Copeptin role in polyuria-polydipsia syndrome (PPS) differential diagnosis and reference range in paediatric age

Summary

Objective

Plasma arginine-vasopressin (AVP) analysis can help in the differential diagnosis of the polyuria-polydipsia syndrome (PPS), even if such investigation is hampered by technical difficulties, conversely to its surrogate copeptin. This study aims to enlarge the existing data on normal copeptin levels in childhood, to evaluate the correlation between copeptin, serum sodium and plasma and urine osmolality, and to assess the utility of the copeptin analysis in the diagnostic work-up of PPS in the paediatric age.

Patients and methods

Plasma copeptin levels were evaluated in 53 children without AVP disorders (control population), in 12 hypopituitaric children and in 15 patients with PPS after water deprivation test (WDT).

Results

Mean basal copeptin levels were 5.2±1.56 (range 2.4-8.6 pmol/L) in the control population, 2.61±0.49 pmol/L in the hypopituitaric children with complete diabetes insipidus (CDI) (p=0.04), and 6.21±1.17 pmol/L in the hypopituitaric patients without DI (p=0.02). After WDT, among 15 naïve polyuric/polydipsic children copeptin values greater than 20 pmol/liter allowed to identify nephrogenic diabetes insipidus (NDI), concentrations below 2.2 pmol/liter complete central DI (CCDI) and between 5-20 pmol/l primary polydipsia (PP). Copeptin cut-off level of 3.5 pmol/l distinguished CDI from PP, with a sensitivity and specificity of 75% and 83.3%, respectively.

Conclusion

Copeptin evaluation holds promises as a diagnostic tool in paediatric PPS; its interpretation might be useful to promptly distinguish NDI, even avoiding the WDT need.

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