Diabetes Insipidus After Neurosurgery

Copeptin - a promising novel tool in the early goal directed management of patients after pituitary surgery

copeptin-for-direct-testing-of-diabetes-insipidus-after-pituitary-surgeryCopeptin levels in controls, medical patients and surgical patients after extubation, mirroring three different levels of physical stress Ref-4Surgery is a stressful event known to stimulate hypothalamic stress hormone release. Ref-2Ref-3 Maximal stress is generally experienced after extubation and it has been shown that Copeptin levels multiplied after surgical treatment.  Ref-4

Manipulation of the pituitary gland during neurosurgery may alter its secretory function. 16-34% of patients undergoing pituitary surgery developed a post-operative Diabetes insipidus (DI).Ref-5 DI is therefore the most common cause of prolonged hospital stay. Ref-6

Although the disease is self-limiting and benign in the majority of cases, Diabetes insipidus occasionally develops into severe hypernatremia and hyperosmolality if the deficit of fluids is not immediately replaced. Therefore, a timely and accurate diagnosis followed by an appropriate patient management is crucial. Ref-7Ref-8

Copeptin forms the C-terminal part of pre-provasopressin. Upon stimulation, vasopressin and Copeptin are released from their storage granules in the pituitary and rapidly enter the bloodstream in equimolar amounts. Ref-9,  Ref-10 Thus, Copeptin can be considered a true surrogate marker of vasopressin.

copeptin-in-neurosurgery

References Diabetes insipidus after neurosurgery

Ref-1: Winzeler B et al., J Clin Endocrinol Metab. 2015

Ref-2: Donald RA et al., Clin Endocrinol (Oxf) 1993; 38, 609-15

Ref-3: Udelsman R et al., J Clin Endocrinol Metab 1987; 64, 986-94

Ref-4: Katan M, et al., Neuro Endocrinol Lett 2008; 29, 341-6

Ref-5: Hensen J et al., Clin Endocrinol (Oxf) 1999; 50, 431-9

Ref-6: Verbalis JG, Pituitary 2002; 5, 119-32

Ref-7: Anderson RJ, Kidney Int 1986; 29, 1237-47

Ref-8: Berl T, Kidney Int 1990; 37, 1006-18

Ref-9: Holwerda DA, Eur J Biochem 1972; 28(3): 334-9

Ref-10: Holwerda DA, Eur J Biochem 1972; 28(3): 340-6

 

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