ODP313 Glucagon-Stimulated Copeptin Measurements in the Differential Diagnosis of Diabetes Insipidus: A Double-Blind Randomized Placebo-Controlled Study

BACKGROUND: The differential diagnosis of diabetes insipidus and primary polydipsia is challenging. To date, the most reliable approaches are copeptin measurement after hypertonic saline infusion or arginine, which is a known growth hormone secretagogue but has recently also been shown to stimulate the neurohypophysis. Similar to arginine, glucagon is also known to stimulate growth hormone release, but its effect on the neurohypophysis unknown. METHODS: In this double-blind, randomized, placebo-controlled trial, we enrolled 22 healthy participants, 10 patients with central diabetes insipidus and 10 patients with primary polydipsia at the University Hospital Basel. Each participant underwent the glucagon test, i. e., subcutaneous injection of 1mg glucagon, and placebo test, i. e., subcutaneous injection of 1 ml 0.9% sodium. Plasma copeptin levels were measured at baseline and 30, 60, 90, 120, 150, 180 minutes after injection. The primary objective was to determine whether glucagon stimulates copeptin and to explore whether the copeptin response differentiates between diabetes insipidus and primary polydipsia. Findings: The median (IQR) age of all participants was 27 years (23; 32), 59% were female. In healthy participants, glucagon injection stimulated copeptin with a median (IQR) increase of 7.56 (2.38; 28. 03) pmol/l, while placebo had no effect (0.10pmol/l (-0.70; 0.68); difference: 7.67 (1.98, 27. 09) pmol/l, p < 0. 001). In patients with central diabetes insipidus, copeptin showed no relevant increase after glucagon injection, with an increase of 0.55pmol/l (0.21; 1.65), whereas copeptin was stimulated in patients with primary polydipsia with an increase of 15.70 (5.99; 24.39) pmol/l. Using a copeptin cutoff level of 4.6pmol/l had a sensitivity of 100% (95%CI 100-100) and a specificity of 90% (95%CI 70-100) to discriminate between diabetes insipidus and primary polydipsia. Interpretation: Glucagon stimulates the neurohypophysis, and glucagon-stimulated plasma copeptin has the potential to be used for a safe, novel, and precise test in the differential diagnosis of polyuria-polydipsia syndrome. Presentation: No date and time listed