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Abstract
Copeptin levels reflect arginine vasopressin (AVP) release from the hypothalamus. Pituitary surgery often impairs AVP release and results in central diabetes insipidus (CDI). Here, we aimed to investigate how serum copeptin level changes 3 months after pituitary surgery and whether it has a diagnostic value for postoperative permanent CDI. Consecutive patients who underwent endoscopic transsphenoidal surgery at a single tertiary hospital were recruited. Serum copeptin levels were measured preoperatively and 3 months postoperatively. Among 88 patients, transient and permanent CDI occurred in 17 (19.3%) and 23 (26.1%), respectively. Three-month postoperative copeptin levels significantly declined from preoperative levels in permanent CDI group (P < 0.001, percentage difference = − 42.2%) and also in the transient CDI group (P = 0.002, − 27.2%). Three months postoperative copeptin level < 1.9 pmol/L under normal serum sodium levels was the optimal cutoff value for diagnosing permanent CDI with an accuracy of 81.8%, while 3-month postoperative copeptin level ≥ 3.5 pmol/L excluded the CDI with a negative predictive value of 100%. Conclusively, 3 months postoperative copeptin levels significantly decreased from preoperative levels in the transient CDI group as well as the permanent CDI group. Three-month postoperative copeptin levels ≥ 3.5 pmol/L under normal serum sodium levels may be diagnostic for excluding postoperative CDI.
Highlights
Copeptin levels reflect arginine vasopressin (AVP) release from the hypothalamus
We aimed to show whether 3-month postoperative copeptin levels have a diagnostic value for postoperative central diabetes insipidus (CDI) and suggest the cutoff value of copeptin levels for diagnosing CDI
Sex, body mass index, comorbidities, previous endoscopic transsphenoidal surgery (ETS), preoperative hormone deficiency, preoperative copeptin level, Gross total resection (GTR) rate, and surgical complication rates were comparable among the three groups (Table 1)
Summary
Copeptin levels reflect arginine vasopressin (AVP) release from the hypothalamus. Pituitary surgery often impairs AVP release and results in central diabetes insipidus (CDI). We aimed to investigate how serum copeptin level changes 3 months after pituitary surgery and whether it has a diagnostic value for postoperative permanent CDI. Three-month postoperative copeptin levels significantly declined from preoperative levels in permanent CDI group (P < 0.001, percentage difference = − 42.2%) and in the transient CDI group (P = 0.002, − 27.2%). 3 months postoperative copeptin levels significantly decreased from preoperative levels in the transient CDI group as well as the permanent CDI group. Transient postoperative CDI related to the dysfunction of AVP-secreting neurons occurs 24–48 h after surgery and resolves within 10 d ays[8]. Previous studies suggested that low copeptin levels at the immediate postoperative time predicted the permanent postoperative CDI since the postsurgical stress stimulates copeptin s ecretion[21,22,23]. The diagnostic value of 3-month postoperative copeptin levels for postoperative CDI and the change of 3-month postoperative copeptin level from the preoperative level have not been studied
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