B·R·A·H·M·S Copeptin proAVP: Endocrinology

Electrolyte/vasopressin-dependent disorders

Because of technical limitations of conventional vasopressin assays, vasopressin (i.e., ADH, AVP) concentrations were rarely measured in the past. The vasopressin surrogate Copeptin opens the possibility to take full advantage of this hormone’s diagnostic potential. 

 

Copeptin is routinely measured as an aid for the differential diagnosis of polyuria-polydipsia syndrome with an easy-to-use, highly sensitive, and highly stable assay technology.

Copeptin in diabetes insipidus (AVP deficiency) (20) after neurosurgery

Surgery is a stressful event known to stimulate hypothalamic stress hormone release.1,2 Maximal stress is generally experienced after extubation, and studies have shown that Copeptin levels can multiply after surgical treatment.3

 

Copeptin levels in controls, medical patients and surgical patients after extubation, mirroring three different levels of physical stress3

Furthermore, manipulation of the pituitary gland during neurosurgery may alter its secretory function. In one study, 16-34% of patients undergoing pituitary surgery developed post-operative AVP deficiency, i.e.diabetes insipidus (DI).4
 

Although most cases of diabetes insipidus are self-limiting and benign, DI can occasionally develop into severe hypernatremia and hyperosmolality if the deficit of fluids is not immediately replaced. Therefore, a timely and accurate diagnosis followed by appropriate patient management is crucial.5,6   
 

Copeptin, as measured by Thermo Scientific B·R·A·H·M·S Copeptin proAVP KRYPTOR Assay, can be considered a true surrogate marker of vasopressin and is useful for monitoring patients with suspected diabetes insipidus (AVP deficiency) after pituitary surgery.

The benefits of implementing Copeptin testing for rule-out of myocardial infarction

Low Copeptin (≤12h post-surgery level vs. baseline)

Diabetes insipidus
  • Low twelve-hour post-operative Copeptin proAVP levels despite surgery-induced stress indicate later diabetes insipidus. 
  • A lack of increase in Copeptin proAVP within twelve hours after surgery indicates deficient function of the posterior lobe of the pituitary and is therefore a reliable marker for the development of post-operative diabetes insipidus.7

High Copeptin(≤12h post-surgery level vs. baseline)  

Uneventful course
  • High twelve-hour post-operative Copeptin proAVP levels are strongly predictive of an uneventful post-operative course in terms of diabetes insipidus.7
  • In patients with intact posterior pituitary lobe function, Copeptin proAVP levels increase due to surgery-induced stress within the first twelve hours after surgery.

Polyuria-polydipsia syndrome – improve diagnosis in your endocrine practice

The challenge clinicians face in the diagnosis of polyuria-polydipsia syndrome is differentiating between cases of primary polydipsia, AVP resistance (nephrogenic DI) and AVP deficiency (partial or complete central DI), respectively.

Characteristics of polyuria-polydipsia syndrome (suspected AVP resistance, AVP deficiency or primary polydipsia)

  • Excessive fluid intake and excessive urine volume
  • Urine osmolality low, serum osmolality high

 

By aiding in the differential diagnosis, Copeptin measurement reduces the burden of water deprivation testing for patients and improves patient management.8 By utilizing B·R·A·H·M·S Copeptin proAVP KRYPTOR Assay, clinics can simplify their workflow and may reduce costs with fewer measurements, fewer personnel, and less time while avoiding complicated and stressful diagnostic pathways for the patient with thirst tests over longer periods of time.

B·R·A·H·M·S Copeptin proAVP KRYPTOR for the differential diagnosis of polyuria-polydipsia syndrome.10 

A diagnostic workflow for the differential diagnosis of polyuria-polydipsia syndrome, modified from Christ-Crain M et al.9 

Explore Copeptin utility for the early-rule out of acute myocardial infarction.

Comparison of a commercially available vasopressin radioimmunoassay1 with the  B·R·A·H·M·S Copeptin proAVP KRYPTOR Assay

 

Features

Vasopressin assay limitations10

Copeptin assay advantages

Ex vivo stability

Unstable even when stored at -20°C

24 h at room temperature & 4 months at -20°C

Sample volume

400 µL

50 µL

Matrix

Plasma (EDTA)

Serum & plasma (EDTA, heparin)

Time to result

3 working days

14 minutes

Handling

Manual

Automated

Sensitivity

Low (because of small molecule size, measurement is ony possible by competitive immunoassays)

High (due to it’s larger size, Copeptin can be measured using a sensitive sandwich immunoassay)

Measuring range

1..25-80 pg/mL (= 1.15-73.8 pmol/L)

2.7-500 pmol/L (up to 2,000 pmol/L with automatic dilution) 

References:

  1. Donald RA et al., Clin Endocrinol (Oxf) 1993; 38, 609-15
  2. Udelsman R et al., J Clin Endocrinol Metab 1987; 64, 986-94
  3. Katan M, et al., Neuro Endocrinol Lett 2008; 29, 341-6
  4. Hensen J et al., Clin Endocrinol (Oxf) 1999; 50, 431-9
  5. Anderson RJ, Kidney Int 1986; 29, 1237-47
  6. Berl T, Kidney Int 1990; 37, 1006-18
  7. Winzeler B et al., J Clin Endocrinol Metab 2015; http://dx.doi.org/10.1210/jc.2014-4527
  8. Timper K, Fenske W, et al. Diagnostic Accuracy of Copeptin in the Differential Diagnosis of the Polyuria-polydipsia Syndrome: A Prospective Multicenter Study. J Clin Endocrinol Metab, June 2015, 100(6):2268–22
  9. Christ-Crain M et al., Nat Rev Endocrinol. 2016;12(3):168-76
  10. Bühlmann Vasopressin RIA (RK-VPD), Instructions for Use

 

Thermo Fisher Scientific products are distributed globally and their uses, applications, indications, claims and availability of products in each country depend on local regulatory marketing authorization status, please consult the Instructions For Use (IFU) available in your country.

© 2026 Thermo Fisher Scientific Inc. All rights reserved. All trademarks are the property of Thermo Fisher Scientific and its subsidiaries unless otherwise specified. B·R·A·H·M·S is a registered trademark of B·R·A·H·M·S GmbH.

KRYPTOR is a trademark of Cisbio Bioassays, licensed for use by B·R·A·H·M·S GmbH, a part of Thermo Fisher Scientific. Other product names in this document are used for identification purposes; they may be trademarks and/or registered trademarks of their respective companies.

 

www.brahms.de/patents