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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Copeptin levels measured after pituitary surgery predict later development of diabetes insipidus

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  • Christian Zweifel - Departments of Endocrinology, Diabetology and Metabolism and Neurosurgery, University Hospital Basel; Neurosurgery Division, Toronto Western Hospital, University of Toronto
  • Bettina Winzeler - Departments of Endocrinology, Diabetology and Metabolism and Neurosurgery, University Hospital Basel
  • Nicole Nigro - Departments of Endocrinology, Diabetology and Metabolism and Neurosurgery, University Hospital Basel
  • Martina Bally - Departments of Endocrinology, Medical University Clinic and Department of Neurosurgery, Kantonsspital Aarau
  • Philipp Schuetz - Departments of Endocrinology, Medical University Clinic and Department of Neurosurgery, Kantonsspital Aarau
  • Sven Berkmann - Departments of Endocrinology, Medical University Clinic and Department of Neurosurgery, Kantonsspital Aarau
  • Hans Landolt - Departments of Endocrinology, Medical University Clinic and Department of Neurosurgery, Kantonsspital Aarau
  • Beat Müller - Departments of Endocrinology, Medical University Clinic and Department of Neurosurgery, Kantonsspital Aarau
  • Fred Gentili - Neurosurgery Division, Toronto Western Hospital, University of Toronto
  • Gelareh Zadeh - Neurosurgery Division, Toronto Western Hospital, University of Toronto
  • Luigi Mariani - Departments of Endocrinology, Diabetology and Metabolism and Neurosurgery, University Hospital Basel
  • Mirjam Christ-Crain - Departments of Endocrinology, Diabetology and Metabolism and Neurosurgery, University Hospital Basel

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMI.10.01

doi: 10.3205/14dgnc320, urn:nbn:de:0183-14dgnc3206

Published: May 13, 2014

© 2014 Zweifel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: 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.

Method: 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 to 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.

Conclusions: 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.