Chelsi Flippo, Christina Tatsi, Ninet Sinaii, Maria De La Luz Sierra, Elena Belyavskaya, Charalampos Lyssikatos, Meg Keil, Elias Spanakis, Constantine A Stratakis
Journal of the Endocrine Society, Volume 6, Issue 6, June 2022, bvac053
https://doi.org/10.1210/jendso/bvac053
Arginine-vasopressin and CRH act synergistically to stimulate secretion of ACTH. There is evidence that glucocorticoids act via negative feedback to suppress arginine-vasopressin secretion.
Our hypothesis was that a postoperative increase in plasma copeptin may serve as a marker of remission of Cushing disease (CD).
Plasma copeptin was obtained in patients with CD before and daily on postoperative days 1 through 8 after transsphenoidal surgery. Peak postoperative copeptin levels and Δcopeptin values were compared among those in remission vs no remission.
Forty-four patients (64% female, aged 7–55 years) were included, and 19 developed neither diabetes insipidus (DI) or syndrome of inappropriate anti-diuresis (SIADH). Thirty-three had follow-up at least 3 months postoperatively. There was no difference in peak postoperative copeptin in remission (6.1 pmol/L [4.3–12.1]) vs no remission (7.3 pmol/L [5.4–8.4], P = 0.88). Excluding those who developed DI or SIADH, there was no difference in peak postoperative copeptin in remission (10.2 pmol/L [6.9–21.0]) vs no remission (5.4 pmol/L [4.6–7.3], P = 0.20). However, a higher peak postoperative copeptin level was found in those in remission (14.6 pmol/L [±10.9] vs 5.8 (±1.4), P = 0.03]) with parametric testing. There was no difference in the Δcopeptin by remission status.
A difference in peak postoperative plasma copeptin as an early marker to predict remission of CD was not consistently present, although the data point to the need for a larger sample size to further evaluate this. However, the utility of this test may be limited to those who develop neither DI nor SIADH postoperatively.
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