Key Points
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The levels of copeptin in the circulation correlate with those of arginine vasopressin (AVP)
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Currently available techniques for the measurement of copeptin have advantages over those for AVP in terms of ex vivo stability of the marker, and the ease and speed of measurement
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In the differential diagnosis of polyuria–polydipsia syndrome, measurement of copeptin has great potential, enabling direct identification of patients with nephrogenic diabetes insipidus, without prior thirsting
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Osmotically stimulated copeptin levels can differentiate between patients with primary polydipsia and those with partial central diabetes insipidus
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In the differential diagnosis of hyponatraemia, low copeptin levels identify primary polydipsia, and the ratio of copeptin to urinary sodium could distinguish between AVP-dependent forms of hyponatraemia
Abstract
Copeptin and arginine vasopressin (AVP) are derived from a common precursor molecule and have equimolar secretion and response to osmotic, haemodynamic and stress-related stimuli. Plasma concentrations of copeptin and AVP in relation to serum osmolality are highly correlated. The physiological functions of AVP with respect to homeostasis of fluid balance, vascular tonus and regulation of the endocrine stress response are well known, but the exact function of copeptin is undetermined. Quantification of AVP can be difficult, but copeptin is stable in plasma and can be easily measured with a sandwich immunoassay. For this reason, copeptin has emerged as a promising marker for the diagnosis of AVP-dependent fluid disorders. Copeptin measurements can enable differentiation between various conditions within the polyuria–polydipsia syndrome. In the absence of prior fluid deprivation, baseline copeptin levels >20 pmol/l identify patients with nephrogenic diabetes insipidus. Conversely, copeptin levels measured upon osmotic stimulation differentiate primary polydipsia from partial central diabetes insipidus. In patients with hyponatraemia, low levels of copeptin together with low urine osmolality identify patients with primary polydipsia, and the ratio of copeptin to urinary sodium can distinguish the syndrome of inappropriate antidiuretic hormone secretion from other AVP-dependent forms of hyponatraemia.
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M. C.-C. and W. F. have received speaking honoraria from Thermo Fisher AG, the manufacturer of the Copeptin Assay.
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Christ-Crain, M., Fenske, W. Copeptin in the diagnosis of vasopressin-dependent disorders of fluid homeostasis. Nat Rev Endocrinol 12, 168–176 (2016). https://doi.org/10.1038/nrendo.2015.224
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