Laway Bashir A, Bansiwal Sailesh K, Baba Mohammad S, Shah Zafar A
Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.
Department of Immunology and Molecular Medicine, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.
Indian J Endocrinol Metab. 2024 May-Jun;28(3):254-259. doi: 10.4103/ijem.ijem_489_23. Epub 2024 Jun 26.
Sheehan syndrome (SS) typically involves the loss of anterior pituitary cells and rarely affects the posterior pituitary. The water deprivation test (WDT) is the gold standard for diagnosing central diabetes insipidus (CDI), but it is cumbersome. Serum copeptin measurements are an alternative for CDI diagnosis. In this study, we measured hypoglycaemia-stimulated serum copeptin in SS patients to assess posterior pituitary function alongside anterior pituitary hormone levels.
This study recruited 43 patients with SS on stable hormonal replacement except for growth hormone (GH), 18 patients with CDI, and 19 body mass index (BMI) and parity-matched controls. All patients with SS and four patients with CDI underwent an insulin tolerance test (ITT), and hypoglycaemia-stimulated copeptin levels were measured at 0, 30, 45, and 90 minutes after insulin injection.
The mean serum copeptin level among patients with SS (26.01 ± 12.41 pmol/L) was significantly lower than that in healthy controls (31.92 ± 7.85 pmol/L) and higher than that in patients with CDI (1.81 ± 0.14 pmol/L). Using pre-defined cut-offs for CDI, basal serum copeptin <2.69 pmol/L and stimulated levels <4.92 pmol/L for complete central DI, and basal copeptin levels >2.69 pmol/L and stimulated copeptin <4.92 pmol/L for partial central DI, 9.2% (n = 4) of patients with SS had CDI, of which half had complete CDI and half had partial CDI.
A significant number of patients with SS who are on hormone replacement therapy show involvement of the posterior pituitary, despite not displaying symptoms.
席汉综合征（SS）通常涉及腺垂体细胞丧失，很少影响神经垂体。禁水试验（WDT）是诊断中枢性尿崩症（CDI）的金标准，但操作繁琐。血清 copeptin 测定是诊断 CDI 的一种替代方法。在本研究中，我们测量了 SS 患者低血糖刺激后的血清 copeptin，以评估神经垂体功能以及腺垂体激素水平。
本研究招募了 43 例除生长激素（GH）外接受稳定激素替代治疗的 SS 患者、18 例 CDI 患者以及 19 例体重指数（BMI）和生育情况匹配的对照者。所有 SS 患者和 4 例 CDI 患者接受了胰岛素耐量试验（ITT），并在注射胰岛素后 0、30、45 和 90 分钟测量低血糖刺激后的 copeptin 水平。
SS 患者的平均血清 copeptin 水平（26.01±12.41 pmol/L）显著低于健康对照者（31.92±7.85 pmol/L），高于 CDI 患者（1.81±0.14 pmol/L）。使用预先设定的 CDI 诊断临界值，即完全性中枢性尿崩症时基础血清 copeptin<2.69 pmol/L 且刺激后水平<4.92 pmol/L，部分性中枢性尿崩症时基础 copeptin 水平>2.69 pmol/L 且刺激后 copeptin<4.92 pmol/L，9.2%（n = 4）的 SS 患者患有 CDI，其中一半为完全性 CDI，一半为部分性 CDI。
大量接受激素替代治疗的 SS 患者尽管未表现出症状，但神经垂体仍受累。
