[PubMed]
1386-341X
3.
Lamas
C
,
del Pozo
C
,
Villabona
C
;
Neuroendocrinology Group of the SEEN
.
Clinical guidelines for management of diabetes insipidus and syndrome of inappropriate antidiuretic hormone secretion after pituitary surgery
.
Endocrinol Nutr
.
2014
Apr
;
61
(
4
):
e15
24
.
[PubMed]
1575-0922
4.
Nemergut
EC
,
Zuo
Z
,
Jane
JA
 Jr
,
Laws
ER
 Jr
.
Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients
.
J Neurosurg
.
2005
Sep
;
103
(
3
):
448
54
.
[PubMed]
0022-3085
5.
Sigounas
DG
,
Sharpless
JL
,
Cheng
DM
,
Johnson
TG
,
Senior
BA
,
Ewend
MG
.
Predictors and incidence of central diabetes insipidus after endoscopic pituitary surgery
.
Neurosurgery
.
2008
Jan
;
62
(
1
):
71
8
.
[PubMed]
0148-396X
6.
Schreckinger
M
,
Walker
B
,
Knepper
J
,
Hornyak
M
,
Hong
D
,
Kim
JM
, et al
Post-operative diabetes insipidus after endoscopic transsphenoidal surgery
.
Pituitary
.
2013
Dec
;
16
(
4
):
445
51
.
[PubMed]
1386-341X
7.
Schreckinger
M
,
Szerlip
N
,
Mittal
S
.
Diabetes insipidus following resection of pituitary tumors
.
Clin Neurol Neurosurg
.
2013
Feb
;
115
(
2
):
121
6
.
[PubMed]
0303-8467
8.
Adams
JR
,
Blevins
LS
 Jr
,
Allen
GS
,
Verity
DK
,
Devin
JK
.
Disorders of water metabolism following transsphenoidal pituitary surgery: a single institution’s experience
.
Pituitary
.
2006
;
9
(
2
):
93
9
.
[PubMed]
1386-341X
9.
Fenske
W
,
Allolio
B
.
Clinical review: Current state and future perspectives in the diagnosis of diabetes insipidus: a clinical review
.
J Clin Endocrinol Metab
.
2012
Oct
;
97
(
10
):
3426
37
.
[PubMed]
0021-972X
10.
Nayak
P
,
Montaser
AS
,
Hu
J
,
Prevedello
DM
,
Kirschner
LS
,
Ghalib
L
.
Predictors of Postoperative Diabetes Insipidus Following Endoscopic Resection of Pituitary Adenomas
.
J Endocr Soc
.
2018
Jul
;
2
(
9
):
1010
9
.
[PubMed]
2472-1972
11.
Heida
JE
,
Boesten
LS
,
Ettema
EM
,
Muller Kobold
AC
,
Franssen
CF
,
Gansevoort
RT
, et al
Comparison of ex vivo stability of copeptin and vasopressin
.
Clin Chem Lab Med
.
2017
Jun
;
55
(
7
):
984
92
.
[PubMed]
1434-6621
12.
Morgenthaler
NG
,
Struck
J
,
Alonso
C
,
Bergmann
A
.
Assay for the measurement of copeptin, a stable peptide derived from the precursor of vasopressin
.
Clin Chem
.
2006
Jan
;
52
(
1
):
112
9
.
[PubMed]
0009-9147
13.
Bankir
L
,
Bichet
DG
,
Morgenthaler
NG
.
Vasopressin: physiology, assessment and osmosensation
.
J Intern Med
.
2017
Oct
;
282
(
4
):
284
97
.
[PubMed]
0954-6820
14.
Timper
K
,
Fenske
W
,
Kühn
F
,
Frech
N
,
Arici
B
,
Rutishauser
J
, et al
Diagnostic Accuracy of Copeptin in the Differential Diagnosis of the Polyuria-polydipsia Syndrome: A Prospective Multicenter Study
.
J Clin Endocrinol Metab
.
2015
Jun
;
100
(
6
):
2268
74
.
[PubMed]
0021-972X
15.
Fenske
W
,
Refardt
J
,
Christ-Crain
M.
Copeptin in the Diagnosis of Diabetes Insipidus. N Engl J Med.
2018
01;379(18):1785–6.
16.
Winzeler
B
,
Zweifel
C
,
Nigro
N
,
Arici
B
,
Bally
M
,
Schuetz
P
, et al
Postoperative Copeptin Concentration Predicts Diabetes Insipidus After Pituitary Surgery
.
J Clin Endocrinol Metab
.
2015
Jun
;
100
(
6
):
2275
82
.
[PubMed]
0021-972X
17.
Garrahy
A
,
Moran
C
,
Thompson
CJ
.
Diagnosis and management of central diabetes insipidus in adults
.
Clin Endocrinol (Oxf)
.
2019
Jan
;
90
(
1
):
23
30
.
[PubMed]
0300-0664
18.
Fleseriu
M
,
Hashim
IA
,
Karavitaki
N
,
Melmed
S
,
Murad
MH
,
Salvatori
R
, et al
Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline
.
J Clin Endocrinol Metab
.
2016
Nov
;
101
(
11
):
3888
921
.
[PubMed]
0021-972X
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