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Sci Rep. 2021;11(1):17240.

Changes in copeptin levels before and 3 months after transsphenoidal surgery according to the presence of postoperative central diabetes insipidus.

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제1저자 김유형, 김용휘 · 교신저자 임환섭, 김정희

PMID 34446748 PMC8390481 DOI 10.1038/s41598-021-95500-x IF 4.9 내분비대사내과
소속 (7)
  1. Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, 03080, Korea.
  2. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul, 10103080, Korea.
  3. Pituitary Center, Seoul National University Hospital, Seoul, 03080, Korea.
  4. Seoul Clinical Laboratories, Heungdeok IT Valley 25F, HeungDeok 1-ro 13, Giheung Gu, YongIn City, 16954, Gyeonggido, Korea.
  5. Seoul Clinical Laboratories, Heungdeok IT Valley 25F, HeungDeok 1-ro 13, Giheung Gu, YongIn City, 16954, Gyeonggido, Korea. jlimhs@scllab.co.kr.
  6. Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, 03080, Korea. jhkxingfu@gmail.com.
  7. Pituitary Center, Seoul National University Hospital, Seoul, 03080, Korea. jhkxingfu@gmail.com.

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.

© 2021. The Author(s).

Figures

Figure 1
Figure 1 (a) Distributions of preoperative copeptin levels and change between preoperative and 3-month postoperative copeptin levels in subjects with (b) non-CDI, (c) transient and (d) permanent CDI. The figures show “Non-CDI,” “Transient CDI,” and “Permanent CDI” in the order from left to right. P-value versus Preop calculated using Wilcoxon signed-rank test was 0.130, 0.002, and < 0.001, respectively. * P < 0.05, versus Preop. Preop, Preoperative; Postop, Postoperative; CDI, Central diabetes insipidus.
Figure 2
Figure 2 (a) Comparison of postoperative copeptin levels according to the presence of central diabetes insipidus at postoperative 3 months visit and (b) receiver operating characteristic curve analysis for diagnosing permanent central diabetes insipidus. (a) P-values versus non-CDI calculated using the Kruskal–Wallis with Dunn’s post-hoc analysis were 0.130, 0.002, and < 0.001, respectively. The dashed lines indicate the important cutoff values of 3.5 pmol/L and 1.9 pmol/L from the top to the bottom. Outlier values have been removed. *, P < 0.05, versus Non-CDI. #, P < 0.05 compared with Transient CDI. (b) Area under the curve (AUC) for postoperative copeptin levels was 0.879 (95% confidence interval = 0.801–0.958). The point indicated by the arrow is the cutoff point maximizing Youden index, which was 1.9 pmol/L. CDI, Central diabetes insipidus.
Figure 3
Figure 3 (a) Morphometric measurement of tumor height (h) and depth (d) from the planum sphenoidale and (b) receiver operating characteristic (ROC) curve analysis of tumor height from the planum sphenoidale for predicting permanent central diabetes insipidus. (a) Tumor height (h) is defined as the vertical distance from the conceptual line (white solid line) [drawn from the cristae galli (white arrowhead, left) to the planum sphenoidale (white arrowhead, right)] to the highest point of the tumor. (b) Area under the curve (AUC) for tumor height from the planum sphenoidale was 0.808 (95% confidence interval = 0.652–0.964). The point indicated by the arrow is the cutoff point maximizing the Youden index, which was 15 mm.

그림 출처: PubMed Central 공개 논문 (PMC8390481)

Conflict of interest statement

The authors declare no competing interests.

그 밖의 정보
출판 형태
Journal Article, Observational Study, Research Support, Non-U.S. Gov't
저널
Scientific reports · eISSN 2045-2322
전자 출판
2021-08-26
MeSH
Adult · Aged · Diabetes Insipidus, Neurogenic / diagnosis / etiology · Female · Glycopeptides / blood · Humans · Male · Middle Aged · Neuroendoscopy / adverse effects / methods · Neurosurgical Procedures / adverse effects / methods · Pituitary Diseases / surgery · Postoperative Complications / diagnosis / etiology · Postoperative Period · Preoperative Period · ROC Curve · Retrospective Studies · Sphenoid Sinus / surgery · Time Factors
Substances
Glycopeptides · copeptins
참고문헌
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