{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T01:30:17Z","timestamp":1789695017024,"version":"4.0.1"},"reference-count":37,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Arginine vasopressin deficiency (AVD) following neurosurgical procedures for pituitary disorders is common and can delay discharge. Copeptin, a stable surrogate marker of arginine vasopressin, may predict postoperative AVD. The authors\u2019 aim was to assess the optimal postoperative sampling time and cut-point concentration of copeptin to predict the development of postsurgical AVD.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Adults without preexisting AVD who were undergoing surgery for a pituitary lesion between February 2020 and April 2022 were eligible for study inclusion. Two samples were drawn from each patient postoperatively to assess the copeptin concentration using an immunofluorescent assay. Samples were denoted as \"early\" (within 6 hours of extubation) or \"postoperative day 1\" (POD1; within 10\u201330 hours of extubation). Patients were evaluated for the development of AVD.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>One hundred ninety-two patients (54.2% female) with a median age of 54.5 years (IQR 39.8\u201367.0 years) were included in the study. The median copeptin concentration at both time points was significantly lower in those with AVD (transient or permanent; n = 22, 11.5%) than in those without (early: 4.9 vs 18.7 pmol\/L, p &lt; 0.001; POD1: 3.4 vs 4.9 pmol\/L, p &lt; 0.001) but did not differ in those who developed transient versus permanent AVD. The optimal copeptin cut point for the prediction of AVD was &lt; 8.5 pmol\/L for early samples (sensitivity 0.70, specificity 0.80, positive predictive value [PPV] 0.29, negative predictive value [NPV] 0.96) and &lt; 4.3 pmol\/L for POD1 samples (sensitivity 0.82, specificity 0.63, PPV 0.22, NPV 0.96). In early samples, a copeptin cutoff of 22.9 pmol\/L increased the sensitivity for the detection of AVD to 95% with an NPV of 99%. The proportion of patients who had AVD was higher (60.0% vs 8.8%, p &lt; 0.001) and the copeptin concentration lower (early: 4.3 vs 17.0 pmol\/L, p &lt; 0.001; POD1: 2.7 vs 4.9 pmol\/L, p &lt; 0.001) among those who had undergone surgery for a craniopharyngeal duct pathology versus a pituitary adenoma. Although copeptin was lower in patients with persistent Cushing\u2019s disease than in those in remission, the difference did not reach statistical significance (early p = 0.11, POD1 p = 0.52). Furthermore, the copeptin concentration could not predict the development of syndrome of inappropriate secretion of antidiuretic hormone. Patients without AVD who had received stress dose steroids intraoperatively had lower median early copeptin (11.7 vs 19.1 pmol\/L, p = 0.027).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>In early postoperative copeptin samples, the optimal copeptin cut point for AVD diagnosis was &lt; 8.5 pmol\/L, and a level &gt; 22.9 pmol\/L had predicative utility in excluding AVD. Caution should be used when interpreting copeptin results, as patients administered glucocorticoids intraoperatively without AVD had lower median copeptin concentrations.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.8.jns23418","type":"journal-article","created":{"date-parts":[[2023,11,11]],"date-time":"2023-11-11T01:28:00Z","timestamp":1699666080000},"page":"1276-1284","source":"Crossref","is-referenced-by-count":5,"title":["Postsurgical utility of copeptin for the prediction of postoperative arginine vasopressin deficiency"],"prefix":"10.3171","volume":"140","author":[{"given":"Diane","family":"Donegan","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Endocrinology Diabetes and Metabolism, Indiana University, Indianapolis, Indiana;"},{"name":"Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Bornhorst","sequence":"additional","affiliation":[{"name":"Departments of Laboratory Medicine and Pathology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Van Gompel","sequence":"additional","affiliation":[{"name":"Neurosurgery,"},{"name":"Otolaryngology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Neurosurgery,"},{"name":"Otolaryngology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J P.","family":"Theobald","sequence":"additional","affiliation":[{"name":"Departments of Laboratory Medicine and Pathology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredric F.","family":"Meyer","sequence":"additional","affiliation":[{"name":"Neurosurgery,"},{"name":"Otolaryngology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Link","sequence":"additional","affiliation":[{"name":"Neurosurgery,"},{"name":"Otolaryngology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Peris-Celda","sequence":"additional","affiliation":[{"name":"Neurosurgery,"},{"name":"Otolaryngology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant","family":"Spears","sequence":"additional","affiliation":[{"name":"Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Erickson","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"J Clin Endocrinol Metab","first-page":"1423","article-title":"Clinical review: disorders of water homeostasis in neurosurgical patients","volume":"97","author":"Hannon MJ","year":"2012","unstructured":"Hannon MJ, Finucane FM, Sherlock M, Agha A, Thompson CJ. 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Endocr Pract. 2021;27(5):463\u2013470."},{"issue":"6","key":"b26","series-title":"Neuroendocrinology","first-page":"525","article-title":"Early copeptin determination allows prompt diagnosis of post-neurosurgical central diabetes insipidus","volume":"110","author":"Berton AM","year":"2020","unstructured":"Berton AM, Gatti F, Penner F,  Early copeptin determination allows prompt diagnosis of post-neurosurgical central diabetes insipidus. Neuroendocrinology. 2020;110(6):525\u2013534."},{"key":"b27","series-title":"Endocrine","article-title":"Post-pituitary surgery copeptin analysis as a \u2018rule-out\u2019 test for post-operative diabetes insipidus","author":"Rostom H","year":"2022","unstructured":"Rostom H, Noronha S, Jafar-Mohammadi B,  Post-pituitary surgery copeptin analysis as a \u2018rule-out\u2019 test for post-operative diabetes insipidus. 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