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Background: Diabetes insipidus (DI) is a recognised complication of pituitary surgery, with diagnosis requiring clinical observation aided by plasma and urine electrolytes and osmolalities. Copeptin is a stable surrogate marker of AVP release and has potential to facilitate prompt diagnosis of post-operative DI. This assay has been shown to accurately predict which patients are likely to develop DI following pituitary surgery. Objective: To determine whether copeptin analysis can be used to predict which patients are at risk of developing DI following transsphenoidal adenomectomy (TSA).Methods: 78 patients undergoing TSA had samples taken for copeptin pre-operatively and at day 1 post-TSA. The majority of patients also had samples from day 2, day 8, and week 6 post-TSA. Results from patients who developed post-operative DI (based on clinical assessment, urine and plasma biochemistry and the need for treatment with DDAVP) were compared to those who did not. Patients with any evidence of pre-operative DI were excluded.Results: Of 78 patients assessed, eleven were clinically determined to have developed DI. Differences were observed between patients with DI and those without in post-operative samples. Of note, there was a significant difference in plasma copeptin at day 1 post-operation (p=0.010 on Kruskal-Wallis test), with copeptin levels greater than 3.4 pmol/L helping to rule out DI (91% sensitivity, 55% specificity at this cut off).Conclusion: In the post-TSA setting, copeptin is a useful rule-out test in patients with values above a defined threshold, which may facilitate earlier decision making and shorter hospital stays.

Background Diabetes insipidus (DI) is a recognised complication of pituitary surgery, with diagnosis requiring clinical observation aided by plasma and urine electrolytes and osmolalities. Copeptin is a stable surrogate marker of AVP release and has potential to facilitate prompt diagnosis of post-operative DI. This assay has been shown to accurately predict which patients are likely to develop DI following pituitary surgery. Objective To determine whether copeptin analysis can be used to predict which patients are at risk of developing DI following trans-sphenoidal surgery (TSS). Methods Seventy-eight patients undergoing TSS had samples taken for copeptin pre-operatively and at day 1 post-TSS. The majority of patients also had samples from day 2, day 8, and week 6 post-TSS. Results from patients who developed post-operative DI (based on clinical assessment, urine and plasma biochemistry and the need for treatment with DDAVP) were compared to those who did not. Patients with any evidence of pre-operative DI were excluded. Results Of 78 patients assessed, 11 were clinically determined to have developed DI. Differences were observed between patients with DI and those without in post-operative samples. Of note, there was a significant difference in plasma copeptin at day 1 post-operation (p = 0.010 on Kruskal–Wallis test), with copeptin levels greater than 3.4 pmol/l helping to rule out DI (91% sensitivity, 55% specificity at this cut off). Conclusion In the post-TSS setting, copeptin is a useful rule-out test in patients with values above a defined threshold, which may facilitate earlier decision making and shorter hospital stays.

Unique in the UK armoury of injectable agents for diabetes, the combination IdegLira offers the clinical advantages of degludec and liraglutide, with the convenience of a once daily injection. The ABCD IDegLira audit, commenced in April 2017, is a nationwide audit evaluating whether the favourable effects of IDegLira on HbA1c and weight previously shown in clinical trials translate into similar advantages when the agent is used in real clinical practice. Data to date has been obtained nationwide via two routes: a physician populated online audit tool and a cloud-based IT system (Eclipse), capable of integrating with existing primary care systems to facilitate audit, risk stratification and patient empowerment. The inclusion criteria were people with type 2 diabetes started on IDegLira, who had HbA1c and weight measured at baseline and 6 months into treatment. Baseline values were defined as the most recent values in the 6-month period prior to initiation of IDegLira. Endpoint data was accepted within a collection window of +/- 45 days. We identified thirty-five patients for HbA1c (15M, 20F, mean ± SD age 57.4 ± 8.2) and twenty-eight patients for weight (13M, 15F, mean ± SD age 75.0 ± 8.6). Baseline HbA1c and weight were compared with the 6-month values with 2-sided p-values using a paired T Test. Mean ± SD HbA1c fell by 1.43% ± 2.04, from 10.17% ± 1.93 to 8.73% ± 1.74 (p Disclosure S. Noronha: None. A.N. Lumb: Advisory Panel; Self; Dexcom, Inc., Novo Nordisk A/S. Consultant; Self; LifeScan, Inc. Speaker's Bureau; Self; Abbott, Novo Nordisk A/S. Other Relationship; Self; Abbott. A. Bickerton: Employee; Self; MyWay Digital Health. S. Sim: None. I.W. Gallen: None. K. Adamson: None. R.E. Ryder: Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Bioquest. Funding Association of British Clinical Diabetologists

Dopamine agonists are the treatment of choice for all patients with prolactinomas. They are generally safe, effective, and well-tolerated. However, a link between their use and the development of impulse control disorders has been well recognized in the field of neurology for some time, and evidence for a similar effect in endocrine patients is emerging. This has mainly been revealed through clinical case reports, plus a small number of comparative studies of varying robustness. We review the current available literature and discuss the implications for clinical practice, in particular emphasizing the need for clinicians to be alert to these uncommon but serious adverse effects.