État des lieux des méthodes d’exploration dynamiques du diabète insipide : utilisation de la copeptine
Year: 2026
Type: dissertation
Abstract: Diabetes insipidus combines polyuria and polydipsia, yet establishing its aetiology remains challenging: central diabetes insipidus, nephrogenic diabetes insipidus and primary polydipsia share the same clinical presentation but require opposite management. The water deprivation test, the reference standard since 1970, achieves only about 70% diagnostic accuracy and relies on thresholds derived from 36 patients that were never prospectively validated. Direct measurement of ADH, the only physiologically relevant marker, remains unusable in routine practice owing to its instability and platelet binding. Copeptin, co-secreted in equimolar amounts from the same precursor but analytically stable, provides a reliable surrogate. This work shows that its diagnostic value lies not in the marker alone but in the quality of the stimulus: measured after arginine or hypertonic saline stimulation, it raises diagnostic accuracy above 95%, including in the most challenging distinction between partial central diabetes insipidus and primary polydipsia, while substantially reducing the burden placed on the patient. On the therapeutic side, desmopressin remains the reference treatment for central diabetes insipidus, but patient-reported data highlight the importance of therapeutic education in preventing hyponatraemia.
Source: HAL
Author: Grabié-Bestion, Léna
Institution: Université de Montpellier
Language: French
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225278981