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Copeptin as a marker for arginine-vasopressin/antidiuretic hormone secretion in the diagnosis of paraneoplastic syndrome of inappropriate ADH secretion

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Abstract

Direct measurement of arginine-vasopressin/antidiuretic hormone (AVP/ADH) concentrations is not included in the standard diagnostic procedures for paraneoplastic syndrome of inappropriate ADH secretion (SIADH). Here, we evaluate the potential of copeptin measurement as a surrogate marker of AVP/ADH secretion for the direct diagnosis of suspected SIADH in cancer patients. Forty-six unselected cancer patients with serum sodium concentrations permanently below 135 mmol/L were included in this study. We compared standard diagnostic criteria for SIADH to the measurement of plasma copeptin in relation to osmolality. Normative data for comparison were constructed from 24 healthy controls studied under basal conditions, experimental dehydration, and hypotonic hypervolemia as well as from 222 hospital patients with no suspicion of an altered ADH regulation. Log transformation of copeptin revealed a linear relationship to plasma osmolality in the controls (R = 0.495, p < 0.001). Compared to these normative data, copeptin levels in most cancer patients were inappropriately high for plasma osmolality and were not significantly correlated. These results, suggestive for paraneoplastic SIADH, could be confirmed by conventional diagnostic procedures for SIADH. Current strategies to diagnose SIADH are difficult to perform under outpatients conditions. Our approach allows screening from a single plasma sample for true paraneoplastic ADH oversecretion and thus rapid selection for a specific therapy with an AVP receptor antagonist.

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Acknowledgments

The help of J. Valle, J. Radford, P. Lorrigan, and D. Darby, The Christie, Manchester, UK, is gratefully acknowledged.

Conflict of interest

The authors declare that there is no conflict of interest.

Ethics declaration

The experiments comply with the current laws of the country. The study was approved by the regional Ethics Committees.

Funding

This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

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Authors and Affiliations

  1. Experimental and Clinical Endocrinology Med. Clinic I, University of Luebeck, Ratzeburger Allee 160D, 23538, Luebeck, Germany

    A. Wuttke, S. C. Werth & G. Brabant

  2. Department of Endocrinology, The Christie, Manchester Academic Health Science Centre, Manchester, M20 4BX, UK

    K. C. Dixit & G. Brabant

  3. Pediatric Endocrinology, University Children’s Hospital Basel, 4056, Basel, Switzerland

    G. Szinnai

  4. Research Department, B.R.A.H.M.S.GmbH, D-16761, Hennigsdorf, Berlin, Germany

    U. Haagen & N. Morgenthaler

  5. Division of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital, 4058, Basel, Switzerland

    M. Christ-Crain

Authors
  1. A. Wuttke
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  2. K. C. Dixit
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  3. G. Szinnai
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  4. S. C. Werth
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  5. U. Haagen
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  6. M. Christ-Crain
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  7. N. Morgenthaler
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  8. G. Brabant
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Corresponding authors

Correspondence to A. Wuttke or G. Brabant.

Additional information

A. Wuttke and K. C. Dixit have contributed equally.

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Wuttke, A., Dixit, K.C., Szinnai, G. et al. Copeptin as a marker for arginine-vasopressin/antidiuretic hormone secretion in the diagnosis of paraneoplastic syndrome of inappropriate ADH secretion. Endocrine 44, 744–749 (2013). https://doi.org/10.1007/s12020-013-9919-9

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  • DOI: https://doi.org/10.1007/s12020-013-9919-9

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