Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Switzerland / University of Basel, Switzerland.
Swiss Med Wkly. 2020 May 6;150:w20237. doi: 10.4414/smw.2020.20237. eCollection 2020 May 4.
Polyuria-polydipsia syndrome consists of the three main entities: central or nephrogenic diabetes insipidus and primary polydipsia. Reliable distinction between these diagnoses is essential as treatment differs substantially, with the wrong treatment potentially leading to serious complications. Past diagnostic measures using the classical water deprivation test had several pitfalls and clinicians were often left with uncertainity concerning the diagnosis. With the establishment of copeptin, a stable and reliable surrogate marker for arginine vasopressin, diagnosis of the polyuria-polydipsia syndrome has been newly evaluated. Whereas unstimulated basal copeptin measurement reliably diagnoses nephrogenic diabetes insipidus, two new tests using stimulated copeptin cutoff levels showed a high diagnostic accuracy in differentiating central diabetes insipidus from primary polydipsia. For the hypertonic saline infusion test, osmotic stimulation via the induction of hypernatraemia is used. This makes the test highly reliable and superior to the classical water deprivation test, but also requires close supervision and the availability of rapid sodium measurements to guarantee the safety of the test. Alternatively, arginine infusion can be used to stimulate copeptin release, opening the doors for an even shorter and safer diagnostic test. The test protocols of the two tests are provided and a new copeptin-based diagnostic algorithm is proposed to reliably differentiate between the different entities. Furthermore, the role of copeptin as a predictive marker for the development of diabetes insipidus following surgical procedures in the sellar region is described.
中枢性或肾性尿崩症和原发性多尿症。可靠地区分这些诊断至关重要，因为治疗方法有很大差异，错误的治疗方法可能会导致严重的并发症。过去使用经典的禁水试验进行诊断存在一些缺陷，临床医生常常对诊断不确定。随着加压素原（copeptin）的建立，一种稳定可靠的精氨酸加压素替代标志物，多尿多饮综合征的诊断得到了新的评估。未刺激基础copeptin 测量可靠地诊断肾性尿崩症，而使用刺激 copeptin 截断值的两个新测试显示出区分中枢性尿崩症和原发性多尿症的高诊断准确性。对于高渗盐水输注试验，通过诱导高血钠来进行渗透压刺激。这使得该试验非常可靠且优于经典的禁水试验，但也需要密切监测和快速钠测量的可用性，以保证试验的安全性。或者，可以使用精氨酸输注来刺激 copeptin 释放，为更短和更安全的诊断试验开辟了道路。提供了这两种试验的试验方案，并提出了一种基于 copeptin 的新诊断算法，以可靠地区分不同的实体。此外，还描述了 copeptin 作为鞍区手术后继发性尿崩症发展的预测标志物的作用。
