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Serum copeptin levels at day two after pituitary surgery and ratio to baseline predict postoperative central diabetes insipidus

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Abstract

Purpose

Central diabetes insipidus is a complication that may occur after pituitary surgery and has been difficult to predict. This study aimed to identify the cutoff levels of serum copeptin and its optimal timing for predicting the occurrence of central diabetes insipidus in patients who underwent transsphenoidal surgery.

Methods

This was a prospective observational study of patients who underwent transsphenoidal surgery for pituitary gland or stalk lesions. Copeptin levels were measured before surgery, 1 h after extubation, and on postoperative days 1, 2, 7, and 90.

Results

Among 73 patients, 14 (19.2%) and 13 (17.8%) patients developed transient and permanent central diabetes insipidus, respectively. There was no significant difference in copeptin levels before surgery and 1 h after extubation; copeptin levels on postoperative days 1, 2, 7, and 90 were significantly lower in patients with permanent central diabetes insipidus than in those without central diabetes insipidus. Copeptin measurement on postoperative day 2 exhibited the highest performance for predicting permanent central diabetes insipidus among postoperative days 1, 2, and 7 (area under the curve [95% confidence interval] = 0.754 [0.632–0.876]). Serum copeptin level at postoperative day 2(< 3.1 pmol/L) showed a sensitivity of 92.3% and a negative predictive value of 97.1%. The ratio of copeptin at postoperative day 2 to baseline (< 0.94) presented a sensitivity of 84.6% and a negative predictive value of 94.9%. The copeptin levels > 3.4 and 7.5 pmol/L at postoperative day 2 and 7 may have ruled out the occurrence of CDI with a negative predictive value of 100%.

Conclusion

The copeptin level at postoperative day 2 and its ratio to baseline can predict the occurrence of permanent central diabetes insipidus after pituitary surgery.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author (J.H.K.) on reasonable request.

Code availability

Not applicable.

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Acknowledgements

We would like to thank the Seoul Clinical Laboratories. The biospecimens used in this study were provided by the Biobank of Seoul National University Hospital, a member of the Korea Biobank Network. We also thank Serena Park for data collection.

Funding

This study was supported by a grant from the Seoul National University Hospital (No. 0420200580 to J.H.K.) and the Seoul Clinical Laboratories.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 03080, Seoul, Republic of Korea

    Han Na Jang, Yoo Hyung Kim & Jung Hee Kim

  2. Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 03080, Seoul, Republic of Korea

    Ho Kang & Yong Hwy Kim

  3. Department of Laboratory Medicine, Seoul Clinical Laboratories, 25F, Heungdeok IT Valley, 13 Heungdeok1-ro, Giheung-gu, 16954, Yongin, Gyeonggi-do, Republic of Korea

    Hwan Sub Lim, Mi-Kyeong Lee & Kyoung-Ryul Lee

  4. Pituitary Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 03080, Seoul, Republic of Korea

    Yong Hwy Kim & Jung Hee Kim

Authors
  1. Han Na Jang
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Contributions

Conceptualization: Yong Hwy Kim, Jung Hee Kim; Methodology: Hwan Sub Lim, Mi-Kyeong Lee, Kyoung-Ryul Lee, Jung Hee Kim; Formal analysis and investigation: Han Na Jang, Ho Kang, Hwan Sub Lim, Mi-Kyeong Lee, Kyoung-Ryul Lee; Writing-original draft preparation: Han Na Jang, Ho Kang; Writing-review and editing: Yong Hwy Kim, Jung Hee Kim; Funding acquisition: Jung Hee Kim; Supervision: Yong Hwy Kim, Jung Hee Kim

Corresponding authors

Correspondence to Yong Hwy Kim or Jung Hee Kim.

Ethics declarations

Ethics approval

This study was approved by the Institutional Review Board of Seoul National University (No. 2006-169-1136) and conducted in compliance with the Declaration of Helsinki and registered at the Korean Clinical Research Information Service (KCT0006488).

Consent to participate

All patients provided written informed consent.

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Not applicable.

Conflict of interest/competing interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Han Na Jang and Ho Kang equally contributed to this work as co-first authors.

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Jang, H.N., Kang, H., Kim, Y.H. et al. Serum copeptin levels at day two after pituitary surgery and ratio to baseline predict postoperative central diabetes insipidus. Pituitary 25, 1004–1014 (2022). https://doi.org/10.1007/s11102-022-01278-0

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