27
| 1 | 2012
Klinisk Biokemi i Norden
(
Fortsætter side 30)
tin plasma concentrations in cardiac disease needs to
be elucidated. While the current paradigm suggests
stress as the main trigger stimulus, it is still compelling
that the pituitary response is so rapid with respect to
chest pain. More data on other diseases that are defined
by acute chest pain urgently needs to be examined,
i.e
.
aortic dissection and infectious cardiac disease. Nota-
bly, these high-risk patients may be misinterpreted as
“
non-cardiac” and rapidly referred to departments
with little or no experience for these severe conditions.
The consequences of such use could be disastrous.
Conclusion
Copeptin plasma measurement has emerged as a
promising surrogate marker of pituitary vasopressin
secretion. The most promising clinical application
so far is in cardiovascular medicine, where copep-
tin measurement may be used for rapid exclusion of
myocardial infarction in acute chest pain patients and
predicting prognosis in patients with heart failure.
As copeptin concentrations are elevated and provide
prognostic information in several life threatening
conditions (Table 1), we speculate that copeptin may
to some extent be used as “an endocrine CRP”, that
is providing useful information to the clinician when
extra care is relevant. We therefore suspect that copep-
tin may soon be included in the analytical repertoire
in Scandinavian laboratories.
References
1.
Holwerda DA. A glycopeptide from the poste-
rior lobe of pig pituitaries. I. Isolation and cha-
racterization. Eur J Biochem 1972;28:334–9.
2.
Struck J, Morgenthaler NG, Bergmann A.
Copeptin, a stable peptide derived from the
vasopressin precursor, is elevated in serum of
sepsis patients. Peptides 2005;26:2500-4.
3.
Morgenthaler NG, Struck J, Alonso C, Berg-
mann A. Assay for the measurement of
copeptin, a stable peptide derived from the
precursor of vasopressin. Morgenthaler NG,
Struck J, Alonso C, Bergmann A. Clin Chem
2006;52:112-9.
4.
Katan M, Morgenthaler NG, Dixit KC, Rutis-
hauser J, Brabant GE et al. Anterior and pos-
terior pituitary function testing with simultan-
eous insulin tolerance test and a novel copeptin
assay. J Clin Endocrinol Metab 2007;92:2640-3.
5.
Fenske W, Quinkler M, Lorenz D, Zopf K,
Haagen U et al. Copeptin in the differen-
tial diagnosis of the polydipsia-polyuria
syndromerevisiting the direct and indirect
water deprivation tests. J Clin Endocrinol
Metab 2011;96:1506-15.
6.
Thygesen K et al. Universal definition
of myocardial infarction. Circulation 200727;
116:2634-53.
7.
Reichlin T, Hochholzer W, Bassetti S, Steuer S,
Stelzig C et al. Early diagnosis of myocardial
infarction with sensitive cardiac troponin assays.
8.
McAlpine HM, Morton JJ, Leckie B, Rumley A,
Gillen G, Dargie HJ. Neuroendocrine activa-
tion after acute myocardial infarction. Br Heart
J 1988;60:117-24.
9.
Charles CJ, Rogers SJ, Donald RA, Ikram H,
Prickett T, Richards AM. Hypothalamo-pitui-
tary-adrenal axis response to coronary artery
embolization: an ovine model of acute myocar-
dial infarction. J Endocrinol 1997;152:489-93.
10.
Khan SQ, Dhillon OS, O‘Brien RJ, Struck J,
Quinn PA et al. C-terminal provasopressin
(
copeptin) as a novel and prognostic marker
in acute myocardial infarction: Leicester Acute
Myocardial Infarction Peptide (LAMP) study.
Circulation. 2007;115:2103-10.
Foto: Henrik Alfthan
