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March CA, Sastry S, McPhaul MJ, Wheeler SE, Garibaldi L. Copeptin Stimulation by Combined Intravenous Arginine and Oral LevoDopa/Carbidopa in Healthy Short Children and Children with the Polyuria-Polydipsia Syndrome. Horm Res Paediatr 2024:1-11. [PMID: 38705144 DOI: 10.1159/000539208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024] Open
Abstract
INTRODUCTION Stimulated copeptin may provide an alternative to water deprivation testing (WDT) in the evaluation of polyuria-polydipsia syndrome (PPS). Though best studied, arginine stimulation alone produces a modest copeptin response in children. We investigated the effectiveness of the arginine + LevoDopa/Carbidopa stimulation test (ALD-ST) for copeptin. METHODS 47 healthy short children (controls), 10 children with primary polydipsia, and 10 children with AVP deficiency received arginine hydrochloride (500 mg/kg intravenously over 30 min) and Levodopa/carbidopa (10:1 ratio; 175 mg of l-Dopa/m2 BSA) orally. Serum copeptin was measured at 0, 60, 90, and 120 min. RESULTS In controls, ALD-ST increased copeptin from a median of 7.0 pmol/L (IQR 5.0-10.0) to a peak of 44.0 pmol/L (IQR 21.4-181.0) between 60 and 120 min (p < 0.001). Copeptin peak was higher in subjects who experienced nausea or vomiting (57%) than in those who did not (131.0 pmol/L [IQR 42.5-193.8] vs. 22.7 pmol/L [IQR 16.0-33.7], p < 0.001). While subjects with primary polydipsia had similar baseline (8.5 pmol/L [IQR 8.0-11.0]) and stimulated (125.2 pmol/L [IQR 87.6-174.0]) copeptin levels as controls, subjects with AVP deficiency had lower baseline (2.5 pmol/L [IQR 2.0-3.1]) and peak levels (4.6 pmol/L [IQR 2.4-6.0]). A peak copeptin of ≥9.3 pmol/L best predicted absence of complete or partial AVP deficiency with a sensitivity of 100% and specificity of 80%. CONCLUSIONS ALD-ST induced a robust peak copeptin in healthy short children and children with primary polydipsia. Nausea/vomiting, a side effect of ALD-ST, amplified the copeptin response. The ALD-ST may be a suitable initial screening test in children with PPS.
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Affiliation(s)
- Christine A March
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shruti Sastry
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael J McPhaul
- Quest Diagnostics Nichols Institute, San Juan Capistrano, California, USA
| | - Sarah E Wheeler
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Luigi Garibaldi
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Al Nofal A, Hanna C, Lteif AN, Pittock ST, Schwartz JD, Brumbaugh JE, Creo AL. Copeptin levels in hospitalized infants and children with suspected vasopressin-dependent disorders: a case series. J Pediatr Endocrinol Metab 2023; 36:492-499. [PMID: 37029788 DOI: 10.1515/jpem-2022-0525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/20/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVES There have been recent advances assessing copeptin levels in adults with suspected disorders of vasopressin release. Very limited data exits on copeptin levels in children and infants, especially in a critically-ill hospitalized population where hyper- and hypo-natremia are very common. Our objective is to describe the institutional experience assessing copeptin levels in hospitalized infants and children with hyper- or hypo-natremia. METHODS We performed a single-center retrospective case series of all infants, children, and adolescents who had an ultrasensitive plasma copeptin level obtained between 2019-2021. RESULTS A total of 29 critically ill patients (6 infants) were identified with 38 % of patients having copeptin levels after neurosurgical procedures for tumors or trauma. Approximately 13/17 children with hypernatremia had CDI to diagnose CDI, A copeptin level ≤ 4.9 pmol/L resulted in an 88 % sensitivity (95 % CI 47-99 %), and 66 % specificity (95 % CI 30-93 %). Amongst those with hyponatremia levels were more variable, 8/12 children had SIAD with copeptin levels ranging 4.7-72.6 pmol/L. CONCLUSIONS While difficult to conclude due to multiple limitations, this case series highlights that typical copeptin cutoffs used to diagnose DI in adults in an ambulatory setting may also translate to a critically-ill pediatric population. Large prospective studies are needed to confirm this observation. In addition, postoperative copeptin levels could potentially be utilized as an additional marker to predict permanent from transient DI, but much larger studies are needed. Further work is needed to establish normative copeptin levels in infants and patients with SIAD.
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Affiliation(s)
- Alaa Al Nofal
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Christian Hanna
- Division of Pediatric Nephrology and Hypertension, Mayo Clinic, Rochester, USA
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Aida N Lteif
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Siobhan T Pittock
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ana L Creo
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
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March CA, Sastry S, McPhaul MJ, Wheeler SE, Garibaldi L. Combined Arginine and Insulin Stimulation Elicits a Robust and Consistent Copeptin Response in Short Children. Horm Res Paediatr 2022; 96:395-403. [PMID: 36513057 PMCID: PMC10261513 DOI: 10.1159/000528661] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Copeptin, co-secreted with arginine vasopressin, is regulated by osmotic and volume stimuli but also responds to intravenous arginine and insulin-induced hypoglycemia. The serum copeptin response to the latter agents has been studied in adults but only to a limited extent in children. The objective of this study was to describe the copeptin response to combined arginine and insulin in children with normal posterior pituitary function. METHODS We conducted a prospective, single-arm assessment of serum copeptin concentrations in children (age 7-16 years, n = 38) undergoing growth hormone stimulation testing with an arginine-insulin tolerance test (AITT) for short stature or growth deceleration in a tertiary referral center. After overnight fasting, arginine (500 mg/kg) was administered between 0 and 30 min intravenously (IV) followed by insulin (0.1 units/kg IV) at 60 min. Copeptin serum concentrations were measured at baseline (0 min), at the post-arginine peak (60 min), and at the post-insulin peak (90 min; 30 min post-insulin), respectively. The main outcome was the peak copeptin concentration. RESULTS Mean ± SD copeptin concentrations increased from 9.9 ± 5.0 pmol/L at 0 min to 13.2 ± 5.8 pmol/L at 60 min (p < 0.0001 vs. 0 min) and 27.7 ± 14.2 pmol/L at 90 min (p < 0.0001 vs. 0 and 60 min). There was no significant correlation between copeptin concentrations and age, BMI, pubertal status, cortisol, growth hormone, or glucose concentrations. DISCUSSION/CONCLUSION Arginine and insulin appear to have an additive and consistent effect resulting in significant stimulation of copeptin secretion in children. The AITT may be a useful tool to evaluate for normal posterior pituitary function in this age-group, with potential implications for the evaluation of polyuria-polydipsia syndrome.
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Affiliation(s)
- Christine A March
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shruti Sastry
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Sarah E Wheeler
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Luigi Garibaldi
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Lee YJ, Lee SY. Relationship between prolactin level and puberty in girls with early breast development. J Pediatr Endocrinol Metab 2022; 35:1177-1182. [PMID: 35942610 DOI: 10.1515/jpem-2022-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 07/13/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Prolactin (PRL) stimulates the mammary glands development; however, it also inhibits gonadotropin-releasing hormone (GnRH) secretion. We evaluated the relationship between PRL levels and puberty in girls with precocious breast development. METHODS This study included 244 girls with breast development < 8 years of age. Patients were categorized as central precocious puberty (CPP) [peak luteinizing hormone (LH) levels ≥ 5 IU/L after GnRH stimulation] versus non-CPP (NPP) group. High PRL was defined as serum PRL > 17.9 ng/mL. RESULTS High PRL was more common in NPP than in CPP group (17.6 vs. 8.1%, p=0.025), although mean PRL levels did not differ. In NPP group, the high PRL group had lower peak LH/follicle-stimulating hormone (FSH) ratio, and later LH peak time after GnRH stimulation than normal PRL group (all p < 0.05). PRL levels of the subgroups according to the peak LH time (15, 30, 45, 60, and 90 min after GnRH stimulation) were different in NPP group, but not in CPP group. PRL levels tended to be higher as the peak LH time was delayed. High PRL was associated with decreased odds for CPP (OR=0.42, p=0.043). CONCLUSIONS Girls with NPP showed higher proportion of high PRL than CPP group. High PRL group showed more features of prepubertal response in NPP group, and associated with decreased odds for CPP, suggesting the possibility of PRL role on breast development while suppressing hypothalamic-pituitary-gonadal axis activation in NPP girls.
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Affiliation(s)
- Yun Jeong Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Seong Yong Lee
- Department of Pediatrics, SMG-SNU Boramae Medical Center, Seoul, Korea
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Bitencourt L, Fischer BL, de Oliveira Campos JL, Vaz de Castro PAS, Soares de Brito SBC, Versiani CM, Soares BS, Drummond JB, Simões E Silva AC. The usefulness of copeptin for the diagnosis of nephrogenic diabetes insipidus in infancy: a case report. J Pediatr Endocrinol Metab 2021; 34:1475-1479. [PMID: 34291622 DOI: 10.1515/jpem-2021-0296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/09/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We report a case of an infant with nephrogenic diabetes insipidus (NDI) diagnosed by the measurement of serum copeptin. There is only one study that previously evaluated the use of copeptin measurement in a pediatric patient. CASE PRESENTATION We present a 10-month-old child with polyuria-polydipsia syndrome (PPS) and hypernatremia that could not support water restriction due to increased risk of dehydration and worsening of his condition. Therefore, plasma measurement of copeptin allowed the diagnosis of NDI. CONCLUSIONS The water deprivation test (WDT) is considered the gold standard for diagnosis in PPS. However, WDT has serious limitations regarding its interpretation. Furthermore, the WDT can cause dehydration and hypernatremia, especially in young children. Therefore, the measurement of plasma copeptin seems to be a promising method to perform an earlier, safer, and accurate investigation of PPS. Up to now, our study is the second to report the usefulness of copeptin in children.
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Affiliation(s)
- Letícia Bitencourt
- Interdisciplinary Laboratory of Medical Investigation, Unit of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Bruna Luisa Fischer
- Interdisciplinary Laboratory of Medical Investigation, Unit of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Juliana Lacerda de Oliveira Campos
- Interdisciplinary Laboratory of Medical Investigation, Unit of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Pedro Alves Soares Vaz de Castro
- Interdisciplinary Laboratory of Medical Investigation, Unit of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Stephanie Bruna Camilo Soares de Brito
- Interdisciplinary Laboratory of Medical Investigation, Unit of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Carolina Mazieiro Versiani
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, UFMG, Belo Horizonte, Brazil
| | - Beatriz Santana Soares
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, UFMG, Belo Horizonte, Brazil
| | - Juliana Beaudette Drummond
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, UFMG, Belo Horizonte, Brazil
| | - Ana Cristina Simões E Silva
- Interdisciplinary Laboratory of Medical Investigation, Unit of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
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Liu L, Dattaroy D, Simpson KF, Barella LF, Cui Y, Xiong Y, Jin J, König GM, Kostenis E, Roman JC, Kaestner KH, Doliba NM, Wess J. α-cell Gq signaling is critical for maintaining euglycemia. JCI Insight 2021; 6:152852. [PMID: 34752420 PMCID: PMC8783673 DOI: 10.1172/jci.insight.152852] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/04/2021] [Indexed: 11/17/2022] Open
Abstract
Glucagon, a hormone released from pancreatic α cells, plays a key role in maintaining euglycemia. New insights into the signaling pathways that control glucagon secretion may stimulate the development of novel therapeutic agents. In this study, we investigated the potential regulation of α cell function by G proteins of the Gq family. The use of a chemogenetic strategy allowed us to selectively activate Gq signaling in mouse α cells in vitro and in vivo. Acute stimulation of α cell Gq signaling led to elevated plasma glucagon levels, accompanied by increased insulin release and improved glucose tolerance. Moreover, chronic activation of this pathway greatly improved glucose tolerance in obese mice. We also identified an endogenous Gq-coupled receptor (vasopressin 1b receptor; V1bR) that was enriched in mouse and human α cells. Agonist-induced activation of the V1bR strongly stimulated glucagon release in a Gq-dependent fashion. In vivo studies indicated that V1bR-mediated glucagon release played a key role in the counterregulatory hyperglucagonemia under hypoglycemic and glucopenic conditions. These data indicate that α cell Gq signaling represents an important regulator of glucagon secretion, resulting in multiple beneficial metabolic effects. Thus, drugs that target α cell–enriched Gq-coupled receptors may prove useful to restore euglycemia in various pathophysiological conditions.
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Affiliation(s)
- Liu Liu
- Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, United States of America
| | - Diptadip Dattaroy
- Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, United States of America
| | - Katherine F Simpson
- Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, United States of America
| | - Luiz F Barella
- Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, United States of America
| | - Yinghong Cui
- Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, United States of America
| | - Yan Xiong
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Jian Jin
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Gabriele M König
- Institute of Pharmaceutical Biology, University of Bonn, Bonn, Germany
| | - Evi Kostenis
- Institute for Pharmaceutical Biology, University of Bonn, Bonn, Germany
| | - Jefferey C Roman
- Institute of Diabetes, Obesity, and Metabolism, The University of Pennsylvania, Philadelphia, United States of America
| | - Klaus H Kaestner
- Institute of Diabetes, Obesity, and Metabolism, Perelman School of Medicine, The University of Pennsylvania, Philadeplhia, United States of America
| | - Nicolai M Doliba
- Institute of Diabetes, Obesity, and Metabolism, Perelman School of Medicine, The University of Pennsylvania, Philadeplhia, United States of America
| | - Jürgen Wess
- Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, United States of America
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Proskurnina E, Portnova G, Ivanova M, Sokolova S. Chemiluminescence analysis of saliva for the assessment of emotional stress in autistic children undergoing a medical examination. ADVANCES IN AUTISM 2021. [DOI: 10.1108/aia-09-2020-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
An electroencephalography (EEG) examination may cause psychological stress in children with autism that can interfere with the examination results. The objective information on the presence or absence of psycho-emotional stress in patients can help interpret electroencephalograms. This paper aimed to demonstrate the potential of noninvasive objective diagnostics of emotional stress in autistic children undergoing an EEG examination based on analysis of saliva.
Design/methodology/approach
This study involved 19 children with autism spectrum disorder (ASD) (ICD-10 F84.0); the mean age was seven years. During EEG examination of the children, behavioral parameters were assessed. The activity of cytochrome P450 reductase (CYPOR) in saliva was measured before and after the EEG procedure using lucigenin-enhanced nicotinamide adenine dinucleotide phosphate-stimulated chemiluminescence assay.
Findings
Significant differences in CYPOR activity were found between the children who were distressed during an EEG examination and the children without behavioral disturbances (Mann–Whitney test, p = 0.002). Thus, the EEG examination resulted in an increase in CYPOR activity in saliva cells, which may prove the stressful effect of this procedure on autistic children.
Originality/value
The chemiluminescent indices reflecting the activity of microsomal CYPOR in cells presenting in saliva correlate with the absence or presence of psychological stress in children; this phenomenon can be explained by an increased metabolism of the stress hormone, cortisol, by the cytochrome P450 microsomal system. Furthermore, the proposed method is completely safe, noninvasive, rapid (recording time is 20 min), inexpensive and promising for an objective assessment of psycho-emotional stress in autistic children undergoing medical examinations.
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Abstract
Vasopressin (AVP) and copeptin are released in equimolar amounts from the same precursor. Due to its molecular stability and countless advantages as compared with AVP, copeptin perfectly mirrors AVP presence and has progressively emerged as a reliable marker of vasopressinergic activation in response to osmotic and hemodynamic stimuli in clinical practice. Moreover, evidence highlighting the prognostic potential of copeptin in several acute diseases, where the activation of the AVP system is primarily linked to stress, as well as in psychologically stressful conditions, has progressively emerged. Furthermore, organic stressors induce a rise in copeptin levels which, although non-specific, is unrelated to plasma osmolality but proportional to their magnitude: suggesting disease severity, copeptin proved to be a reliable prognostic biomarker in acute conditions, such as sepsis, early post-surgical period, cardiovascular, cerebrovascular or pulmonary diseases, and even in critical settings. Evidence on this topic will be briefly discussed in this article.
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A Review of Biophysiological and Biochemical Indicators of Stress for Connected and Preventive Healthcare. Diagnostics (Basel) 2021; 11:diagnostics11030556. [PMID: 33808914 PMCID: PMC8003811 DOI: 10.3390/diagnostics11030556] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/14/2021] [Accepted: 03/17/2021] [Indexed: 12/05/2022] Open
Abstract
Stress is a known contributor to several life-threatening medical conditions and a risk factor for triggering acute cardiovascular events, as well as a root cause of several social problems. The burden of stress is increasing globally and, with that, is the interest in developing effective stress-monitoring solutions for preventive and connected health, particularly with the help of wearable sensing technologies. The recent development of miniaturized and flexible biosensors has enabled the development of connected wearable solutions to monitor stress and intervene in time to prevent the progression of stress-induced medical conditions. This paper presents a review of the literature on different physiological and chemical indicators of stress, which are commonly used for quantitative assessment of stress, and the associated sensing technologies.
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