Gippert Sebastian, Brune Maik, Choukair Daniela, Bettendorf Markus
Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics I, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany.
Division of Endocrinology, Diabetes, Metabolic Diseases and Clinical Chemistry, Central Laboratory, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany.
Horm Res Paediatr. 2024 Sep 18:1-8. doi: 10.1159/000541330.
The diagnosis of arginine vasopressin deficiency (AVD, formerly central diabetes insipidus) remains a challenge. In recent years, stimulated copeptin has emerged as a promising tool to diagnose AVD.
In this single centre retrospective study, we identified paediatric patients with suspected pituitary insufficiency who underwent standard insulin tolerance testing (ITT) previously. Patients with AVD and non-matched controls without polyuria-polydipsia syndrome were identified. Diagnosis of AVD was confirmed retrospectively using comprehensive clinical and diagnostic characteristics. Serum copeptin concentrations were measured using a commercially available automated immunofluorescence assay (B.R.A.H.M.S Copeptin-proAVP KRYPTOR®) in -20°C stored samples collected before and 30, 45, and 60 min after insulin injection. Cut-off analyses were performed using ROC curves.
Twenty-five patients with AVD and 43 non-matched controls were available for analysis. Median basal copeptin concentrations of 1.51 pmol/L (IQR: 0.91-1.95; serum osmolarity: 288.5 mmol/L, IQR: 282.3-293.5) increased at a median of 30 min to a maximum of 1.95 pmol/L (IQR: 1.31-2.39) in AVD patients (p = 0.113) and from 4.41 pmol/L (IQR: 3.36-6.68; serum osmolarity: 281.0 mmol/L, IQR: 274.0-286.0, p < 0.001) to a maximum of 8.39 pmol/L (IQR: 4.95-19.72, p < 0.001) in controls. ROC analysis resulted in a cut-off of 3.0 pmol/L for maximum copeptin (91.7% sensitivity, 94.1% specificity) for the diagnosis of AVD.
Our results suggest that insulin-stimulated serum copeptin concentrations are a sensitive and specific diagnostic tool for AVD in paediatric patients, which allows us to test multiple pituitary hormone axes simultaneously in a single test.
精氨酸血管加压素缺乏症（AVD，既往称为中枢性尿崩症）的诊断仍然是一项挑战。近年来，刺激后的 copeptin 已成为诊断 AVD 的一种有前景的工具。
在这项单中心回顾性研究中，我们确定了先前接受过标准胰岛素耐量试验（ITT）的疑似垂体功能不全的儿科患者。确定了患有 AVD 的患者和无多尿 - 多饮综合征的非匹配对照。通过综合临床和诊断特征对 AVD 进行回顾性确诊。使用市售的自动免疫荧光测定法（B.R.A.H.M.S Copeptin - proAVP KRYPTOR®）在 -20°C 储存的胰岛素注射前以及注射后 30、45 和 60 分钟采集的样本中测量血清 copeptin 浓度。使用 ROC 曲线进行截断分析。
25 例 AVD 患者和 43 例非匹配对照可供分析。AVD 患者的 copeptin 基础浓度中位数为 1.51 pmol/L（IQR：0.91 - 1.95；血清渗透压：288.5 mmol/L，IQR：282.3 - 293.5），在 30 分钟时中位数增加至最高 1.95 pmol/L（IQR：1.31 - 2.39）（p = 0.113），而对照从 4.41 pmol/L（IQR：3.36 - 6.68；血清渗透压：281.0 mmol/L，IQR：274.0 - 286.0，p < 0.001）增加至最高 8.39 pmol/L（IQR：4.95 - 19.72，p < 0.001）。ROC 分析得出诊断 AVD 的最大 copeptin 截断值为 3.0 pmol/L（敏感性 91.7%，特异性 94.1%）。
我们的结果表明，胰岛素刺激后的血清 copeptin 浓度是儿科患者 AVD 的一种敏感且特异的诊断工具，这使我们能够在一次检测中同时检测多个垂体激素轴。
