Arginine-stimulated copeptin measurements in the differential diagnosis of diabetes insipidus: A prospective diagnostic study
The Lancet Jul 17, 2019
Winzeler B, et al. - Given that hypertonic saline-stimulated copeptin measurements are most reliable for the differential diagnosis of diabetes insipidus but requires the induction of hypernatraemia and close monitoring of plasma sodium concentrations, researchers examined the utility of arginine-stimulated copeptin measurements as an alternative, simple, and safe test. In this prospective diagnostic study, the development cohort and the validation cohort comprised patients who were aged 18 years or older, were newly referred with polyuria (>50 mL/kg bodyweight per day) or had a known diagnosis of central diabetes insipidus or primary polydipsia. For both cohorts, a comparator cohort of healthy controls was also recruited which comprised adults (aged 18 years and older, with normal drinking habits, and no history of polyuria) and children who underwent arginine stimulation to diagnose growth hormone deficiency (children were only included in the comparator cohort to the development cohort as proof of concept). As per the pooled patient and control datasets, healthy adult controls and participants with primary polydipsia show an increase in the median arginine-stimulated copeptin concentrations, but those with diabetes insipidus show only minimal increase. In the development cohort, the highest diagnostic accuracy of 94% (95% CI 84–98) was reached with a cutoff of 3·5 pM at 60 min. The outcomes thereby support the high diagnostic accuracy of arginine-stimulated copeptin measurements for diabetes insipidus. In clinical practice, these measurements could be used as a simplified, novel, and safe diagnostic approach to diabetes insipidus.
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