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Bhattarai A, Shah S, Baidya S, Thapa R, Bhandari S, Tuladhar ET, Acharya SP, Sah R. Association of copeptin levels with patient prognosis and survival in sepsis syndromes: a meta-analysis. Int J Surg 2024; 110:2355-2365. [PMID: 38668663 PMCID: PMC11019991 DOI: 10.1097/js9.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/24/2023] [Indexed: 04/29/2024]
Abstract
BACKGROUND Sepsis syndromes are a major burden in the ICU with very high mortality. Vasopressin and copeptin are released in response to hypovolemia and have shown potential significance in diagnosing sepsis. OBJECTIVE To investigate the levels of copeptin in patients with sepsis syndromes and evaluate its relation with patient prognosis and mortality. METHODS Four databases were searched for literature published from inception to the 8th of November 2022. Original research articles where copeptin was measured in sepsis patients and compared with controls were included. Data extraction and synthesis: study characteristics, levels of copeptin in the participants, and copeptin assay description were extracted. Levels of copeptin in patients were pooled and compared with controls in terms of the standard mean difference (SMD) generated using a random-effects model. RESULTS Fifteen studies met the selection criteria. Copeptin levels were significantly higher in patients with sepsis, severe sepsis, and septic shock as compared to controls [(SMD: 1.49, 95% CI: 0.81-2.16, P<0.0001), (SMD: 1.94, 95% CI: 0.34-3.54, P=0.02), and (SMD: 2.17, 95% CI: 0.68-3.66, P=0.004), respectively]. The highest copeptin levels were noted in septic shock patients. The admission copeptin levels were significantly lower in survivors as compared to nonsurvivors (SMD: -1.73; 95% CI: -2.41 to -1.06, P<0.001). CONCLUSION AND RELEVANCE Copeptin was significantly elevated in sepsis, severe sepsis, and septic shock. Survivors had a significantly lower copeptin during admission. Copeptin offered an excellent predictability to predict 1-month mortality. Measuring the copeptin in sepsis patients can aid treating physicians to foresee patients' prognosis.
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Affiliation(s)
| | | | | | | | | | - Eans T. Tuladhar
- Department of Biochemistry, Institute of Medicine, Tribhuvan University
| | | | - Ranjit Sah
- Department of Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
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2
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Erdélyi LS, Hunyady L, Balla A. V2 vasopressin receptor mutations: future personalized therapy based on individual molecular biology. Front Endocrinol (Lausanne) 2023; 14:1173601. [PMID: 37293495 PMCID: PMC10244717 DOI: 10.3389/fendo.2023.1173601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/15/2023] [Indexed: 06/10/2023] Open
Abstract
The diluting and concentrating function of the kidney plays a crucial role in regulating the water homeostasis of the body. This function is regulated by the antidiuretic hormone, arginine vasopressin through the type 2 vasopressin receptor (V2R), allowing the body to adapt to periods of water load or water restriction. Loss-of-function mutations of the V2R cause X-linked nephrogenic diabetes insipidus (XNDI), which is characterized by polyuria, polydipsia, and hyposthenuria. Gain-of-function mutations of the V2R lead to nephrogenic syndrome of inappropriate antidiuresis disease (NSIAD), which results in hyponatremia. Various mechanisms may be responsible for the impaired receptor functions, and this review provides an overview of recent findings about the potential therapeutic interventions in the light of the current experimental data.
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Affiliation(s)
- László Sándor Erdélyi
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - László Hunyady
- Department of Physiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Institute of Enzymology, Research Center for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - András Balla
- Department of Physiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- ELKH-SE Laboratory of Molecular Physiology, Eötvös Loránd Research Network, Budapest, Hungary
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3
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Wang J, Zhu F, Huang W, Chen Z, Zhao P, Lei Y, Liu Y, Liu X, Sun B, Li H. Therapeutic Effect and Mechanism of Acupuncture in Autoimmune Diseases. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2022; 50:639-652. [PMID: 35282807 DOI: 10.1142/s0192415x22500252] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Autoimmune diseases (AIDs) are conditions arising from abnormal immune reactions to autoantigens, which can be defined as the loss of immune tolerance to autoantigens, causing the production of autoantibodies and subsequent inflammation and tissue injury. The etiology of AIDs remains elusive, which may involve both genetic and environmental factors, such as diet, drugs, and infections. Despite rapid progress in the treatment of autoimmune diseases over the past few decades, there is still no approach that can cure AIDs. As an alternative approach, traditional Chinese medicine (TCM) such as acupuncture has been used in an attempt to treat AIDs including multiple sclerosis (MS), rheumatoid arthritis (RA), and inflammatory bowel disease (IBD), and the results have proven to be quite promising, despite the fact that its mechanism is still not fully understood. In this review, the present knowledge regarding mechanisms of acupuncture in the treatment of AIDs has been summarized, and deeper insights will be provided in order to better understand how acupuncture may regulate immune responses during AIDs.
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Affiliation(s)
- Jing Wang
- Department of Neurobiology, School of Basic Medical Sciences, Harbin Medical University Harbin, Heilongjiang 150081, P. R. China
| | - Fangyi Zhu
- Department of Neurobiology, School of Basic Medical Sciences, Harbin Medical University Harbin, Heilongjiang 150081, P. R. China
| | - Wei Huang
- Department of Neurobiology, School of Basic Medical Sciences, Harbin Medical University Harbin, Heilongjiang 150081, P. R. China
| | - Zhengyi Chen
- Department of Neurobiology, School of Basic Medical Sciences, Harbin Medical University Harbin, Heilongjiang 150081, P. R. China
| | - Ping Zhao
- Department of Neurobiology, School of Basic Medical Sciences, Harbin Medical University Harbin, Heilongjiang 150081, P. R. China
| | - Yanting Lei
- Department of Neurobiology, School of Basic Medical Sciences, Harbin Medical University Harbin, Heilongjiang 150081, P. R. China
| | - Yumei Liu
- Department of Neurobiology, School of Basic Medical Sciences, Harbin Medical University Harbin, Heilongjiang 150081, P. R. China
| | - Xijun Liu
- Department of Neurobiology, School of Basic Medical Sciences, Harbin Medical University Harbin, Heilongjiang 150081, P. R. China
| | - Bo Sun
- Department of Neurobiology, School of Basic Medical Sciences, Harbin Medical University Harbin, Heilongjiang 150081, P. R. China
| | - Hulun Li
- Department of Neurobiology, School of Basic Medical Sciences, Harbin Medical University Harbin, Heilongjiang 150081, P. R. China
- The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education Harbin, Heilongjiang 150081, P. R. China
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Circulating Levels of the Cardiovascular Biomarkers ST2 and Adrenomedullin Predict Outcome within a Randomized Phase III Lung Cancer Trial (RASTEN). Cancers (Basel) 2022; 14:cancers14051307. [PMID: 35267617 PMCID: PMC8909619 DOI: 10.3390/cancers14051307] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 12/07/2022] Open
Abstract
Cardiovascular comorbidity is common in small cell lung cancer (SCLC) and may significantly affect treatment tolerability and patient outcome. Still, there are no established biomarkers for objective and dynamic assessment as a tool for improved treatment decisions. We have investigated circulating levels of midregional-pro-adrenomedullin (MR-proADM), midregional-pro-atrial-natriuretic peptide (MR-proANP), copeptin (surrogate for vasopressin) and suppression-of-tumorigenicity-2 (ST2), all known to correlate with various aspects of cardiovascular function, in a SCLC cohort (N = 252) from a randomized, controlled trial (RASTEN). For all measured biomarkers, protein levels were inversely associated with survival, particularly with ST2 and MR-proADM, where the top versus bottom quartile was associated with an adjusted hazard ratio of 2.40 (95% CI 1.44−3.98; p = 0.001) and 2.18 (95% CI 1.35−3.51; p = 0.001), respectively, in the entire cohort, and 3.43 (95% CI 1.73−6.79; p < 0.001) and 3.49 (95% CI 1.84−6.60; p < 0.001), respectively, in extensive disease patients. A high combined score of MR-proADM and ST2 was associated with a significantly reduced median OS of 7.0 months vs. 14.9 months for patients with a low combined score. We conclude that the cardiovascular biomarkers MR-proADM and ST2 strongly correlate with survival in SCLC, warranting prospective studies on the clinical utility of MR-proADM and ST2 for improved, individualized treatment decisions.
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Ortolá Buigues A, Gómez-Hoyos E, Ballesteros Pomar MD, Vidal Casariego A, García Delgado Y, Ocón Bretón MJ, Abad González ÁL, Luengo Pérez LM, Matía Martín P, Tapia Guerrero MJ, Del Olmo García MD, Herrero Ruiz A, Álvarez Hernández J, Tejera Pérez C, Herranz Antolín S, Tenorio Jiménez C, García Zafra MV, Botella Romero F, Argente Pla M, Martínez Olmos MÁ, Bretón Lemes I, Runkle De la Vega I, De Luis Román D. Aetiological diagnosis of hyponatraemia in non-critical patients on total parenteral nutrition: A prospective multicentre study. ENDOCRINOL DIAB NUTR 2022; 69:160-167. [PMID: 35396114 DOI: 10.1016/j.endien.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/15/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND In patients receiving total parenteral nutrition (TPN), the frequency of hyponatraemia is high. However, the causes of hyponatraemia in TPN have not been elucidated, although diagnosis is required for appropriate therapy. The aim of this study is to describe the aetiology of hyponatraemia in non-critical hospitalised patients receiving TPN. METHODS Prospective multicentre study in 19 Spanish hospitals. Non-critically hyponatraemic patients receiving TPN and presenting hyponatraemia over a 9-month period were studied. Data collected included sex, age, previous comorbidities, and serum sodium levels (SNa) before and following TPN initiation. Parameters for study of hyponatraemia were also included: clinical volaemia, the presence of pain, nausea, gastrointestinal losses, diuretic use, oedema, renal function, plasma and urine osmolality, urinary electrolytes, cortisolaemia, and thyroid stimulating hormone. RESULTS 162 patients were included, 53.7% males, age 66.4 (SD13.8) years. Volume status was evaluated in 142 (88%): 21 (14.8%) were hypovolaemic, 96 (67.6%) euvolaemic and 25 (17.6%) hypervolaemic. In 111/142 patients the analytical assessment of hyponatraemia was completed. Hypovolaemic hyponatraemia was secondary to GI losses in 10/111 (9%), and to diuretics in 3/111 (2.7%). Euvolaemic hyponatraemia was due to Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) in 47/111 (42.4%), and to physiological stimuli of Arginine Vasopressin (AVP) secretion in 28/111 (25.2%). Hypervolaemic hyponatraemia was induced by heart failure in 19/111 (17.1%), cirrhosis of the liver in 4/111 (3.6%). CONCLUSIONS SIADH was the most frequent cause of hyponatraemia in patients receiving TPN. The second most frequent cause was physiological stimuli of AVP secretion induced by pain/nausea.
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Affiliation(s)
- Ana Ortolá Buigues
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain.
| | - Emilia Gómez-Hoyos
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain
| | | | - Alfonso Vidal Casariego
- Endocrinology and Nutrition Department, Complejo Asistencial Universitario de León, León, Spain
| | - Yaiza García Delgado
- Endocrinology and Nutrition Department, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
| | - María Julia Ocón Bretón
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Ángel Luis Abad González
- Endocrinology and Nutrition Department, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Pilar Matía Martín
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria San Carlos (IDISSC), Madrid, Spain
| | | | | | - Ana Herrero Ruiz
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Julia Álvarez Hernández
- Endocrinology and Nutrition Department, Hospital Universitario Príncipe de Asturias, Getafe, Spain
| | - Cristina Tejera Pérez
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Sandra Herranz Antolín
- Endocrinology and Nutrition Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | | | - Francisco Botella Romero
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - María Argente Pla
- Endocrinology and Nutrition Department, Hospital Universitario y Politécnico de La Fe, Valencia, Spain
| | - Miguel Ángel Martínez Olmos
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Irene Bretón Lemes
- Endocrinology and Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Isabelle Runkle De la Vega
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria San Carlos (IDISSC), Madrid, Spain
| | - Daniel De Luis Román
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain
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Mu D, Ma C, Cheng J, Zou Y, Qiu L, Cheng X. Copeptin in fluid disorders and stress. Clin Chim Acta 2022; 529:46-60. [PMID: 35143773 DOI: 10.1016/j.cca.2022.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 12/16/2022]
Abstract
Copeptin, a glycosylated peptide of 39 amino acids, is the C-terminal segment of arginine vasopressin (AVP) precursor peptide, which is consisted of two other fragments, vasopressin and neurophysin Ⅱ. The main physiological functions of AVP are fluid and osmotic balance, cardiovascular homeostasis and regulation of the endocrine stress response. Numerous studies have demonstrated that the endogenous AVP in plasma is a meaningful biomarker to guide diagnosis and therapy of diseases associated with fluids disorders and stress. However, due to its instability, short half-time life in circulation and lack of readily available AVP assays, clinical measurement of AVP is restricted. In contrast to AVP, copeptin which is released in an equimolar mode with AVP from the pituitary, has emerged as a stable and simple-to-measure surrogate marker of AVP and displays excellent potential in diagnosis, differentiation and prognosis of various diseases. This review will discuss the studies on the clinical value of copeptin in different diseases, especially in AVP-dependent fluids disorders, as well as issues and prospects of the application of this potential biomarker.
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Affiliation(s)
- Danni Mu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Chaochao Ma
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Jin Cheng
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Yutong Zou
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Ling Qiu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xinqi Cheng
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China.
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Szalai L, Sziráki A, Erdélyi LS, Kovács KB, Tóth M, Tóth AD, Turu G, Bonnet D, Mouillac B, Hunyady L, Balla A. Functional Rescue of a Nephrogenic Diabetes Insipidus Causing Mutation in the V2 Vasopressin Receptor by Specific Antagonist and Agonist Pharmacochaperones. Front Pharmacol 2022; 13:811836. [PMID: 35153784 PMCID: PMC8829706 DOI: 10.3389/fphar.2022.811836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/12/2022] [Indexed: 11/25/2022] Open
Abstract
The urine concentrating function of the kidney is essential to maintain the water homeostasis of the human body. It is mainly regulated by the arginine-vasopressin (AVP), which targets the type 2 vasopressin receptor (V2R) in the kidney. The inability of V2R to respond to AVP stimulation leads to decreased urine concentration and congenital nephrogenic diabetes insipidus (NDI). NDI is characterized by polyuria, polydipsia, and hyposthenuria. In this study, we identified a point mutation (S127F) in the AVPR2 gene of an NDI patient, and we characterized the impaired function of the V2R mutant in HEK293 cells. Based on our data, the S127F-V2R mutant is almost exclusively located intracellularly in the endoplasmic reticulum (ER), and very few receptors were detected at the cell surface, where the receptor can bind to AVP. The overexpressed S127F-V2R mutant receptor has negligible cAMP generation capability compared to the wild-type receptor in response to AVP stimulation. Since certain misfolded mutant proteins, that are retained in the ER, can be rescued by pharmacological chaperones, we examined the potential rescue effects of two pharmacochaperones on the S127F-V2R. We found that pretreatment with both tolvaptan (an established V2R inverse agonist) and MCF14 compound (a cell-permeable high-affinity agonist for the V2R) were capable of partially restoring the cAMP generating function of the receptor in response to vasopressin stimulation. According to our data, both cell permeant agonists and antagonists can function as pharmacochaperones, and serve as the starting compounds to develop medicines for patients carrying the S127F mutation.
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Affiliation(s)
- Laura Szalai
- Department of Physiology, Semmelweis University, Budapest, Hungary
- MTA-SE Laboratory of Molecular Physiology, Eötvös Loránd Research Network and Semmelweis University, Budapest, Hungary
| | - András Sziráki
- Department of Physiology, Semmelweis University, Budapest, Hungary
| | | | | | - Miklós Tóth
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - András Dávid Tóth
- Department of Physiology, Semmelweis University, Budapest, Hungary
- MTA-SE Laboratory of Molecular Physiology, Eötvös Loránd Research Network and Semmelweis University, Budapest, Hungary
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Gábor Turu
- Department of Physiology, Semmelweis University, Budapest, Hungary
- MTA-SE Laboratory of Molecular Physiology, Eötvös Loránd Research Network and Semmelweis University, Budapest, Hungary
| | - Dominique Bonnet
- Laboratoire D'Innovation Thérapeutique, Strasbourg Drug Discovery and Development Institute (IMS), UMR7200 CNRS, Université de Strasbourg, Illkirch-Graffenstaden, France
| | - Bernard Mouillac
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - László Hunyady
- Department of Physiology, Semmelweis University, Budapest, Hungary
- MTA-SE Laboratory of Molecular Physiology, Eötvös Loránd Research Network and Semmelweis University, Budapest, Hungary
- Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary
- *Correspondence: László Hunyady, ; András Balla,
| | - András Balla
- Department of Physiology, Semmelweis University, Budapest, Hungary
- MTA-SE Laboratory of Molecular Physiology, Eötvös Loránd Research Network and Semmelweis University, Budapest, Hungary
- *Correspondence: László Hunyady, ; András Balla,
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Yuen KCJ, Sharf V, Smith E, Kim M, Yuen ASM, MacDonald PR. Sodium and water perturbations in patients who had an acute stroke: clinical relevance and management strategies for the neurologist. Stroke Vasc Neurol 2021; 7:258-266. [PMID: 34969834 PMCID: PMC9240457 DOI: 10.1136/svn-2021-001230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/26/2021] [Indexed: 12/17/2022] Open
Abstract
Sodium and water perturbations, manifesting as hyponatraemia and hypernatraemia, are common in patients who had an acute stroke, and are associated with worse outcomes and increased mortality. Other non-stroke-related causes of sodium and water perturbations in these patients include underlying comorbidities and concomitant medications. Additionally, hospitalised patients who had an acute stroke may receive excessive intravenous hypotonic solutions, have poor fluid intake due to impaired neurocognition and consciousness, may develop sepsis or are administered drugs (eg, mannitol); factors that can further alter serum sodium levels. Sodium and water perturbations can also be exacerbated by the development of endocrine consequences after an acute stroke, including secondary adrenal insufficiency, syndrome of inappropriate antidiuretic hormone secretion and diabetes insipidus. Recently, COVID-19 infection has been reported to increase the risk of development of sodium and water perturbations that may further worsen the outcomes of patients who had an acute stroke. Because there are currently no accepted consensus guidelines on the management of sodium and water perturbations in patients who had an acute stroke, we conducted a systematic review of the literature published in English and in peer-reviewed journals between January 2000 and December 2020, according to PRISMA guidelines, to assess on the current knowledge and clinical practices of this condition. In this review, we discuss the signs and symptoms of hyponatraemia and hypernatraemia, the pathogenesis of hyponatraemia and hypernatraemia, their clinical relevance, and we provide our recommendations for effective treatment strategies for the neurologist in the management of sodium and water perturbations in commonly encountered aetiologies of patients who had an acute stroke.
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Affiliation(s)
- Kevin C J Yuen
- Departments of Neuroendocrinology and Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA .,University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, Arizona, USA
| | - Valerie Sharf
- University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, Arizona, USA.,Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | | | - Minhwan Kim
- Creighton University School of Medicine, Phoenix, Arizona, USA
| | | | - Paul R MacDonald
- University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, Arizona, USA.,Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
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9
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Gupta S, Ozimek-Kulik JE, Phillips JK. Nephronophthisis-Pathobiology and Molecular Pathogenesis of a Rare Kidney Genetic Disease. Genes (Basel) 2021; 12:genes12111762. [PMID: 34828368 PMCID: PMC8623546 DOI: 10.3390/genes12111762] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/17/2022] Open
Abstract
The exponential rise in our understanding of the aetiology and pathophysiology of genetic cystic kidney diseases can be attributed to the identification of cystogenic genes over the last three decades. The foundation of this was laid by positional cloning strategies which gradually shifted towards next-generation sequencing (NGS) based screenings. This shift has enabled the discovery of novel cystogenic genes at an accelerated pace unlike ever before and, most notably, the past decade has seen the largest increase in identification of the genes which cause nephronophthisis (NPHP). NPHP is a monogenic autosomal recessive cystic kidney disease caused by mutations in a diverse clade of over 26 identified genes and is the most common genetic cause of renal failure in children. NPHP gene types present with some common pathophysiological features alongside a diverse range of extra-renal phenotypes associated with specific syndromic presentations. This review provides a timely update on our knowledge of this disease, including epidemiology, pathophysiology, anatomical and molecular features. We delve into the diversity of the NPHP causing genes and discuss known molecular mechanisms and biochemical pathways that may have possible points of intersection with polycystic kidney disease (the most studied renal cystic pathology). We delineate the pathologies arising from extra-renal complications and co-morbidities and their impact on quality of life. Finally, we discuss the current diagnostic and therapeutic modalities available for disease management, outlining possible avenues of research to improve the prognosis for NPHP patients.
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Affiliation(s)
- Shabarni Gupta
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia; (J.E.O.-K.); (J.K.P.)
- Correspondence:
| | - Justyna E. Ozimek-Kulik
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia; (J.E.O.-K.); (J.K.P.)
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW 2031, Australia
- Department of Paediatric Nephrology, Sydney Children’s Hospital Network, Children’s Hospital at Westmead, Sydney, NSW 2145, Australia
| | - Jacqueline Kathleen Phillips
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia; (J.E.O.-K.); (J.K.P.)
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10
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Mieszczański P, Górniewski G, Błaszczyk B, Pacholczyk M, Trzebicki J. Copeptin (CTproAVP) - A Biomarker of a Circulatory Impairment in Liver Transplant Recipients? A Prospective, Observational Study. Transplant Proc 2021; 53:1969-1974. [PMID: 34243965 DOI: 10.1016/j.transproceed.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Copeptin, an easily measured and stable surrogate marker of arginine vasopressin, is a biomarker of a homeostasis disorder and a circulatory impairment in a wide spectrum of morbidities. The aim of this study was to evaluate the potential of copeptin as a biomarker of a circulatory impairment in patients undergoing liver transplantation (LT). METHODS This was a prospective, observational study. Blood samples were obtained from 38 patients undergoing LT. Serum copeptin level was measured by means of a sandwich immunoassay pre-, intra-, and postoperatively up to 21 days after the operation. RESULTS The mean concentration of copeptin remained in the range of values slightly below 1000 pg/mL during the analyzed observation period and remained higher than the values observed in healthy individuals. Intraoperative and immediately postoperative copeptin levels did not correlate with hemodynamic parameters. There was also no correlation between preoperative copeptin levels (C1) and preoperative Model for End-Stage Liver Disease scores, serum creatinine levels, plasma transaminase levels, international normalized ratio, or hematocrit (Spearman ρ, P > .05). CONCLUSIONS Preoperative copeptin levels are elevated in most LT recipients and remain elevated for 21 days after surgery. There was no correlation between the concentration of copeptin and the Model for End-Stage Liver Disease-Sodium score or the cause of a hepatic failure. It cannot be concluded that copeptin is a biomarker of a circulatory impairment in patients with transplanted liver in the perioperative period. The secretion of vasopressin, as measured by copeptin concentration during and after LT, requires further study.
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Affiliation(s)
- Piotr Mieszczański
- Departments of 1st Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland.
| | - Grzegorz Górniewski
- Departments of 1st Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland; Departments of Anaesthesiology and Intensive Care Teaching Section, Medical University of Warsaw, Warsaw, Poland
| | - Beata Błaszczyk
- Departments of 1st Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Marek Pacholczyk
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Trzebicki
- Departments of 1st Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
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Ortolá Buigues A, Gómez-Hoyos E, Ballesteros Pomar MD, Vidal Casariego A, García Delgado Y, Ocón Bretón MJ, Abad González ÁL, Luengo Pérez LM, Matía Martín P, Tapia Guerrero MJ, Del Olmo García MD, Herrero Ruiz A, Álvarez Hernández J, Tejera Pérez C, Herranz Antolín A, Tenorio Jiménez C, García Zafra MV, Botella Romero F, Argente Pla M, Martínez Olmos MÁ, Bretón Lemes I, Runkle De la Vega I, De Luis Román D. Aetiological diagnosis of hyponatraemia in non-critical patients on total parenteral nutrition: A prospective multicentre study. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00123-3. [PMID: 34244097 DOI: 10.1016/j.endinu.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND In patients receiving total parenteral nutrition (TPN), the frequency of hyponatraemia is high. However, the causes of hyponatraemia in TPN have not been elucidated, although diagnosis is required for appropriate therapy. The aim of this study is to describe the aetiology of hyponatraemia in non-critical hospitalised patients receiving TPN. METHODS Prospective multicentre study in 19 Spanish hospitals. Non-critically hyponatraemic patients receiving TPN and presenting hyponatraemia over a 9-month period were studied. Data collected included sex, age, previous comorbidities, and serum sodium levels (SNa) before and following TPN initiation. Parameters for study of hyponatraemia were also included: clinical volaemia, the presence of pain, nausea, gastrointestinal losses, diuretic use, oedema, renal function, plasma and urine osmolality, urinary electrolytes, cortisolaemia, and thyroid stimulating hormone. RESULTS 162 patients were included, 53.7% males, age 66.4 (SD13.8) years. Volume status was evaluated in 142 (88%): 21 (14.8%) were hypovolaemic, 96 (67.6%) euvolaemic and 25 (17.6%) hypervolaemic. In 111/142 patients the analytical assessment of hyponatraemia was completed. Hypovolaemic hyponatraemia was secondary to GI losses in 10/111 (9%), and to diuretics in 3/111 (2.7%). Euvolaemic hyponatraemia was due to Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) in 47/111 (42.4%), and to physiological stimuli of Arginine Vasopressin (AVP) secretion in 28/111 (25.2%). Hypervolaemic hyponatraemia was induced by heart failure in 19/111 (17.1%), cirrhosis of the liver in 4/111 (3.6%). CONCLUSIONS SIADH was the most frequent cause of hyponatraemia in patients receiving TPN. The second most frequent cause was physiological stimuli of AVP secretion induced by pain/nausea.
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Affiliation(s)
- Ana Ortolá Buigues
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain.
| | - Emilia Gómez-Hoyos
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain
| | | | - Alfonso Vidal Casariego
- Endocrinology and Nutrition Department, Complejo Asistencial Universitario de León, León, Spain
| | - Yaiza García Delgado
- Endocrinology and Nutrition Department, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
| | - María Julia Ocón Bretón
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Ángel Luis Abad González
- Endocrinology and Nutrition Department, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Pilar Matía Martín
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria San Carlos (IDISSC), Madrid, Spain
| | | | | | - Ana Herrero Ruiz
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Julia Álvarez Hernández
- Endocrinology and Nutrition Department, Hospital Universitario Príncipe de Asturias, Getafe, Spain
| | - Cristina Tejera Pérez
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | | | | | | | - Francisco Botella Romero
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - María Argente Pla
- Endocrinology and Nutrition Department, Hospital Universitario y Politécnico de La Fe, Valencia, Spain
| | - Miguel Ángel Martínez Olmos
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Irene Bretón Lemes
- Endocrinology and Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Isabelle Runkle De la Vega
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos and Instituto de Investigación Sanitaria San Carlos (IDISSC), Madrid, Spain
| | - Daniel De Luis Román
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain
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12
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Alvelos MI, Francisco Â, Gomes L, Paiva I, Melo M, Marques P, Gama-de-Sousa S, Carreiro S, Quintela T, Gonçalves I, Lemos MC. Familial neurohypophyseal diabetes insipidus: clinical, genetic and functional studies of novel mutations in the arginine vasopressin gene. Pituitary 2021; 24:400-411. [PMID: 33433888 DOI: 10.1007/s11102-020-01119-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Familial neurohypophyseal diabetes insipidus (FNDI) is a rare disorder characterized by childhood-onset progressive polyuria and polydipsia due to mutations in the arginine vasopressin (AVP) gene. The aim of the study was to describe the clinical and molecular characteristics of families with neurohypophyseal diabetes insipidus. METHODS Five Portuguese families with autosomal dominant FNDI underwent sequencing of the AVP gene and the identified mutations were functionally characterized by in vitro studies. RESULTS Three novel and two recurrent heterozygous mutations were identified in the AVP gene. These consisted of one initiation codon mutation in the signal peptide coding region (c.2T > C, p.Met1?), three missense mutations in the neurophysin II (NPII) coding region (c.154T > C, p.Cys52Arg; c.289C > G, p.Arg97Gly; and c.293G > C, p.Cys98Ser), and one nonsense mutation in the NPII coding region (c.343G > T, p.Glu115Ter). In vitro transfection of neuronal cells with expression vectors containing each mutation showed that the mutations resulted in intracellular retention of the vasopressin prohormone. Patients showed progressive symptoms of polyuria and polydipsia, but with wide variability in severity and age at onset. No clear genotype-phenotype correlation was observed. CONCLUSION The intracellular accumulation of mutant vasopressin precursors supports the role of cellular toxicity of the mutant proteins in the etiology of the disorder and explains the progressive onset of the disorder. These findings further expand the AVP mutational spectrum in FNDI and contribute to the understanding of the molecular pathogenic mechanisms involved in FNDI.
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Affiliation(s)
- Maria Inês Alvelos
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506, Covilha, Portugal
- ULB Center for Diabetes Research, Medical Faculty, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Ângela Francisco
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506, Covilha, Portugal
| | - Leonor Gomes
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário de Coimbra, 3000-075, Coimbra, Portugal
| | - Isabel Paiva
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário de Coimbra, 3000-075, Coimbra, Portugal
| | - Miguel Melo
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário de Coimbra, 3000-075, Coimbra, Portugal
| | - Pedro Marques
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa, 1099-023, Lisboa, Portugal
| | - Susana Gama-de-Sousa
- Serviço de Pediatria, Centro Hospitalar do Médio Ave, Unidade de V. N. Famalicão, 4761-917, Vila Nova de Famalicão, Portugal
| | - Sofia Carreiro
- Serviço de Patologia Clínica, Instituto Português de Oncologia de Coimbra, 3000-075, Coimbra, Portugal
| | - Telma Quintela
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506, Covilha, Portugal
| | - Isabel Gonçalves
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506, Covilha, Portugal
| | - Manuel Carlos Lemos
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506, Covilha, Portugal.
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13
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Bichard LK, Torpy DJ. Diabetes insipidus complicating apoplexy during pregnancy: the potential use of copeptin. Intern Med J 2021; 50:877-879. [PMID: 32656971 DOI: 10.1111/imj.14918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 11/30/2022]
Abstract
Pituitary apoplexy during pregnancy is rare but important to recognise, particularly in the hyperoestrogenaemic state when known lactotroph hyperplasia occurs. Untreated, the complication rates from pituitary adenomas depend upon the size of the adenoma before pregnancy. A history of thirst plus polydipsia during pregnancy raises suspicion for diabetes insipidus and a 24-h urine collection quantifying polyuria with an inappropriately low urine osmolality confirms the diagnosis. Further evaluation for assessing diabetes insipidus in pregnancy may be facilitated by the use of a copeptin.
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Affiliation(s)
- Lisa K Bichard
- Adult Endocrinology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - David J Torpy
- Adult Endocrinology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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14
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Mazzolai M, Apicella A, Marzuillo P, Rabach I, Taddio A, Barbi E, Cozzi G. Severe hyponatremia in children: a review of the literature through instructive cases. Minerva Pediatr (Torino) 2021; 74:61-69. [PMID: 33820399 DOI: 10.23736/s2724-5276.21.05856-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hyponatriemia is the most common electrolyte disorder in the paediatric population. Symptoms are related to the time in which hyponatriemia has developed. The acute presentation could be dramatic, with neurological symptoms like headache, seizure, impaired mental status and even coma. It is essential for the physician to be aware of the possible causes of hyponatremia in the child in order to start a prompt treatment.
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Affiliation(s)
- Michele Mazzolai
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy -
| | | | - Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Ingrid Rabach
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Andrea Taddio
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy.,Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy.,Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Giorgio Cozzi
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
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15
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Henn L, Zanta NC, Girardi CEN, Suchecki D. Chronic Escitalopram Treatment Does Not Alter the Effects of Neonatal Stress on Hippocampal BDNF Levels, 5-HT 1A Expression and Emotional Behaviour of Male and Female Adolescent Rats. Mol Neurobiol 2021; 58:926-943. [PMID: 33063280 DOI: 10.1007/s12035-020-02164-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
Early life stress is considered a risk factor for the development of long-term psychiatric disorders. Maternal deprivation (MD) is a useful paradigm to understand the neurobiological underpinnings of early stress-induced changes in neurodevelopment trajectory. The goal of the present study was to examine the effects of a chronic treatment with escitalopram (ESC) on the hippocampal levels of BDNF and neuropeptide Y (NPY), expression of serotonin type 1A receptor (5-HT1A), plasma corticosterone levels and emotional behaviours in male and female adolescent rats submitted to MD at 9 days of life (group DEP9) and challenged with a brief and mild stress (saline injection (SAL)) at the end of MD. Whole litters were kept with mothers (CTL) or submitted to MD (DEP9). Within each group, pups were stress-challenged (CTL-SAL and DEP9-SAL) or not (CTL-NSAL and DEP9-NSAL). ESC or vehicle treatments began at weaning and lasted 24 days, when animals were sacrificed for determination of neurobiological variables or submitted to a battery of tests for evaluation of emotional behaviours. The results showed that BDNF levels were higher in SAL-challenged males and in DEP9-SAL females, whereas 5-HT1A receptor expression was reduced in DEP9 males and in SAL-challenged females. There were no changes in NPY or corticosterone levels. In the forced swim test, SAL-challenged males and DEP9 females displayed less immobility and ESC only increased social motivation in males. The results indicated that neonatal stress led to sex-dependent changes in neurobiology and behaviour and that chronic ESC treatment had minor effects on these parameters.
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Affiliation(s)
- Lorena Henn
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, 1° andar, São Paulo, SP, 04024-002, Brazil
| | - Natália C Zanta
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, 1° andar, São Paulo, SP, 04024-002, Brazil
| | - Carlos Eduardo N Girardi
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, 1° andar, São Paulo, SP, 04024-002, Brazil
| | - Deborah Suchecki
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, 1° andar, São Paulo, SP, 04024-002, Brazil.
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16
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Mutter CM, Smith T, Menze O, Zakharia M, Nguyen H. Diabetes Insipidus: Pathogenesis, Diagnosis, and Clinical Management. Cureus 2021; 13:e13523. [PMID: 33786230 PMCID: PMC7996474 DOI: 10.7759/cureus.13523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/23/2021] [Indexed: 12/22/2022] Open
Abstract
Diabetes insipidus (DI) is an endocrine condition involving the posterior pituitary peptide hormone, antidiuretic hormone (ADH). ADH exerts its effects on the distal convoluted tubule and collecting duct of the nephron by upregulating aquaporin-2 channels (AQP2) on the cellular apical membrane surface. DI is marked by expelling excessive quantities of highly dilute urine, extreme thirst, and craving for cold water. The two main classifications of DI are central diabetes insipidus (CDI), characterized by a deficiency of the posterior pituitary gland to release ADH, and nephrogenic diabetes insipidus (NDI), characterized by the terminal distal convoluted tubule and collecting duct resistance to ADH. The two less common classifications include dipsogenic DI, characterized by excessive thirst due to a low osmotic threshold, and gestational DI, characterized by increased concentration of placental vasopressinase during pregnancy. Treatment of DI is dependent on the disease classification, but severe complications may arise if not tended to appropriately. The most important step in symptom management is maintaining fluid intake ahead of fluid loss with emphasis placed on preserving the quality of life. The most common treatment of CDI and gestational DI is the administration of synthetic ADH, desmopressin (DDAVP). Nephrogenic treatment, although more challenging, requires discontinuation of medications as well as maintaining a renal-friendly diet to prevent hypernatremia. Treatment of dipsogenic DI is mainly focused on behavioral therapy aimed at regulating water intake and/or administration of antipsychotic pharmaceutical therapy. Central and nephrogenic subtypes of DI share a paradoxical treatment in thiazide diuretics.
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Affiliation(s)
- Cody M Mutter
- Basic Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Trevor Smith
- Basic Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Olivia Menze
- Basic Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Mariah Zakharia
- Basic Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Hoang Nguyen
- Basic Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
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17
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Gomes DA, de Almeida Beltrão RL, de Oliveira Junior FM, da Silva Junior JC, de Arruda EPC, Lira EC, da Rocha MJA. Vasopressin and copeptin release during sepsis and septic shock. Peptides 2021; 136:170437. [PMID: 33181268 DOI: 10.1016/j.peptides.2020.170437] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/22/2022]
Abstract
Sepsis is defined as a potentially fatal organ dysfunction caused by a dysregulated host response to infection. Despite tremendous progress in the medical sciences, sepsis remains one of the leading causes of morbidity and mortality worldwide. The host response to sepsis and septic shock involves changes in the immune, autonomic, and neuroendocrine systems. Regarding neuroendocrine changes, studies show an increase in plasma vasopressin (AVP) concentrations followed by a decline, which may be correlated with septic shock. AVP is a peptide hormone derived from a larger precursor (preprohormone), along with two peptides, neurophysin II and copeptin. AVP is synthesized in the hypothalamus, stored and released from the neurohypophysis into the bloodstream by a wide range of stimuli. The measurement of AVP has limitations due to its plasma instability and short half-life. Copeptin is a more stable peptide than AVP, and its immunoassay is feasible. The blood concentrations of copeptin mirror those of AVP in many physiological states; paradoxically, during sepsis-related organ dysfunction, an uncoupling between copeptin and AVP blood levels appears to happen. In this review, we focus on clinical and experimental studies that analyzed AVP and copeptin blood concentrations over time in sepsis. The findings suggest that AVP and copeptin behave similarly in the early stages of sepsis; however, we did not find a proportional decrease in copeptin concentrations as seen with AVP during septic shock. Copeptin levels were higher in nonsurvivors than in survivors, suggesting that copeptin may work as a marker of severity or sepsis-related organ dysfunction.
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Affiliation(s)
- Dayane Aparecida Gomes
- Department of Physiology and Pharmacology, Bioscience Center, Federal University of Pernambuco, Brazil.
| | | | | | | | | | - Eduardo Carvalho Lira
- Department of Physiology and Pharmacology, Bioscience Center, Federal University of Pernambuco, Brazil
| | - Maria José Alves da Rocha
- Department of Basic and Oral Biology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Brazil
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18
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Hasegawa H, Shin M, Makita N, Shinya Y, Kondo K, Saito N. Delayed Postoperative Hyponatremia Following Endoscopic Transsphenoidal Surgery for Non-Adenomatous Parasellar Tumors. Cancers (Basel) 2020; 12:cancers12123849. [PMID: 33419307 PMCID: PMC7766216 DOI: 10.3390/cancers12123849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022] Open
Abstract
Little is known about delayed postoperative hyponatremia (DPH) accompanied with transsphenoidal surgery for non-adenomatous skull base tumors (NASBTs). Consecutive data on 30 patients with parasellar NASBT was retrospectively reviewed with detailed analyses on perioperative serial sodium levels. Serological DPH (sodium ≤ 135 mmol/L) was observed in eight (27%), with four (13%) of them being symptomatic. DPH developed on postoperative day 7-12 where the mean sodium levels were 134 mmol/L (a mean of 7 mmol/L drop from the baseline) in asymptomatic and 125 mmol/L (a mean of 17.5 mmol/L drop from the baseline) in symptomatic DPH. Serological DPH was accompanied with "weight loss and hemoconcentration (cerebral salt wasting type)" in four (50%), "weight gain and hemodilution (syndrome of inappropriate antidiuretic hormone secretion type)" in three (38%), and no significant weight change in one. Intraoperative extradural retraction of the pituitary gland was the only significant factor for serological DPH (p = 0.035; odds ratio, 12.25 (95% confidence interval, 1.27-118.36)). DPH should be recognized as one of the significant postsurgical complications associated with TSS for NASBTs. Although the underlying mechanism is still controversial, intraoperative extradural compression of the pituitary gland and subsequent dysregulation of the hypothalamo-hypophyseal axis may be responsible.
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Affiliation(s)
- Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan; (H.H.); (Y.S.); (N.S.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Masahiro Shin
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan; (H.H.); (Y.S.); (N.S.)
- Correspondence: ; Tel.: +81-3-5800-8853
| | - Noriko Makita
- Department of Endocrinology and Nephrology, The University of Tokyo Hospital, Tokyo 113-8655, Japan;
| | - Yuki Shinya
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan; (H.H.); (Y.S.); (N.S.)
| | - Kenji Kondo
- Department of Otolaryngology, The University of Tokyo Hospital, Tokyo 113-8655, Japan;
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan; (H.H.); (Y.S.); (N.S.)
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19
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Bianco D, Napoli F, Morana G, Pistorio A, Allegri AEM, Fava D, Schiavone M, Thiabat HF, Crocco M, Camia T, Lezzi M, Calandrino A, Tortora D, Severino M, Patti G, Ibba A, Rossi A, Di Iorgi N, Maghnie M. Endocrine Outcomes In Central Diabetes Insipidus: the Predictive Value of Neuroimaging "Mismatch Pattern". J Clin Endocrinol Metab 2020; 105:5892808. [PMID: 32797230 DOI: 10.1210/clinem/dgaa540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/11/2020] [Indexed: 01/21/2023]
Abstract
CONTEXT The etiology of central diabetes insipidus (CDI) in children is often unknown. Clinical and radiological features at disease onset do not allow discrimination between idiopathic forms and other conditions or to predict anterior pituitary dysfunction. OBJECTIVE To evaluate the evolution of pituitary stalk (PS) thickening and the pattern of contrast-enhancement in relation with etiological diagnosis and pituitary function. METHODS We enrolled 39 children with CDI, 29 idiopathic and 10 with Langerhans cell histiocytosis (LCH). Brain magnetic resonance images taken at admission and during follow-up (332 studies) were examined, focusing on PS thickness, contrast-enhancement pattern, and pituitary gland size; T2-DRIVE and postcontrast T1-weighted images were analyzed. RESULTS Seventeen of 29 patients (58.6%) with idiopathic CDI displayed "mismatch pattern," consisting in a discrepancy between PS thickness in T2-DRIVE and postcontrast T1-weighted images; neuroimaging findings became stable after its appearance, while "mismatch" appeared in LCH patients after chemotherapy. Patients with larger PS displayed mismatch more frequently (P = 0.003); in these patients, reduction of proximal and middle PS size was documented over time (P = 0.045 and P = 0.006). The pituitary gland was smaller in patients with mismatch (P < 0.0001). Patients with mismatch presented more frequently with at least one pituitary hormone defect, more often growth hormone deficiency (P = 0.033). CONCLUSIONS The PS mismatch pattern characterizes patients with CDI, reduced pituitary gland size, and anterior pituitary dysfunction. The association of mismatch pattern with specific underlying conditions needs further investigation. As patients with mismatch show stabilization of PS size, we assume a prognostic role of this peculiar pattern, which could be used to lead follow-up.
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Affiliation(s)
- Deborah Bianco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Flavia Napoli
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Giovanni Morana
- Department of Neurosciences, University of Turin, Turin, Italy
| | - Angela Pistorio
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Daniela Fava
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Maurizio Schiavone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Hanan F Thiabat
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Marco Crocco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Tiziana Camia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Marilea Lezzi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Andrea Calandrino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Domenico Tortora
- Pediatric Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Giuseppa Patti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Anastasia Ibba
- SSD Endocrinologia Pediatrica, Azienda Ospedaliera Brotzu, SSD Endocrinologia Pediatrica, Ospedale Pediatrico Microcitemico "A. Cao", Cagliari, Italy
| | - Andrea Rossi
- Pediatric Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Natascia Di Iorgi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Mohamad Maghnie
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
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20
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Burckhardt MA, Gotta V, Beglinger S, Renggli L, Bachmann S, Hess M, Rentsch K, Pfister M, Koch G, Davis EA, Zumsteg U, Jones TW, Szinnai G. Copeptin Kinetics and Its Relationship to Osmolality During Rehydration for Diabetic Ketoacidosis in Children. J Clin Endocrinol Metab 2020; 105:5896600. [PMID: 32835363 DOI: 10.1210/clinem/dgaa568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/17/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Copeptin is a surrogate marker for arginine vasopressin (AVP) release in response to hyperosmolal stimuli such as diabetic ketoacidosis (DKA). OBJECTIVE The objective of this work is to characterize kinetics of copeptin and osmolality, and their dynamic relationship during rehydration and insulin therapy in children with type 1 diabetes (T1D) and DKA. DESIGN AND SETTING A prospective, observational, multicenter study was conducted. PATIENTS AND INTERVENTION Children with T1D admitted for DKA underwent serial serum copeptin and osmolality measurements from start of rehydration at 14 time points during 72 hours. MAIN OUTCOME MEASURES Measurements included temporal course of copeptin and osmolality (kinetics), relationship between both (dynamics), and association between-subject variability (BSV) (coefficient of variation, CV%). RESULTS Twenty-eight children (20 newly diagnosed T1D) aged 1 to 16 years were included. Copeptin decreased from 95 pmol/L (95% CI, 55-136 pmol/L) (CV%, 158%) to 9.7 pmol/L (95% CI, 8.1-11.4 pmol/L) (CV%, 31%) with a 50% recovery time (t1/2) of 7.1 hours (range, 5.1-11.5 hours) (114%). Serum osmolality decreased from 321 mOsm/kg (range, 315-327 mOsm/kg) (4%) to 294 mOsm/kg (range, 292-296 mOsm/kg) (1%) with a t1/2 of 4.3 hours (range, 3.0-5.6 hours) (64%). Copeptin levels doubled with each osmolality increase by 15 mOsm/kg (range, 10-21 mOsm/kg) (59%), from 9.8 pmol/L (range, 7.3-12.3 pmol/L) (48%) to 280 mOsm/kg. Copeptin kinetics differed between newly diagnosed and known T1D patients (P = .001), and less between mild vs moderate-severe DKA (P = .04). CONCLUSIONS First, this study characterized for the first time copeptin kinetics and dynamics in the high hyperosmolar range in children with DKA. Second, it revealed significant differences in copeptin kinetics between newly diagnosed and known T1D patients that may be explained by changes at the osmoreceptor and renal AVP receptor level due to longstanding osmotic diuresis and DKA.
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Affiliation(s)
- Marie-Anne Burckhardt
- Pediatric Endocrinology and Diabetology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Children's Diabetes Centre, Telethon Kids Institute, University of Western Australia, Australia and Perth Children's Hospital, Perth, WA, Australia
| | - Verena Gotta
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Svetlana Beglinger
- Pediatric Emergency Department, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Luzia Renggli
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Sara Bachmann
- Pediatric Endocrinology and Diabetology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Melanie Hess
- Pediatric Endocrinology and Diabetology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Katharina Rentsch
- Department of Laboratory Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gilbert Koch
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Elizabeth A Davis
- Children's Diabetes Centre, Telethon Kids Institute, University of Western Australia, Australia and Perth Children's Hospital, Perth, WA, Australia
| | - Urs Zumsteg
- Pediatric Endocrinology and Diabetology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Timothy W Jones
- Children's Diabetes Centre, Telethon Kids Institute, University of Western Australia, Australia and Perth Children's Hospital, Perth, WA, Australia
| | - Gabor Szinnai
- Pediatric Endocrinology and Diabetology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
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21
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Abstract
In the majority of cases, hereditary neurohypophyseal diabetes insipidus (DI) is a monogenic disorder caused by mutations in the AVP gene. Dominant transmission is by far the most common form. In these patients, symptoms develop gradually at various ages during childhood, progressing with complete penetrance to polyuria and polydipsia that is usually severe. In autosomal dominant neurohypophyseal DI (ADNDI), the mutant prohormone is folding deficient and consequently retained in the ER, where it forms amyloid-like fibrillar aggregates. Degradation by proteasomes occurs, but their clearance capacity appears to be insufficient. Postmortem studies in affected individuals suggest a neurodegenerative process confined to vasopressinergic neurons. Other forms of genetic neurohypophyseal DI include the very rare autosomal recessive type, also caused by mutations in the AVP gene, and complex multiorgan disorders, such as Wolfram syndrome. In all individuals where a congenital form of DI is suspected, including nephrogenic types, genetic analysis should be performed.
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Affiliation(s)
- Martin Spiess
- University of Basel, Biozentrum, Klingelbergstrasse 50/70, CH-4056 Basel, Switzerland.
| | - Nicole Beuret
- University of Basel, Biozentrum, Klingelbergstrasse 50/70, CH-4056 Basel, Switzerland.
| | - Jonas Rutishauser
- University of Basel, Biozentrum, Klingelbergstrasse 50/70, CH-4056 Basel, Switzerland; Kantonsspital Baden, Clinical Trial Unit, Im Ergel 1, CH-5405 Baden, Switzerland.
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22
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Kuwahara H, Imamura T, Sobajima M, Ueno H, Kinugawa K. Regulation and Clinical Implication of Arginine Vasopressin in Patients with Severe Aortic Stenosis Referred to Trans-Catheter Aortic Valve Implantation. ACTA ACUST UNITED AC 2020; 56:medicina56040165. [PMID: 32268535 PMCID: PMC7230582 DOI: 10.3390/medicina56040165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 12/28/2022]
Abstract
Background and objectives: Plasma arginine vasopressin (P-AVP) is regulated by the non-osmotic pathway in patients with heart failure (HF) and reduced ejection fraction. However, the regulation of P-AVP in patients with severe aortic stenosis (AS) remains unknown. Materials and Methods: Consecutive patients with severe AS who received trans-catheter aortic valve implantation (TAVI) between Apr 2016 and Apr 2019 were enrolled in this prospective study. Clinical data including P-AVP were obtained just before TAVI, and the correlation between P-AVP and other variables was investigated. Results: In total, 159 patients with severe AS (85.3 ± 4.6 years, male 26%) were enrolled. P-AVP was 1.45 ± 1.13 ng/mL and cardiac index was relatively preserved (2.76 ± 0.54 L/min/m2). There was no significant correlation between cardiac index and P-AVP (p > 0.05), whereas plasma osmolality had a moderate positive correlation with P-AVP (r = 0.35, p < 0.01), predominantly due to blood urea nitrogen (r = 0.27, p < 0.01). Patients with diuretics had significantly higher P-AVP than those without diuretics (1.65 ± 1.43 vs. 1.22 ± 0.57 pg/mL, p < 0.01). Two-year survivals free from HF readmission were statistically comparable irrespective of the level of pre-procedural P-AVP (p = 0.44). Conclusion: In patients with severe high-gradient AS who received TAVI, the P-AVP level was dominantly regulated by plasma osmolality instead of arterial underfilling. The clinical implication of elevated P-AVP in the TAVI candidates is the next concern.
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23
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Armstrong LE, Muñoz CX, Armstrong EM. Distinguishing Low and High Water Consumers-A Paradigm of Disease Risk. Nutrients 2020; 12:E858. [PMID: 32210168 PMCID: PMC7146321 DOI: 10.3390/nu12030858] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 12/31/2022] Open
Abstract
A long-standing body of clinical observations associates low 24-h total water intake (TWI = water + beverages + food moisture) with acute renal disorders such as kidney stones and urinary tract infections. These findings prompted observational studies and experimental interventions comparing habitual low volume (LOW) and high volume (HIGH) drinkers. Investigators have learned that the TWI of LOW and HIGH differ by 1-2 L·d-1, their hematological values (e.g., plasma osmolality, plasma sodium) are similar and lie within the laboratory reference ranges of healthy adults and both groups appear to successfully maintain water-electrolyte homeostasis. However, LOW differs from HIGH in urinary biomarkers (e.g., reduced urine volume and increased osmolality or specific gravity), as well as higher plasma concentrations of arginine vasopressin (AVP) and cortisol. Further, evidence suggests that both a low daily TWI and/or elevated plasma AVP influence the development and progression of metabolic syndrome, diabetes, obesity, chronic kidney disease, hypertension and cardiovascular disease. Based on these studies, we propose a theory of increased disease risk in LOW that involves chronic release of fluid-electrolyte (i.e., AVP) and stress (i.e., cortisol) hormones. This narrative review describes small but important differences between LOW and HIGH, advises future investigations and provides practical dietary recommendations for LOW that are intended to decrease their risk of chronic diseases.
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Affiliation(s)
- Lawrence E. Armstrong
- Professor Emeritus, Human Performance Laboratory and Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Colleen X. Muñoz
- Assistant Professor, Department of Health Sciences, University of Hartford, West Hartford, CT 06117, USA;
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24
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Amyloid-like aggregation of provasopressin. VITAMINS AND HORMONES 2020. [PMID: 32138954 DOI: 10.1016/bs.vh.2019.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
The antidiuretic hormone vasopressin is synthesized as a longer precursor protein. After folding in the endoplasmic reticulum (ER), provasopressin is transported through the secretory pathway, forms secretory granules in the trans-Golgi network (TGN), is processed, and finally secreted into the circulation. Mutations in provasopressin cause autosomal dominant diabetes insipidus. They prevent native protein folding and cause fibrillar, amyloid-like aggregation in the ER, which eventually results in cell death. Secretory granules of peptide hormones were proposed to constitute functional amyloids and thus might be the cause of amyloid formation of misfolded mutant protein in the ER. Indeed, the same two segments in the precursor-vasopressin and a C-terminal glycopeptide-were found to be responsible for pathological aggregation in the ER and physiological aggregation in granule formation in the TGN. Furthermore, even wild-type provasopressin tends to aggregate in the ER, but is controlled by ER-associated degradation. When essential components thereof, Sel1L or Hrd1, were inactivated, wild-type provasopressin accumulated as fibrillar aggregates in vasopressinergic neurons in mice, causing diabetes insipidus. Evolution of amyloidogenic sequences for granule formation thus made provasopressin dependent on ER quality control mechanisms. These principles may similarly apply to other peptide hormones.
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25
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Christ-Crain M, Fenske WK. Copeptin in the differential diagnosis of hypotonic polyuria. J Endocrinol Invest 2020; 43:21-30. [PMID: 31368050 DOI: 10.1007/s40618-019-01087-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/17/2019] [Indexed: 11/26/2022]
Abstract
COPEPTIN Copeptin is secreted in equimolar amount to Arginine Vasopressin (AVP) but can easily be measured with a sandwich immunoassay. Both peptides, copeptin and AVP, show a high correlation. Accordingly, copeptin mirrors the amount of AVP in the circulation and its measurement provides an attractive marker in the differential diagnosis of diabetes insipidus. THE POLYURIA POLYDIPSIA SYNDROME Diabetes insipidus-either central or nephrogenic-has to be differentiated from primary polydipsia. Differentiation is crucial since wrong treatment can have deleterious consequences. Since many decades, the "gold standard" for differential diagnosis has been the classical water deprivation test, which has several limitations leading to an overall limited diagnostic accuracy. In addition, the test has a long duration of 17 hours and is cumbersome for patients. Clinical signs and symptoms as well as MRI characteristics overlap between patients with diabetes insipidus and primary polydipsia. Direct measurement of AVP upon osmotic stimulation was first shown to overcome these limitations, but failed to enter clinical practice mainly due to technical limitations of the AVP assay. COPEPTIN AS DIAGNOSTIC TOOL IN THE POLYURIA POLYDIPSIA SYNDROME We have recently shown that copeptin, without prior water deprivation, identifies patients with nephrogenic diabetes insipidus. On the other hand, for the more difficult differentiation between central diabetes insipidus and primary polydipsia, a copeptin level of 4.9 pmol/L stimulated with hypertonic saline infusion differentiates between these two entities with a high diagnostic accuracy, and is superior to the water deprivation test. It is important to note that close sodium monitoring during the hypertonic saline test is a prerequisite. CONCLUSION Therefore, we propose that copeptin upon hypertonic saline infusion should become the new standard test in the differential diagnosis of diabetes insipidus.
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Affiliation(s)
- M Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital of Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Medical Department III-Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, University Hospital Leipzig, Leipzig, Germany.
| | - W K Fenske
- Department of Endocrinology, Diabetology and Metabolism, University Hospital of Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Medical Department III-Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, University Hospital Leipzig, Leipzig, Germany.
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26
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Lindenberger M, Fedorowski A, Melander O, Gallo W, Engvall J, Skoog J. Cardiovascular biomarkers and echocardiographic findings at rest and during graded hypovolemic stress in women with recurrent vasovagal syncope. J Cardiovasc Electrophysiol 2019; 30:2936-2943. [DOI: 10.1111/jce.14207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/19/2019] [Accepted: 09/26/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Marcus Lindenberger
- Department of CardiologyLinköping University HospitalLinköping Sweden
- Department of Medical and Health SciencesLinköping UniversityLinköping Sweden
| | - Arthur Fedorowski
- Department of Clinical SciencesLund UniversityMalmö Sweden
- Department of CardiologySkåne University HospitalMalmö Sweden
| | - Olle Melander
- Department of Clinical SciencesLund UniversityMalmö Sweden
| | - Widet Gallo
- Department of Clinical SciencesLund UniversityMalmö Sweden
| | - Jan Engvall
- Department of Medical and Health SciencesLinköping UniversityLinköping Sweden
| | - Johan Skoog
- Department of Medical and Health SciencesLinköping UniversityLinköping Sweden
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27
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Abstract
Sodium perturbations are a common complication after pituitary surgery, with hyponatremia being the most frequent. Postoperative assessments should be tailored to the early and late periods, and monitoring sodium perturbations is recommended. Cerebral salt wasting is rare after pituitary surgery, and diagnosis and management can be challenging. Providing patient counseling and close postoperative follow-up is important to effectively manage diabetes insipidus and reduce hospital readmissions due to sodium perturbations.
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Affiliation(s)
- Kevin C J Yuen
- Department of Neuroendocrinology, Barrow Pituitary Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, University of Arizona College of Medicine and Creighton School of Medicine, 124 W Thomas Road, Suite 300, Phoenix, AZ 85013, USA.
| | - Adnan Ajmal
- Department of Internal Medicine and Endocrinology, St. Joseph's Hospital and Medical Center, Creighton University School of Medicine, 500 W Thomas Road, Suite 900B Phoenix, AZ 85013, USA
| | - Ricardo Correa
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Phoenix Veterans Administration Medical Center, University of Arizona College of Medicine, Creighton School of Medicine and Mayo School of Medicine, 650 E Indian School Road, Building 21, Suite 117, Phoenix, AZ 85014, USA
| | - Andrew S Little
- Department of Neurosurgery, Barrow Pituitary Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, University of Arizona College of Medicine, 300 W Thomas Road, Phoenix, AZ 85013, USA
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28
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Lindestam U, Fläring U, Almström M, Andersson A, Svensson JF, Malmquist P, Jacks J, Lönnqvist PA, Jensen BL, Carlström M, Krmar RT. Sodium and water homeostasis in children admitted with acute appendicitis: a prospective study. Pediatr Res 2019; 86:5-8. [PMID: 30812028 DOI: 10.1038/s41390-019-0353-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/04/2019] [Accepted: 02/17/2019] [Indexed: 01/11/2023]
Affiliation(s)
- Ulf Lindestam
- Department of Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology (FYFA), Karolinska Institutet, Stockholm, Sweden
| | - Urban Fläring
- Department of Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology (FYFA), Karolinska Institutet, Stockholm, Sweden
| | - Markus Almström
- Department of Paediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Andersson
- Department of Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology (FYFA), Karolinska Institutet, Stockholm, Sweden
| | - Jan F Svensson
- Department of Paediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden
| | - Pia Malmquist
- Department of Pediatric Emergency Medicine, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Johannes Jacks
- Department of Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Per-Arne Lönnqvist
- Department of Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology (FYFA), Karolinska Institutet, Stockholm, Sweden
| | - Boye L Jensen
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Mattias Carlström
- Department of Physiology and Pharmacology (FYFA), Karolinska Institutet, Stockholm, Sweden
| | - Rafael T Krmar
- Department of Physiology and Pharmacology (FYFA), Karolinska Institutet, Stockholm, Sweden.
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29
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Christ-Crain M. EJE AWARD 2019: New diagnostic approaches for patients with polyuria polydipsia syndrome. Eur J Endocrinol 2019; 181:R11-R21. [PMID: 31067508 PMCID: PMC6598864 DOI: 10.1530/eje-19-0163] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/08/2019] [Indexed: 02/02/2023]
Abstract
Diabetes insipidus (DI), be it from central or nephrogenic origin, must be differentiated from secondary forms of hypotonic polyuria such as primary polydipsia. Differentiation is crucial since wrong treatment can have deleterious consequences. Since decades, the gold standard for differentiation has been the water deprivation test, which has limitations leading to an overall unsatisfying diagnostic accuracy. Furthermore, it is cumbersome for patients with a long test duration. Clinical signs and symptoms and MRI characteristics overlap between patients with DI and primary polydipsia. The direct test including vasopressin (AVP) measurement upon osmotic stimulation was meant to overcome these limitations, but failed to enter clinical practice mainly due to technical constraints of the AVP assay. Copeptin is secreted in equimolar amount to AVP but can easily be measured with a sandwich immunoassay. A high correlation between copeptin and AVP has been shown. Accordingly, copeptin mirrors the amount of AVP in the circulation and has led to a 'revival' of the direct test in the differential diagnosis of DI. We have shown that a baseline copeptin, without prior thirsting, unequivocally identifies patients with nephrogenic DI. In contrast, for the differentiation between central DI and primary polydipsia, a stimulated copeptin level of 4.9 pmol/L upon hypertonic saline infusion differentiates these two entities with a high diagnostic accuracy and is superior to the water deprivation test. Close sodium monitoring during the test is a prerequisite. Further new test methods are currently evaluated and might provide an even simpler way of differential diagnosis in the future.
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Affiliation(s)
- Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism and Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
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30
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Abstract
Body fluid homeostasis is essential for normal life. In the maintenance of water balance, the most important factor and regulated process is the excretory function of the kidneys. The kidneys are capable to compensate not only the daily fluctuations of water intake but also the consequences of fluid loss (respiration, perspiration, sweating, hemorrhage). The final volume and osmolality of the excreted urine is set in the collecting duct via hormonal regulation. The hormone of water conservation is the vasopressin (AVP), and a large volume of urine is produced and excreted in the absence of AVP secretion or if AVP is ineffective in the kidneys. The aquaporin-2 water channel (AQP2) is expressed in the principal cells, and it plays an essential role in the reabsorption of water in the collecting ducts via type 2 vasopressin receptor (V2R)-mediated mechanism. If neural or hormonal regulation fails to operate the normal function of AVP-V2R-AQP2 system, it can result in various diseases such as diabetes insipidus (DI) or nephrogenic syndrome of inappropriate diuresis (NSIAD). The DI is characterized by excessive production of hyposmotic urine ("insipidus" means tasteless) due to the inability of the kidneys to concentrate urine. In this chapter, we focus and discuss the pathophysiology of nephrogenic DI (NDI) and the potential therapeutic interventions in the light of the current experimental data.
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Affiliation(s)
- András Balla
- Faculty of Medicine, Department of Physiology, Semmelweis University, Budapest, Hungary
- MTA-SE Laboratory of Molecular Physiology, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - László Hunyady
- Faculty of Medicine, Department of Physiology, Semmelweis University, Budapest, Hungary.
- MTA-SE Laboratory of Molecular Physiology, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary.
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31
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Zhang Y, Wang D, Feng Y, Zhang W, Zeng X. Juvenile-onset gout and adipsic diabetes insipidus: A case report and literature review. J Int Med Res 2018; 46:4829-4836. [PMID: 30270804 PMCID: PMC6259371 DOI: 10.1177/0300060518800114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The prevalence of juvenile-onset gout has been increasing. Hereditary factors and secondary diseases should be considered in these patients. Adipsic diabetes insipidus (ADI) is characterized by arginine vasopressin (AVP) deficiency, which results in hypotonic polyuria, and dysfunction of thirst osmoreceptors, which results in failure to generate a thirst sensation in response to hypernatremia. We herein report a case of a boy with gouty arthritis, refractory hyperuricemia, prominent hypernatremia, a high creatinine concentration, and a history of surgery for a hypothalamic hamartoma. The patient was diagnosed with central diabetes insipidus after endocrine evaluation. Because he never had symptoms of thirst, the final diagnosis was corrected to ADI. This is the first report of gout due to chronic ADI in an adolescent. Volume contraction due to ADI might be one cause of hyperuricemia and renal impairment in such patients. Moreover, AVP deficiency might directly lead to low urate clearance due to the lack of vasopressin receptor 1 stimulation. Lack of polydipsia and polyuria may delay the diagnosis of ADI and lead to severe complications of a chronic hyperosmolar status. Sufficient and effective establishment of normovolemia is critical for these patients.
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Affiliation(s)
- Yun Zhang
- 1 Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Dongmei Wang
- 2 Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yiding Feng
- 3 Department of Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Wen Zhang
- 4 Department of Rheumatology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Xuejun Zeng
- 1 Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, China
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Nigro N, Grossmann M, Chiang C, Inder WJ. Polyuria-polydipsia syndrome: a diagnostic challenge. Intern Med J 2018; 48:244-253. [PMID: 28967192 DOI: 10.1111/imj.13627] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/10/2017] [Accepted: 09/21/2017] [Indexed: 01/28/2023]
Abstract
The main determinants for the maintenance of water homeostasis are the hormone arginine vasopressin (AVP) and thirst. Disturbances in these regulatory mechanisms can lead to polyuria-polydipsia syndrome, which comprises of three different conditions: central diabetes insipidus (DI) due to insufficient secretion of AVP, nephrogenic DI caused by renal insensitivity to AVP action and primary polydipsia due to excessive fluid intake and consequent physiological suppression of AVP. It is crucial to determine the exact diagnosis because treatment strategies vary substantially. To differentiate between the causes of the polyuria-polydipsia syndrome, a water deprivation test combined with desmopressin administration is the diagnostic 'gold standard'. Thereby, AVP activity is indirectly evaluated through the measurement of urine osmolality after prolonged dehydration. However, this test has several limitations and may fail to distinguish precisely between patients with primary polydipsia and mild forms of central and nephrogenic DI. The direct measurement of AVP during the water deprivation test, which was reported in the 1980s, has not been widely adopted due to availability, assay issues and diagnostic performance. Recently, copeptin, the c-terminal portion of the larger precursor peptide of AVP, has been evaluated in the setting of polyuria-polydipsia syndrome and appears to be a useful candidate biomarker for the differential diagnosis. A standardised method for the water deprivation test is presented as part of a joint initiative of the Endocrine Society of Australia, the Australasian Association of Clinical Biochemists and the Royal College of Pathologists of Australasia to harmonise dynamic endocrine tests across Australia.
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Affiliation(s)
- Nicole Nigro
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Mathis Grossmann
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cherie Chiang
- Department of Endocrinology, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Warrick J Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Fenske WK, Schnyder I, Koch G, Walti C, Pfister M, Kopp P, Fassnacht M, Strauss K, Christ-Crain M. Release and Decay Kinetics of Copeptin vs AVP in Response to Osmotic Alterations in Healthy Volunteers. J Clin Endocrinol Metab 2018; 103:505-513. [PMID: 29267966 DOI: 10.1210/jc.2017-01891] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 12/12/2017] [Indexed: 12/29/2022]
Abstract
CONTEXT Copeptin is the C-terminal fragment of the arginine vasopressin (AVP) prohormone whose measurement is more robust than that of AVP. Similar release and clearance characteristics have been suggested promoting copeptin as a surrogate marker. OBJECTIVE To characterize the physiology of osmotically regulated copeptin release and its half-life in direct comparison with plasma AVP. DESIGN Ninety-one healthy volunteers underwent a standardized three-phase test protocol including (1) osmotic stimulation into the hypertonic range by hypertonic-saline infusion followed by osmotic suppression via (2) oral water load and (3) subsequent glucose infusion. Plasma copeptin, AVP, serum sodium, and osmolality levels were measured in regular intervals. RESULTS In phase 1, an increase in median osmotic pressure [289 (286; 291) to 311 (309; 314) mOsm/kg H2O] caused similar release kinetics of plasma copeptin [4 (3.1; 6) to 29.3 (18.6; 48.2) pmol/L] and AVP [1 (0.7; 1.6) to 10.3 (6.8; 18.8) pg/mL]. Subsequent osmotic suppression to 298 (295; 301) mOsm/kg at the end of phase 3 revealed markedly different decay kinetics between both peptides-an estimated initial half-life of copeptin being approximately 2 times longer than that of AVP (26 vs 12 minutes). CONCLUSION Copeptin is released in equimolar amounts with AVP in response to osmotic stimulation, suggesting its high potential as an AVP surrogate for differentiation of osmotic disorders. Furthermore, we here describe the decay kinetics of copeptin in response to osmotic depression enabling to identify a half-life for copeptin in direct comparison with AVP.
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Affiliation(s)
- Wiebke K Fenske
- Leipzig University Medical Center, Integrated Center for Research and Treatment Adiposity Diseases, Leipzig, Germany
- Internal Medicine (Endocrinology and Nephrology), University of Leipzig, Germany, Leipzig, Germany
| | - Ingeborg Schnyder
- Department of Endocrinology, Diabetology, and Metabolism, University Hospital of Basel, Basel, Switzerland
| | - Gilbert Koch
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital of Basel, Basel, Switzerland
| | - Carla Walti
- Department of Endocrinology, Diabetology, and Metabolism, University Hospital of Basel, Basel, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital of Basel, Basel, Switzerland
| | - Peter Kopp
- Division of Endocrinology, Metabolism, and Molecular Medicine and Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Konrad Strauss
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology, and Metabolism, University Hospital of Basel, Basel, Switzerland
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Fiordoliva I, Meletani T, Baleani MG, Rinaldi S, Savini A, Di Pietro Paolo M, Berardi R. Managing hyponatremia in lung cancer: latest evidence and clinical implications. Ther Adv Med Oncol 2017; 9:711-719. [PMID: 29344107 PMCID: PMC5764155 DOI: 10.1177/1758834017736210] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 09/01/2017] [Indexed: 01/08/2023] Open
Abstract
Hyponatremia is the most common electrolyte disorder in lung cancer patients. This condition may be related to many causes including incidental medications, concurrent diseases and side effects of antineoplastic treatments or the disease itself. Although not frequently life-threatening, it is usually associated with prolonged hospitalization, delays in scheduled chemotherapy, worsening of patient performance status and quality of life and may also negatively affect treatment response and survival. Most of the available data focus on thoracic tumors, especially small-cell lung cancer (SCLC), where hyponatremia is frequently related to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Few studies specifically focus on non-small cell lung cancer (NSCLC) patients. Hyponatremia treatment needs to be personalized based on severity and duration of sodium serum reduction, extracellular fluid volume and etiology. However, literature data highlight the importance of early correction of the serum concentration levels. To achieve this the main options are fluid restriction, hypertonic saline, loop diuretics, isotonic saline, tolvaptan and urea. The aim of this review is to analyze the role of hyponatremia in lung cancer patients, evaluating causes, diagnosis, management and clinical implications.
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Affiliation(s)
- Ilaria Fiordoliva
- Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Tania Meletani
- Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Maria Giuditta Baleani
- Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Silvia Rinaldi
- Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Agnese Savini
- Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Marzia Di Pietro Paolo
- Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Rossana Berardi
- Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I, GM Lancisi, G Salesi di Ancona, Via Conca 71 - 60126 Ancona, Italy
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Aakre KM, Kleiven Ø, Skadberg Ø, Bjørkavoll-Bergseth MF, Melberg T, Strand H, Hagve TA, Ørn S. The copeptin response after physical activity is not associated with cardiac biomarkers or asymptomatic coronary artery disease: The North Sea Race Endurance Exercise Study (NEEDED) 2013. Clin Biochem 2017; 52:8-12. [PMID: 29079359 DOI: 10.1016/j.clinbiochem.2017.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/06/2017] [Accepted: 10/13/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Copeptin concentrations increase both during acute coronary syndrome and following physical exercise. The relationship between copeptin increase following physical exercise and coronary artery disease (CAD) is uncertain. The aim of this study was to 1) describe the copeptin response following strenuous physical exercise, and 2) investigate the determinants of exercise induced copeptin concentrations, particularly in relation to cardiac biomarkers and CAD. METHODS Serum samples were collected from 97 recreational cyclists 24h before, and immediately, 3 and 24h after a 91-km bike race. Three subjects were subsequently diagnosed with significant asymptomatic CAD. Delta copeptin concentrations were correlated to patient characteristics and to biomarker concentrations. RESULTS Participants were 42.8±9.6years, and 76.3% were male. Copeptin concentrations increased to maximal levels immediately after the race and were normalized in >90% after 3h. A total of 53% and 39% exceeded the 95th and 99th percentile of the assay (10 and 19pmol/L) respectively. In multivariate models, race time, serum sodium, creatinine and cortisol were significant predictors of copeptin levels. There was no correlation between changes in copeptin and changes in cardiac biomarkers (hs-cTnI, hs-cTnT and BNP). Copeptin concentrations were normal in the subjects with asymptomatic CAD. CONCLUSIONS The moderate, short-term, exercise induced copeptin increase observed in the present study was not related to hs-cTn or BNP levels. Copeptin was normal in three asymptomatic recreational athletes with significant CAD.
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Affiliation(s)
- Kristin M Aakre
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway.
| | - Øyunn Kleiven
- Cardiology Department, Stavanger University Hospital, Stavanger, Norway
| | - Øyvind Skadberg
- Laboratory of Clinical Biochemistry, Stavanger University Hospital, Stavanger, Norway
| | | | - Tor Melberg
- Cardiology Department, Stavanger University Hospital, Stavanger, Norway
| | - Heidi Strand
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway
| | - Tor-Arne Hagve
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway; Institute of clinical medicine, Akershus University Hospital, University of Oslo, Norway
| | - Stein Ørn
- Cardiology Department, Stavanger University Hospital, Stavanger, Norway; Department of Electrical Engineering and Computer Science, University of Stavanger, Norway
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Abstract
Vasopressin (AVP) plays a major role in the regulation of water and sodium homeostasis by its antidiuretic action on the kidney, mediated by V2 receptors. AVP secretion is stimulated by a rise in plasma osmolality, a decline in blood volume or stress. V1a receptors are expressed in vascular smooth muscle cells, but the role of vasopressin in blood pressure regulation is still a matter of debate. AVP may also play a role in some metabolic pathways, including gluconeogenesis, through its action on V1a receptors expressed in the liver. It is now understood that thirst and arginine vasopressin (AVP) release are regulated not only by the classical homeostatic, intero-sensory plasma osmolality negative feedback, but also by novel, extero-sensory, anticipatory signals. AVP measurement is time-consuming, and AVP level in the blood in the physiological range is often below the detection limit of the assays. Recently, an immunoassay has been developed for the measurement of copeptin, a fragment of the pre-provasopressin molecule that is easier to measure. It has been shown to be a good surrogate marker of AVP.
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Affiliation(s)
- L Bankir
- Centre de Recherche des Cordeliers, INSERM Unit 1138, 75006, Paris, France.,Université Pierre et Marie Curie, 75006, Paris, France
| | - D G Bichet
- Université de Montréal, Montréal, QC, Canada.,Départements de Pharmacologie, Physiologie et de Médecine, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada
| | - N G Morgenthaler
- Institut für Experimentelle Endokrinologie, Charité Universitätsmedizin Berlin, Berlin, Germany.,InVivo Biotech Services, Neuendorfstraße 24a, Hennigsdorf/Berlin, Germany
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The Circadian Rhythm of Copeptin, the C-Terminal Portion of Arginine Vasopressin. J Biomark 2017; 2017:4737082. [PMID: 28656120 PMCID: PMC5471567 DOI: 10.1155/2017/4737082] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/02/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Several studies have investigated copeptin as a prognostic marker of different acute diseases and as a diagnostic marker in disorders of water and salt homeostasis. However, no data of the normal circadian rhythm of copeptin in healthy subjects are available. AIM To investigate the circadian rhythm of copeptin in healthy subjects under standardized conditions. METHODS 19 healthy volunteers aged 18 to 53 years, male and female, were studied in a prospective observational study. In all 19 participants, blood samples for copeptin were taken in regular intervals of 30 minutes for 24 hours after a fasting period of minimum 8 hours. RESULTS The mean values of copeptin showed a circadian rhythm, similar to that described for AVP release, with a trend towards higher levels (5.9 ± 1 pmol/L) at night and early morning between 4 am and 6 am and lowest levels (2.3 ± 0.2 pmol/L) in the late afternoon between 5 pm and 7 pm. This finding was only observed in individuals with initial higher copeptin levels, whereas in individuals with lower basal copeptin levels no circadian rhythm was observed. CONCLUSION There is evidence for a circadian rhythm in copeptin release during 24 hours, however, of minor extent. These findings suggest that copeptin levels can be determined irrespectively of the time of the day.
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Short article: Impact of genetic variation in the vasopressin 1a receptor on the development of organ failure in patients admitted for acute decompensation of liver cirrhosis. Eur J Gastroenterol Hepatol 2017; 29:535-538. [PMID: 28350742 DOI: 10.1097/meg.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Vasopressin receptor-mediated vasoconstriction is considered to be involved in the pathogenesis of organ failure in acute-on-chronic liver failure (ACLF). PATIENTS AND METHODS We studied the association between six single nucleotide polymorphisms (SNPs) of the vasopressin 1a receptor gene and the development of organ failure in 826 patients admitted for acute decompensation of liver cirrhosis (n=641) or ACLF (n=185). RESULTS No associations were found for SNPs with the presence of circulatory or renal failure. A C>T mutation in SNP rs7308855 and a T>A mutation in SNP rs7298346 showed an association with the presence of coagulation failure in the entire population (n=61, P=0.024 and 0.060, respectively) and in the subgroup of patients with ACLF (n=44, P=0.081 and 0.056, respectively). CONCLUSION Genetic variation in the vasopressin 1a receptor was found not to be associated with circulatory or renal failure, but with the presence of coagulation failure in patients with acute decompensation of liver cirrhosis and ACLF.
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Salt Ö, Durukan P, Ozkan S, Saraymen R, Sen A, Yurci MA. Plasma copeptin levels in the patients with gastrointestinal bleeding. Am J Emerg Med 2017; 35:1440-1443. [PMID: 28431872 DOI: 10.1016/j.ajem.2017.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/10/2017] [Accepted: 04/13/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Gastrointestinal bleeding is a significant cause of morbidity and mortality worldwide. In addition, it constitutes an important part of health expenditures. In this study, we aimed to determine whether there is a relationship between plasma copeptin levels and the etiology, location and severity of gastrointestinal bleeding. MATERIALS AND METHODS This study was performed prospectively in 104 consecutive patients who were admitted to an emergency department with complaints of bloody vomiting or bloody or black stool. To evaluate the level of biochemical parameters such as Full Blood Count (FBC), serum biochemistry, bleeding parameters and copeptin, blood samples were obtained at admission. For the copeptin levels, 2 more blood samples were obtained at the 12th and 24th hours after admission. The values obtained were compared using statistical methods. RESULTS In terms of the etiology of bleeding, the copeptin levels in the patients with peptic ulcer were higher than the levels in patients with other gastrointestinal bleeding. However, the difference was not statistically significant. There were no significant differences among all groups' 0th, 12th and 24th hour levels of copeptin. DISCUSSION We conclude that copeptin cannot be effectively used as a biochemical parameter in an emergency department to determine the etiology and location of gastrointestinal bleeding. It can, however, be used to make decisions on endoscopy and the hospitalization of patients with suspected gastrointestinal bleeding.
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Affiliation(s)
- Ömer Salt
- Trakya University, Medical Faculty Hospital Department of Emergency Medicine, Edirne, Turkey.
| | - Polat Durukan
- Erciyes University, Medical Faculty Department of Emergency Medicine, Kayseri, Turkey
| | - S Ozkan
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Emergency Medicine, Ankara, Turkey
| | - R Saraymen
- Erciyes University, Medical Faculty Department of Biochemistry, Kayseri, Turkey
| | - A Sen
- Yuksekova State Hospital, Department of Biochemistry, Hakkari, Turkey
| | - M A Yurci
- Erciyes University, Medical Faculty Department of Gastroenterology, Kayseri, Turkey
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Longitudinal Extensive Transverse Myelitis and Central Diabetes Insipidus: A Severe Flare of Systemic Lupus Erythematosus. J Clin Rheumatol 2017; 23:122-124. [PMID: 28225517 DOI: 10.1097/rhu.0000000000000485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chen Y, Xu F, Zhang L, Wang X, Wang Y, Woo AYH, Zhu W. GRK2/β-arrestin mediates arginine vasopressin-induced cardiac fibroblast proliferation. Clin Exp Pharmacol Physiol 2017; 44:285-293. [DOI: 10.1111/1440-1681.12696] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/19/2016] [Accepted: 11/03/2016] [Indexed: 02/04/2023]
Affiliation(s)
- Yunxuan Chen
- Department of Pharmacology; Nantong University School of Pharmacy; Nantong China
| | - Feifei Xu
- Department of Pharmacology; Nantong University School of Pharmacy; Nantong China
| | - Lingling Zhang
- Department of Pharmacology; Nantong University School of Pharmacy; Nantong China
| | - Xiaojun Wang
- Department of Pharmacology; Nantong University School of Pharmacy; Nantong China
| | - Yifan Wang
- Department of Pharmacology; Nantong University School of Pharmacy; Nantong China
| | - Anthony Yiu-Ho Woo
- Department of Pharmacology; School of Life Sciences and Biopharmaceutics; Shenyang Pharmaceutical University; Shenyang China
| | - Weizhong Zhu
- Department of Pharmacology; Nantong University School of Pharmacy; Nantong China
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Rutigliano G, Rocchetti M, Paloyelis Y, Gilleen J, Sardella A, Cappucciati M, Palombini E, Dell'Osso L, Caverzasi E, Politi P, McGuire P, Fusar-Poli P. Peripheral oxytocin and vasopressin: Biomarkers of psychiatric disorders? A comprehensive systematic review and preliminary meta-analysis. Psychiatry Res 2016; 241:207-20. [PMID: 27183106 DOI: 10.1016/j.psychres.2016.04.117] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 04/28/2016] [Accepted: 04/29/2016] [Indexed: 11/29/2022]
Abstract
A large array of studies have investigated peripheral oxytocin (OT) and vasopressin (ADH) as potential biomarkers of psychiatric disorders, with highly conflicting and heterogenous findings. We searched Web of KnowledgeSM and Scopus® for English original articles investigating OT and/or ADH levels in different biological fluids (plasma/serum, saliva, urine and cerebrospinal fluid) across several psychiatric disorders. Sixty-four studies were included. We conducted 19 preliminary meta-analyses addressing OT alterations in plasma/serum, saliva, urine and cerebrospinal fluid of 7 psychiatric disorders and ADH alterations in plasma/serum, saliva, urine and cerebrospinal fluid of 6 psychiatric disorders compared to controls. Hedge's g was used as effect size measure, together with heterogeneity analyses, test of publication biases and quality control. None of them (except serum OT in anorexia nervosa) revealed significant differences. There is no convincing evidence that peripheral ADH or OT might be reliable biomarkers in psychiatric disorders. However, the lack of significant results was associated with high methodological heterogeneity, low quality of the studies, small sample size, and scarce reliability of the methods used in previous studies, which need to be validated and standardized.
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Affiliation(s)
- Grazia Rutigliano
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO63, De Crespigny Park, SE58AF London, UK; Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67-56126 Pisa, Italy
| | - Matteo Rocchetti
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO63, De Crespigny Park, SE58AF London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Yannis Paloyelis
- Neuroimaging Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO89, De Crespigny Park, SE58AF London, UK
| | - James Gilleen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO63, De Crespigny Park, SE58AF London, UK; Department of Psychology, University of Roehampton, UK
| | - Alberto Sardella
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO63, De Crespigny Park, SE58AF London, UK
| | - Marco Cappucciati
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO63, De Crespigny Park, SE58AF London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Erika Palombini
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO63, De Crespigny Park, SE58AF London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67-56126 Pisa, Italy
| | - Edgardo Caverzasi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO63, De Crespigny Park, SE58AF London, UK
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO63, De Crespigny Park, SE58AF London, UK; OASIS clinic, SLaM NHS Foundation Trust, 190 Kennington Lane, SE11 5DL London, UK.
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Abstract
PURPOSE To discuss the clinical case of a patient suffering visual dysfunction secondary to a metabolic brain injury, the patient's visual rehabilitative treatment, and outcomes. CASE REPORT A 24-year-old Caucasian male presented to the Southern Arizona Veteran's Affairs Healthcare System's Traumatic Brain Injury (TBI) eye clinic for evaluation and treatment of visual dysfunction secondary to an anoxic brain injury suffered 4 months before. Symptoms included persistent right homonymous hemianopia, oculomotor dysfunction, and a visual information processing deficit. After 5 weeks of vision rehabilitation, the patient was reassessed and displayed significant improvement in both signs and symptoms. CONCLUSIONS The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a metabolic syndrome that causes hyponatremia and, in severe cases, encephalopathy and anoxic brain injury. Damage to the visual pathways can produce visual field, ocular motility, and binocular vision deficits. Comprehensive treatment including rehabilitative vision therapy bolstering the natural neuroplasticity process can provide improvements in patients' quality of life.
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Busnelli M, Dagani J, de Girolamo G, Balestrieri M, Pini S, Saviotti FM, Scocco P, Sisti D, Rocchi M, Chini B. Unaltered Oxytocin and Vasopressin Plasma Levels in Patients with Schizophrenia After 4 Months of Daily Treatment with Intranasal Oxytocin. J Neuroendocrinol 2016; 28. [PMID: 26715485 DOI: 10.1111/jne.12359] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 12/18/2015] [Accepted: 12/26/2015] [Indexed: 11/30/2022]
Abstract
The neuropeptide oxytocin (OXT) has been proposed as a treatment for a number of neuropsychiatric disorders characterised by impaired social behaviour, including schizophrenia. Although several studies have reported the chronic administration of OXT to be safe and tolerable, its effects on circulating levels of OXT, as well as the related neuropeptide arginine vasopressin (AVP), have not been assessed. In the present study, in a within-subjects cross-over, double-blind, randomised controlled trial, we assayed the plasma levels of OXT and AVP in 31 patients with schizophrenia who were treated daily for 4 months with 40 IU of intranasal OXT or placebo. Our data indicate a mean ± SD baseline OXT concentration of 1.62 ± 0.68 pg/ml, as determined by radioimmunoassay, which did not display any significant variation after chronic treatment with OXT or placebo. Similarly, the mean ± SD baseline AVP value of 2.40 ± 1.26 pg/ml remained unchanged. The present study also assessed cardiovascular and body fluid indicators (osmolality, plasma sodium concentration and systolic blood pressure), as well as a parameter for food intake (body mass index), with all observed to remain stable. By reporting that daily treatment with 40 IU of intranasal OXT or placebo for 4 months does not impact on OXT and AVP plasma levels, nor on cardiovascular, body fluids and food intake parameters, the present study represents an important step towards developing OXT as a safe treatment.
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Affiliation(s)
- M Busnelli
- CNR, Institute of Neuroscience, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - J Dagani
- IRCCS Saint John of God Clinical Research Centre, Brescia, Italy
| | - G de Girolamo
- IRCCS Saint John of God Clinical Research Centre, Brescia, Italy
| | - M Balestrieri
- Psychiatric Clinic, DISM, Università di Udine, Udine, Italy
| | - S Pini
- Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy
| | - F M Saviotti
- Department of Mental Health, AO Desenzano del Garda, Italy
| | - P Scocco
- Department of Mental Health, Azienda ULSS 16, Padua, Italy
| | - D Sisti
- Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino, Urbino, Italy
| | - M Rocchi
- Department of Biomolecular Sciences, Service of Biostatistics, University of Urbino, Urbino, Italy
| | - B Chini
- CNR, Institute of Neuroscience, Milan, Italy
- Humanitas Clinical and Research Center, Rozzano, Italy
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Kerbert AJC, Weil D, Verspaget HW, Moréno JP, van Hoek B, Cervoni JP, Di Martino V, Coenraad MJ, Thevenot T. Copeptin is an independent prognostic factor for transplant-free survival in cirrhosis. Liver Int 2016; 36:530-7. [PMID: 26502363 DOI: 10.1111/liv.12992] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/13/2015] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Copeptin is a stable cleavage product of the arginine vasopressin (AVP) precursor and is equimolarly secreted with AVP. Copeptin is currently considered a reliable prognostic marker in a wide variety of diseases other than cirrhosis. We aimed to investigate the association between severity of cirrhosis and copeptin concentrations and to confirm whether copeptin is of prognostic significance in cirrhosis. METHODS One hundred and eighty-four cirrhotic patients hospitalized in two tertiary referral centres were studied. Serum copeptin was measured in samples obtained at hospital admission. Differences in serum copeptin between Child-Pugh classes were evaluated using the Kruskal-Wallis test. Cox proportional hazard regression and Kaplan-Meier analyses were performed to evaluate associations of copeptin and other possible prognostic factors with 6- and 12-month mortality. RESULTS Median serum copeptin (interquartile range) increased significantly through Child-Pugh classes A [5.4 (3.1-10.7) pmol/L], B [9.6 (6.0-17.3) pmol/L] and C [13.8 (5.8-34.1) pmol/L, P < 0.01]. Patients with serum copeptin >12.3 pmol/L displayed significantly higher mortality rates at 6 and 12 months as compared to those with serum copeptin ≤12.3 pmol/L (Log-rank test: P < 0.01). Serum copeptin >12.3 pmol/L was significantly associated with mortality, particularly at 6 months, independently of age, clinical parameters and Model for End stage Liver Disease (MELD), MELD-sodium and Child-Pugh score. CONCLUSIONS Serum copeptin concentration increases significantly along with the severity of cirrhosis as defined by the Child-Pugh classification. A high serum copeptin concentration predicts survival, particularly at 6 months, independently of liver-specific scoring systems in a heterogeneous population of hospitalized cirrhotic patients.
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Affiliation(s)
- Annarein J C Kerbert
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Delphine Weil
- Department of Hepatology, University Hospital of Besançon, Besançon, France
| | - Hein W Verspaget
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Bart van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean-Paul Cervoni
- Department of Hepatology, University Hospital of Besançon, Besançon, France
| | - Vincent Di Martino
- Department of Hepatology, University Hospital of Besançon, Besançon, France
| | - Minneke J Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Thierry Thevenot
- Department of Hepatology, University Hospital of Besançon, Besançon, France
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46
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Fenske W, Sandner B, Christ-Crain M. A copeptin-based classification of the osmoregulatory defects in the syndrome of inappropriate antidiuresis. Best Pract Res Clin Endocrinol Metab 2016; 30:219-33. [PMID: 27156760 DOI: 10.1016/j.beem.2016.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The syndrome of inappropriate antidiuretic hormone secretion (SIADH), also referred to as syndrome of inappropriate antidiuresis (SIAD), is the most common cause of hyponatremia characterized by extracellular hypotonicity and impaired urine dilution in the absence of any recognizable nonosmotic stimuli for the antidiuretic hormone arginine vasopressin (AVP). Hyponatremia in SIADH is primarily the result of excessive water retention caused by a combination of inappropriate antidiuresis and persistent fluid intake in the presence of impaired osmoregulated inhibition of thirst. It is sometimes aggravated by a sodium deficiency caused by a decreased intake or a secondary natriuresis in response to elevated extracellular volume. Inappropriate antidiuresis usually results from endogenous production of AVP that can be either ectopic (from a malignancy) or eutopic (from the hypothalamus/neurohypophysis). Regardless of its origin, different types of osmotic dysregulation of AVP have been reported with possibly fundamental deviations in treatment need and efficacy. A recent quantitative analysis of 50 patients with SIADH, which underwent serial measurements of copeptin during hypertonic saline infusion, revealed five distinct types of osmoregulatory defect ("type A to E") without affiliation to specific underlying diseases. In addition to apparently impaired osmoregulated inhibition of AVP release in the majority of patients, 12% of patients showed an AVP-independent mechanism of inappropriate antidiuresis, whilst 20% of them presented a reverse relation between hormone release and serum osmolality, presumably related to interrupted nonosmotic inhibitory pathways. The interference of these different types of SIAD with clinical presentation and therapy response will be a relevant subject for future research.
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Affiliation(s)
- W Fenske
- Leipzig University Medical Center, Integrated Research and Treatment Center for Adiposity Diseases, Leipzig, Germany.
| | - B Sandner
- Department of Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany.
| | - M Christ-Crain
- Department of Endocrinology, University Hospital Basel, University of Basel, Switzerland.
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Abstract
Neurohypophyseal diabetes insipidus is characterized by polyuria and polydipsia owing to partial or complete deficiency of the antidiuretic hormone, arginine vasopressin (AVP). Although in most patients non-hereditary causes underlie the disorder, genetic forms have long been recognized and studied both in vivo and in vitro. In most affected families, the disease is transmitted in an autosomal dominant manner, whereas autosomal recessive forms are much less frequent. Both phenotypes can be caused by mutations in the vasopressin-neurophysin II (AVP) gene. In transfected cells expressing dominant mutations, the mutated hormone precursor is retained in the endoplasmic reticulum, where it forms fibrillar aggregates. Autopsy studies in humans and a murine knock-in model suggest that the dominant phenotype results from toxicity to vasopressinergic neurons, but the mechanisms leading to cell death remain unclear. Recessive transmission results from AVP with reduced biologic activity or the deletion of the locus. Genetic neurohypophyseal diabetes insipidus occurring in the context of diabetes mellitus, optic atrophy, and deafness is termed DIDMOAD or Wolfram syndrome, a genetically and phenotypically heterogeneous autosomal recessive disorder caused by mutations in the wolframin (WFS 1) gene.
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Affiliation(s)
- Jonas Rutishauser
- Kantonsspital Baselland, Department of Medicine, CH-4101 Bruderholz, Switzerland; University of Basel, Biozentrum, Klingelbergstrasse 50/70, CH-4056 Basel, Switzerland.
| | - Martin Spiess
- University of Basel, Biozentrum, Klingelbergstrasse 50/70, CH-4056 Basel, Switzerland.
| | - Peter Kopp
- Northwestern University, Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Tarry 15, 303 East Chicago Ave., Chicago, IL 60611, USA.
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Hennrikus E, Ou G, Kinney B, Lehman E, Grunfeld R, Wieler J, Damluji A, Davis C, Mets B. Prevalence, Timing, Causes, and Outcomes of Hyponatremia in Hospitalized Orthopaedic Surgery Patients. J Bone Joint Surg Am 2015; 97:1824-32. [PMID: 26582612 DOI: 10.2106/jbjs.o.00103] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hyponatremia is common among orthopaedic patients and is associated with adverse clinical outcomes. We examined the prevalence, timing, causes, and outcomes of hyponatremia in adult hospitalized orthopaedic surgery patients. METHODS We evaluated the medical records of 1067 consecutive orthopaedic surgery patients admitted to a tertiary academic institution. The medical records were reviewed to investigate hyponatremia (serum sodium <135 mEq/L) that (1) had been present on hospital admission or (2) had developed postoperatively. The primary outcomes were the prevalence and timing of, and risk factors for, presentation with or development of hyponatremia. Secondary outcomes were hospital length of stay, total hospital cost, and discharge disposition. Multivariable logistic regression models were used to assess the variables associated with hyponatremia and the effects of hyponatremia on clinical outcomes. RESULTS Of the 1067 patients, seventy-one (7%) had preoperative hyponatremia and 319 (30%) developed hyponatremia postoperatively. Of the latter, 298 (93%) developed hyponatremia within forty-eight hours postoperatively. Compared with patients with normonatremia, those who presented with hyponatremia, on the average, were older (67.2 versus 60.5 years, p < 0.001), had longer hospital stays (4.6 versus 3.3 days, p < 0.001), incurred higher hospital costs ($19,200 versus $17,000, p = 0.006), and were more likely to be discharged to an extended-care facility (odds ratio [OR] = 2.87, p < 0.001). Developing hyponatremia postoperatively resulted, on average, in a longer hospital stay (3.7 versus 3.3 days, p = 0.002) and greater hospital cost ($18,800 versus $17,000, p < 0.001). Age (OR = 1.13 per decade, p = 0.012), spine surgery (OR = 2.76 versus knee, p < 0.001), hip surgery (OR = 1.76 versus knee, p < 0.001), and the amount of lactated Ringer solution used (OR = 1.16, p = 0.002) increased the risk of developing hyponatremia. CONCLUSIONS Hyponatremia in orthopaedic patients is associated with longer, costlier hospitalizations. The factors that significantly increased the risk of developing postoperative hyponatremia were an older age, spine fusion, hip arthroplasty, and the amount of lactated Ringer solution used.
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Affiliation(s)
- Eileen Hennrikus
- Departments of Internal Medicine (E.H.), Orthopedics and Rehabilitation (C.D.), and Anesthesiology (B.M.), Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 500 University Drive, MC H034, Hershey, PA 17033. E-mail address for E. Hennrikus:
| | - George Ou
- Department of Internal Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, BC V5Z 1M9, Canada
| | - Bradley Kinney
- Senior Medical Officer, Special Boat Team 22, Stennis Space Center, MS 39520
| | - Erik Lehman
- Department of Public Health Sciences, Penn State Hershey College of Medicine, 90 Hope Drive, Hershey, PA 17033
| | - Robert Grunfeld
- Department of Orthopedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY 14642
| | - Jane Wieler
- Rocky Vista University College of Osteopathic Medicine, 8401 South Chambers Road, Parker, CO 80134
| | - Abdulla Damluji
- Cardiovascular Division Internal Medicine, University of Miami Miller School of Medicine, 1600 NW 10th Avenue, Miami, FL 33136
| | - Charles Davis
- Departments of Internal Medicine (E.H.), Orthopedics and Rehabilitation (C.D.), and Anesthesiology (B.M.), Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 500 University Drive, MC H034, Hershey, PA 17033. E-mail address for E. Hennrikus:
| | - Berend Mets
- Departments of Internal Medicine (E.H.), Orthopedics and Rehabilitation (C.D.), and Anesthesiology (B.M.), Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 500 University Drive, MC H034, Hershey, PA 17033. E-mail address for E. Hennrikus:
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Rafat C, Flamant M, Gaudry S, Vidal-Petiot E, Ricard JD, Dreyfuss D. Hyponatremia in the intensive care unit: How to avoid a Zugzwang situation? Ann Intensive Care 2015; 5:39. [PMID: 26553121 PMCID: PMC4639545 DOI: 10.1186/s13613-015-0066-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 09/02/2015] [Indexed: 12/11/2022] Open
Abstract
Hyponatremia is a common
electrolyte derangement in the setting of the intensive care unit. Life-threatening neurological complications may arise not only in case of a severe (<120 mmol/L) and acute fall of plasma sodium levels, but may also stem from overly rapid correction of hyponatremia. Additionally, even mild hyponatremia carries a poor short-term and long-term prognosis across a wide range of conditions. Its multifaceted and intricate physiopathology may seem deterring at first glance, yet a careful multi-step diagnostic approach may easily unravel the underlying mechanisms and enable physicians to adopt the adequate measures at the patient’s bedside. Unless hyponatremia is associated with obvious extracellular fluid volume increase such as in heart failure or cirrhosis, hypertonic saline therapy is the cornerstone of the therapeutic of profound or severely symptomatic hyponatremia. When overcorrection of hyponatremia occurs, recent data indicate that re-lowering of plasma sodium levels through the infusion of hypotonic fluids and the cautious use of desmopressin acetate represent a reasonable strategy. New therapeutic options have recently emerged, foremost among these being vaptans, but their use in the setting of the intensive care unit remains to be clarified.
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Affiliation(s)
- Cédric Rafat
- AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, France. .,AP-HP, Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Paris, France.
| | - Martin Flamant
- AP-HP, Service de Physiologie Rénale, Hôpital Bichat, Paris, France. .,Université Paris Diderot, Sorbonne Paris Cité, Paris, France. .,INSERM, U1149, Centre de Recherche sur l'Inflammation, Paris, France.
| | - Stéphane Gaudry
- AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, France. .,Université Paris Diderot, Sorbonne Paris Cité, Paris, France. .,ECEVE UMR 1123, ECEVE, Paris, France.
| | - Emmanuelle Vidal-Petiot
- AP-HP, Service de Physiologie Rénale, Hôpital Bichat, Paris, France. .,Université Paris Diderot, Sorbonne Paris Cité, Paris, France. .,INSERM, U1149, Centre de Recherche sur l'Inflammation, Paris, France.
| | - Jean-Damien Ricard
- AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, France. .,Université Paris Diderot, Sorbonne Paris Cité, Paris, France. .,INSERM UMR 1137, IAME, Paris, France.
| | - Didier Dreyfuss
- AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, France. .,Université Paris Diderot, Sorbonne Paris Cité, Paris, France. .,INSERM UMR 1137, IAME, Paris, France.
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50
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Kerbert AJC, Verbeke L, Chiang FWT, Laleman W, van der Reijden JJ, van Duijn W, Nevens F, Wolterbeek R, van Hoek B, Verspaget HW, Coenraad MJ. Copeptin as an Indicator of Hemodynamic Derangement and Prognosis in Liver Cirrhosis. PLoS One 2015; 10:e0138264. [PMID: 26378453 PMCID: PMC4574924 DOI: 10.1371/journal.pone.0138264] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/27/2015] [Indexed: 12/21/2022] Open
Abstract
Background Advanced liver cirrhosis is associated with systemic hemodynamic derangement leading to the development of severe complications associated with increased mortality. Copeptin is a stable cleavage product of the precursor of arginine vasopressin, a key-regulator in hemodynamic homeostasis. Copeptin is currently considered a reliable prognostic marker in a wide variety of diseases other than cirrhosis. The present study aimed to assess copeptin, both experimentally and clinically, as a potential biomarker of hemodynamic derangement and to evaluate its prognostic significance in cirrhosis. Materials and Methods Two studies were executed: 1) in 18 thioacetamide-induced cirrhotic rats and 5 control rats, plasma copeptin and hemodynamic measurements were performed, 2) in 61 cirrhotic patients, serum copeptin concentration was measured in samples collected at time of registration at the waiting list for liver transplantation. In 46 patients, also a second copeptin measurement was performed during follow-up while registered at the waiting list for liver transplantation. To determine the association of serum copeptin and clinical data with outcome, Cox proportional hazard regression analysis and Kaplan Meier analysis were performed. Results Plasma copeptin concentration was significantly higher in cirrhotic rats than in controls (1.6 ± 0.5 vs. 0.9 ± 0.1 pmol/L, p< 0.01) and was negatively correlated to the mean arterial blood pressure (r = -0.574, p = 0.013). In cirrhotic patients, serum copeptin concentration was high [11.0 (5.2–24.0) pmol/L] and increased significantly during the time of registration at the waiting list for liver transplantation. MELD and MELD-sodium score were significantly correlated to serum copeptin [MELD: (r = 0.33, p = 0.01), MELD-sodium: (r = 0.29, p = 0.02)], also at time of the second copeptin measurement [MELD and MELD-sodium: r = 0.39, p< 0.01]. In cirrhotic humans, serum copeptin concentration was significantly associated with outcome, independently of the MELD and MELD-sodium score. Patients with a low serum copeptin concentration at time of registration at the liver transplant waiting list had significantly better transplant-free survival rates at 3, 6 and 12 months of follow-up as compared to those with a high serum copeptin concentration (Log-rank: p< 0.01, p< 0.01 and p = 0.02 respectively). Conclusions Circulating copeptin levels are elevated in rats and humans with cirrhosis. Copeptin is independently associated with outcome in cirrhotic patients awaiting liver transplantation.
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Affiliation(s)
- Annarein J. C. Kerbert
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
- * E-mail: (AJCK); (MJC)
| | - Len Verbeke
- Department of Liver and Biliopancreatic Diseases, University Hospital Gasthuisberg, Leuven, Belgium
| | - Fang W. T. Chiang
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wim Laleman
- Department of Liver and Biliopancreatic Diseases, University Hospital Gasthuisberg, Leuven, Belgium
| | - Johan J. van der Reijden
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wim van Duijn
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frederik Nevens
- Department of Liver and Biliopancreatic Diseases, University Hospital Gasthuisberg, Leuven, Belgium
| | - Ron Wolterbeek
- Department of Medical Statistics and Bio-Informatics, Leiden University Medical Center, Leiden, the Netherlands
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hein W. Verspaget
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Minneke J. Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
- * E-mail: (AJCK); (MJC)
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