Urea-stimulated copeptin: a novel diagnostic approach in polyuria polydipsia syndrome.

IF 5.3 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Sven Lustenberger, Cihan Atila, Juliana Baumgartner, Sophie Monnerat, Julia Beck, Joyce Santos de Jesus, Mirjam Christ-Crain
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引用次数: 0

Abstract

Background: Distinguishing arginine vasopressin (AVP) deficiency from primary polydipsia remains challenging. While hypertonic saline-stimulated copeptin testing offers high diagnostic accuracy, it is complex and limited to specialized centers. Intravenous urea is known to stimulate AVP secretion, but the effect of oral urea on copeptin levels is unknown.

Methods: Twenty-two healthy adults were included in a randomized, double-blind, placebo-controlled cross-over trial receiving a single dose of urea (0.5 g/kg; minimum 30 g, maximum 45 g) and placebo. Serum copeptin was measured at 30-min intervals for 2.5 h. In a second step, 13 patients with AVP-deficiency and 13 patients with primary polydipsia were included in an open-label pilot study, receiving urea only. The primary endpoint was maximum copeptin within 150 min.

Results: In healthy adults, median [IQR] copeptin significantly increased from 4.6 [3.0-5.7] pmol/L at baseline to a maximum of 10.1 [7.2-11.6] pmol/L at 120 min after ingestion of urea, while it remained stable at 3.8 [2.9-6.6] pmol/L after placebo intake (P < .001). In patients with AVP-deficiency, copeptin remained below detection limit throughout the test, while in patients with primary polydipsia the peak was seen 150 min after ingestion of urea at 7.4 pmol/L [4.3, 10.3]. The best copeptin cut-off for differentiating AVP-deficiency from primary polydipsia was 3.5 pmol/L after 120 min, with 93% sensitivity and specificity.

Conclusion: Oral urea stimulates copeptin in healthy adults and patients with primary polydipsia, but not in patients with AVP-deficiency, establishing the first oral copeptin-based test in differentiating primary polydipsia from AVP-deficiency.

尿刺激copeptin:一种诊断多尿多渴综合征的新方法。
背景:区分精氨酸抗利尿素(AVP)缺乏症和原发性渴烦症仍然具有挑战性。虽然高渗盐刺激copeptin测试提供了很高的诊断准确性,但它是复杂的,并且仅限于专门的中心。已知静脉尿素可刺激AVP分泌,但口服尿素对copeptin水平的影响尚不清楚。方法:22名健康成人纳入随机、双盲、安慰剂对照交叉试验,接受单剂量尿素(0.5 g/kg;最少30克,最多45克)和安慰剂。每隔30分钟测定血清copeptin,持续2.5小时。第二步,13例avp缺乏症患者和13例原发性烦渴患者被纳入一项开放标签的先导研究,仅接受尿素治疗。主要终点是150分钟内的最大copeptin。结果:健康成人中位[IQR] copeptin从基线时的4.6 [3.0-5.7]pmol/L显著增加到摄入尿素后120分钟的最大值10.1 [7.2-11.6]pmol/L,而摄入安慰剂后保持稳定在3.8 [2.9-6.6]pmol/L (p < 0.001)。在avp缺乏症患者中,copeptin在整个检测过程中始终低于检测限,而在原发性多饮患者中,在摄入7.4 pmol/L尿素后150分钟出现峰值[4.3,10.3]。区分avp缺乏症与原发性烦渴的最佳copeptin临界值为120分钟后3.5 pmol/L,敏感性和特异性均为93%。结论:口服尿素对健康成人和原发性烦渴患者的copeptin有刺激作用,而对avp缺乏症患者无刺激作用,首次建立了以口服copeptin为基础的区分原发性烦渴和avp缺乏症的试验。
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来源期刊
European Journal of Endocrinology
European Journal of Endocrinology 医学-内分泌学与代谢
CiteScore
9.80
自引率
3.40%
发文量
354
审稿时长
1 months
期刊介绍: European Journal of Endocrinology is the official journal of the European Society of Endocrinology. Its predecessor journal is Acta Endocrinologica. The journal publishes high-quality original clinical and translational research papers and reviews in paediatric and adult endocrinology, as well as clinical practice guidelines, position statements and debates. Case reports will only be considered if they represent exceptional insights or advances in clinical endocrinology. Topics covered include, but are not limited to, Adrenal and Steroid, Bone and Mineral Metabolism, Hormones and Cancer, Pituitary and Hypothalamus, Thyroid and Reproduction. In the field of Diabetes, Obesity and Metabolism we welcome manuscripts addressing endocrine mechanisms of disease and its complications, management of obesity/diabetes in the context of other endocrine conditions, or aspects of complex disease management. Reports may encompass natural history studies, mechanistic studies, or clinical trials. Equal consideration is given to all manuscripts in English from any country.
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