Highlights & Basics
- Arginine vasopressin deficiency (AVP-D; previously known as central diabetes insipidus) or resistance (AVP-R; previously known as nephrogenic diabetes insipidus) are disorders characterized by polydipsia, polyuria, and formation of inappropriately hypotonic (dilute) urine due to renal water loss.
- AVP-D occurs due to reduced synthesis or release of AVP from the hypothalamo-pituitary axis. AVP-R occurs due to renal insensitivity to AVP.
- Recognized risk factors for AVP-D include pituitary surgery, craniopharyngioma, infiltrative pituitary stalk lesions, traumatic brain injury, subarachnoid hemorrhage, congenital hypothalamo-pituitary defects, autoimmune disorders, and Wolfram syndrome. Risk factors for AVP-R include lithium therapy, chronic kidney disease, and chronic hypercalcemia or hypokalemia. Genetic mutations are responsible for inherited forms of both types.
- Both AVP-D and AVP-R may be associated with hypernatremia, and this may present as a medical emergency. Significant hypernatremia usually only occurs in these conditions in association with adipsia or impaired access to free water.
- Treatment goals are correction and stabilization of water deficit and electrolyte balance, together with reduction in symptoms of excessive urinary water loss and thirst. In AVP-D, the synthetic AVP analog desmopressin (also known as DDAVP) is the treatment of choice. AVP-R is treated with an adequate fluid intake; salt restriction and diuretics may help reduce polyuria.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
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