J Neurol Surg A Cent Eur Neurosurg 2014; 75 - p25
DOI: 10.1055/s-0034-1383761

Copeptin Levels Measured after Pituitary Surgery Predict Later Development of Diabetes Insipidus

Ch. Zweifel 1, B. Winzeler 1, M. Bally 2, B. Arici 2, S. Berkmann 2, Ph. Schuetz 2, H. Landolt 2, F. Gentili 3, G. Zadeh 3, B. Mueller 2, L. Mariani 1, M. Christ-Crain 1
  • 1Departments of Neurosurgery and Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
  • 2Departments of Endocrinology, Medical University Clinic and Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
  • 3Neurosurgery Division, Toronto Western Hospital, University of Toronto, Toronto, Canada

Aim: Disorders of water balance caused by disturbances in arginine vasopressin (AVP) secretion remain a common cause of complicated hospital stay after pituitary surgery. Copeptin, the stable C-terminal glycopeptide of the AVP prohormone, is a reliable surrogate of plasma AVP. Our aim is to elucidate whether Copeptin may become a useful marker in the diagnostic approach of water and electrolyte disturbances after pituitary surgery.

Methods: This is a prospective multicenter trial. From the preoperative day to the day of discharge, patients undergoing transsphenoidal or transcranial pituitary surgery were daily monitored for clinical items, routine laboratory parameters and copeptin.

Results: A total of 205 patients (mean age 53y, 55.6% females) were included into this study. A total of 50 patients (24.4%) developed DI during the hospitalization of which 27 patients had transient DI and 12 had persistent DI. Patients with development of DI had significantly lower median (IQR) postoperative copeptin levels compared with patients without DI (2.9 (1.9, 7.9) vs. 10.8 (5.2, 30.4), p less than 0.001). This was most pronounced for patients with postoperative measurement within the first 12 hours post-operatively. Copeptin levels postoperatively showed high discrimination as assessed by the receiver operating characteristic curve with AUCs of 0.79 (95%CI 0.72, 0.86) in the overall population, and 0.84 (0.76, 0.91) in patients with copeptin measurement within 12 hours.

Conclusion: Low copeptin levels measured after pituitary surgery predicts diabetes insipidus. Copeptin may become a novel tool in the early goal-directed management of patients with disturbance of the neuroendocrine homeostasis after pituitary surgery.