deamino-arginine-vasopressin and Diabetes-Insipidus

Human neurohormone vasopressin (AVP) is synthesized in overlapping regions in the hypothalamus. It is mainly known for its vasoconstricting abilities, and it is responsible for the regulation of plasma osmolality by maintaining fluid homeostasis. Over years, many attempts have been made to modify this hormone and find AVP analogues with different pharmacological profiles that could overcome its limitations. Non-peptide AVP analogues with low molecular weight presented good affinity to AVP receptors. Natural peptide counterparts, found in animals, are successfully applied as therapeutics; for instance, lypressin used in treatment of diabetes insipidus. Synthetic peptide analogues compensate for the shortcomings of AVP. Desmopressin is more resistant to proteolysis and presents mainly antidiuretic effects, while terlipressin is a long-acting AVP analogue and a drug recommended in the treatment of varicose bleeding in patients with liver cirrhosis. Recently published results on diverse applications of AVP analogues in medicinal practice, including potential lypressin, terlipressin and ornipressin in the treatment of SARS-CoV-2, are discussed.

Topics: Animals; Antidiuretic Agents; COVID-19; COVID-19 Drug Treatment; Deamino Arginine Vasopressin; Diabetes Insipidus; Hemostatics; Humans; Lypressin; Molecular Structure; Ornipressin; Pandemics; SARS-CoV-2; Terlipressin; Vasopressins

Diabetes insipidus (DI) is a disorder characterized by a high hypotonic urinary output of more than 50ml per kg body weight per 24 hours, with associated polydipsia of more than 3 liters a day [1,2]. Central DI results from inadequate secretion and usually deficient synthesis of Arginine vasopressin (AVP) in the hypothalamus or pituitary gland. Besides central DI further underlying etiologies of DI can be due to other primary forms (renal origin) or secondary forms of polyuria (resulting from primary polydipsia). All these forms belong to the Polyuria Polydipsia Syndrom (PPS). In most cases central and nephrogenic DI are acquired, but there are also congenital forms caused by genetic mutations of the AVP gene (central DI) [3] or by mutations in the gene for the AVP V2R or the AQP2 water channel (nephrogenic DI) [4]. Primary polydipsia (PP) as secondary form of polyuria includes an excessive intake of large amounts of fluid leading to polyuria in the presence of intact AVP secretion and appropriate antidiuretic renal response. Differentiation between the three mentioned entities is difficult [5], especially in patients with Primary polydipsia or partial, mild forms of DI [1,6], but different tests for differential diagnosis, most recently based on measurement of copeptin, and a thorough medical history mostly lead to the correct diagnosis. This is important since treatment strategies vary and application of the wrong treatment can be dangerous [7]. Treatment of central DI consists of fluid management and drug therapy with the synthetic AVP analogue Desmopressin (DDAVP), that is used as nasal or oral preparation in most cases. Main side effect can be dilutional hyponatremia [8]. In this review we will focus on central diabetes insipidus and describe the prevalence, the clinical manifestations, the etiology as well as the differential diagnosis and management of central diabetes insipidus in the out- and inpatient setting.

Topics: Adult; Antidiuretic Agents; Aquaporin 2; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Glycopeptides; Humans; Mutation; Neurophysins; Pituitary Gland; Polydipsia; Polyuria; Protein Precursors; Vasopressins

The treatment of central diabetes insipidus has not changed significantly in recent decades, and dDAVP and replacement of free water deficit remain the cornerstones of treatment. Oral dDAVP has replaced nasal dDAVP as a more reliable mode of treatment for chronic central diabetes insipidus. Hyponatraemia is a common side effect, occurring in one in four patients, and should be avoided by allowing a regular break from dDAVP to allow a resultant aquaresis. Hypernatraemia is less common, and typically occurs during hospitalization, when access to water is restricted, and in cases of adipsic DI. Management of adipsic DI can be challenging, and requires initial inpatient assessment to establish dose of dDAVP, daily fluid prescription, and eunatraemic weight which can guide day-to-day fluid targets in the long-term.

Topics: Body Weight; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Humans; Hypernatremia; Hyponatremia; Neurophysins; Protein Precursors; Vasopressins

Diabetes insipidus and the syndrome of inappropriate antidiuretic hormone secretion lie at opposite ends of the spectrum of disordered renal handling of water. Whereas renal retention of water insidiously causes hypotonic hyponatremia in syndrome of inappropriate antidiuretic hormone secretion, diabetes insipidus may lead to free water loss, hypernatremia, and volume depletion. Hypernatremia and hyponatremia are associated with worse outcomes and longer intensive care stays. Moreover, pathologies causing polyuria and hyponatremia in patients in intensive care may be multiple, making diagnosis challenging. We provide an approach to the diagnosis and management of these conditions in intensive care patients.

Topics: Antidiuretic Agents; Critical Care; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hypernatremia; Hyponatremia; Inappropriate ADH Syndrome; Male; Practice Guidelines as Topic; Water-Electrolyte Balance

Diabetes insipidus, characterized by polyuria and polydipsia, is a rare disease during pregnancy. Nevertheless, its recognition is important to avoid complications due to dehydration and hypernatremia. Its manifestation during pregnancy ranges from exacerbation of pre-existing central or nephrogenic diabetes insipidus to transient pregnancy-induced diabetes insipidus due to the increased metabolism of the antidiuretic hormone vasopressin (AVP) by the placental vasopressinase. Diagnosis can be challenging, as urinary frequency is common during pregnancy and primary polydipsia also needs to be excluded. Also, the standard water deprivation test is not recommended during pregnancy due to the increased risk of complications. Treatment depends upon the final diagnosis, with desmopressin (DDAVP) being the medication of choice in AVP-deficient diabetes insipidus, whereas nephrogenic diabetes insipidus requires treatment of the underlying disease and supportive measures.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hypoglycemic Agents; Pregnancy; Pregnancy Complications

Disruption of water and electrolyte balance is frequently encountered in clinical medicine. Regulating water metabolism is critically important. Diabetes insipidus (DI) presented with excessive water loss from the kidney is a major disorder of water metabolism. To understand the molecular and cellular mechanisms and pathophysiology of DI and rationales of clinical management of DI is important for both research and clinical practice. This chapter will first review various forms of DI focusing on central diabetes insipidus (CDI) and nephrogenic diabetes insipidus (NDI ) . This is followed by a discussion of regulatory mechanisms underlying CDI and NDI , with a focus on the regulatory axis of vasopressin, vasopressin receptor 2 (V2R ) and the water channel molecule, aquaporin 2 (AQP2 ). The clinical manifestation, diagnosis and management of various forms of DI will also be discussed with highlights of some of the latest therapeutic strategies that are developed from in vitro experiments and animal studies.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Antidiuretic Agents; Aquaporin 2; Deamino Arginine Vasopressin; Diabetes Insipidus; Disease Models, Animal; Gene Expression Regulation; Humans; Kidney; Phosphodiesterase Inhibitors; Protein Isoforms; Receptors, Vasopressin; Vasopressins; Water; Water-Electrolyte Balance

Diabetes insipidus (DI) in pregnancy is a heterogeneous syndrome, most classically presenting with polyuria and polydipsia that can complicate approximately 1 in 30,000 pregnancies. The presentation can involve exacerbation of central or nephrogenic DI during pregnancy, which may have been either overt or subclinical prior to pregnancy. Women without preexisting DI can also be affected by the actions of placental vasopressinase which increases in activity between the 4th and 38th weeks of gestation, leading to accelerated metabolism of AVP and causing a transient form of DI of pregnancy. This type of DI may be associated with certain complications during pregnancy and delivery, such as preeclampsia. Management of DI of pregnancy depends on the pathophysiology of the disease; forms of DI that lack AVP can be treated with desmopressin (DDAVP), while forms of DI that involve resistance to AVP require evaluation of the underlying causes.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Pregnancy; Pregnancy Complications

Diabetes insipidus (DI) is a rare complication of pregnancy. It is usually transient, being due to increased placental production of vasopressinase that inactivates circulating vasopressin. Gestational, transient DI occurs late in pregnancy and disappears few days after delivery. Acquired central DI can also occur during pregnancy, for example in a patient with hypophysitis or neuroinfundibulitis during late pregnancy or postpartum. Finally, pre-existing central or nephrogenic DI may occasionally be unmasked by pregnancy. Treatment with dDAVP (desmopressin, Minirin(®)) is very effective on transient DI of pregnancy and also on pre-existing or acquired central DI. Contrary to vasopressin, dDAVP is not degraded by vasopressinase. Nephrogenic DI is insensitive to dDAVP and is therefore more difficult to treat during pregnancy if fluid intake needs to be restricted.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Female; Humans; Pregnancy; Pregnancy Complications; Vasopressins

Central diabetes insipidus (CDI) is a complex and heterogeneous clinical syndrome affecting the hypothalamic-neurohypophyseal network and water balance. A recent national surveillance in Denmark showed a prevalence rate of twenty-three CDI patients per 100,000 inhabitants in five years. The differential diagnosis between several presenting conditions with polyuria and polydipsia is puzzling, and the etiological diagnosis of CDI remains a challenge before the identification of an underlying cause. For clinical practice, a timely diagnosis for initiating specific treatment in order to avoid central nervous system damage, additional pituitary defects and the risk of dissemination of germ cell tumor is advisable. Proper etiological diagnosis can be achieved via a series of steps that start with careful clinical observation of several signs and endocrine symptoms and then progress to more sophisticated imaging tools. This review summarizes the best practice and approach for the diagnosis and treatment of patients with CDI.

Topics: Antidiuretic Agents; Brain Injuries; Brain Neoplasms; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Diagnosis, Differential; Disease Management; Histiocytosis, Langerhans-Cell; Humans; Magnetic Resonance Imaging; Neoplasms, Germ Cell and Embryonal

Diabetes insipidus is an uncommon disorder of water-electrolyte balance characterized by the excretion of abnormally large volumes of diluted urine (polyuria) and increased fluid intake (polydipsia). The disease may result from the insufficient production of vasopressin, its increased degradation, an impaired response of kidneys to vasopressin, or may be secondary to excessive water intake. Patients with severe and uncompensated symptoms may develop marked dehydration, neurologic symptoms and encephalopathy, and therefore diabetes insipidus can be a life-threatening condition if not properly diagnosed and managed. Patients with diabetes insipidus require treatment with desmopressin or drugs increasing sensitivity of the distal nephron to vasopressin, but this treatment may be confusing because of the disorder's variable pathophysiology and side-effects of pharmacotherapy. This review summarizes the current knowledge on different aspects of the pathophysiology, classification, clinical presentation, diagnosis, and management of diabetes insipidus. The reader is also provided with some practical recommendations on dealing with patients suffering from this disease.

Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans

Central diabetes insipidus (DI) is a rare disorder in children caused by a deficiency of antidiuretic hormone arginine (vasopressin). Desmopressin is the first line agent in management of central DI. However, one of the side effects of desmopressin is water intoxication and hyponatraemia. This study reviews the patterns of desmopressin use and side effects in our institution.. Retrospective chart review of all patients with central DI followed up in one tertiary centre between 1 January 2008 and 31 December 2010.. Forty-one patients (22 males and 19 females) were included. Twelve patients (29.3%) had congenital and 29 patients (70.7%) had acquired DI, mostly as a result of intracranial tumours. Thirty-six (87.8%) patients were on oral desmopressin and the remaining on nasal formulation. The median oral dose was 9.5 (4.2-17.0) μg/kg/day with median frequency of 2.5 (2-3). The median nasal dose was 0.7 (0.4-1.4) μg/kg/day with median frequency of 2.0 (2-3.5). Fourteen patients (34.1%) were switched from nasal to oral desmopressin with the median dose conversion factor of 20.1 (10.7-31.8). Forty percent of patients on nasal desmopressin experienced hypo/hypernatraemia compared to 18.1% on oral, however, there were no significance difference between standardized hypo/hypernatraemia episodes per treatment year.. Oral desmopressin is used in the majority of our patients including infants and toddlers. There is wide inter-individual variation in dose requirement and dosing intervals. Management of central diabetes insipidus remains a challenge in adipsic patients and in young children during intercurrent illness regardless of the desmopressin formulation.

Topics: Adolescent; Antidiuretic Agents; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Male; Retrospective Studies

Central diabetes insipidus (CDI) is the end result of a number of conditions that affect the hypothalamic-neurohypophyseal system. The known causes include germinoma/craniopharyngioma, Langerhans cell histiocytosis (LCH), local inflammatory, autoimmune or vascular diseases, trauma resulting from surgery or an accident, sarcoidosis, metastases and midline cerebral and cranial malformations. In rare cases, the underlying cause can be genetic defects in vasopressin synthesis that are inherited as autosomal dominant, autosomal recessive or X-linked recessive traits. The diagnosis of the underlying condition is challenging and raises several concerns for patients and parents as it requires long-term follow-up. Proper etiological diagnosis can be achieved via a series of steps that start with clinical observations and then progress to more sophisticated tools. Specifically, MRI identification of pituitary hyperintensity in the posterior part of the sella, now considered a clear marker of neurohypophyseal functional integrity, together with the careful analysis of pituitary stalk shape and size, have provided the most striking findings contributing to the diagnosis and understanding of some forms of 'idiopathic' CDI. MRI STIR (short-inversion-time inversion recovery sequencing) is a promising technology for the early identification of LCH-dependent CDI.

Topics: Adult; Age Factors; Animals; Antidiuretic Agents; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Insipidus, Nephrogenic; Diabetes Insipidus, Neurogenic; Drug Monitoring; Fluid Therapy; Humans; Infant

Vasopressin V(2) agonists are well known as effective therapies in the treatment of central diabetes insipidus and nocturnal enuresis. Furthermore, given their mode of action, these particular agonists have more recently been considered, in both the pharmaceutical industry and in academia, as viable therapies for urological conditions such as nocturia.. For the past 10 years, significant progress has been made in the discovery and development of vasopressin V(2) agonists. This article provides the reader with information on the recent progress in the discovery and development of these compounds based on patents published from 2002 onward. Specifically, the article looks at the discovery of new non-peptide agonists as well as well as novel formulations of the vasopressin V(2) agonist desmopressin.. The V(2) receptor is currently one of the hottest therapeutic targets investigated for the treatment of urinary disorders such as nocturia and central diabetes. Over the past 10 years, significant progress has been made in the discovery and development of vasopressin V(2) receptor agonists, for the treatment of these disorders. The author anticipates that these agonists will be launched to market in the not-too-distant future.

Topics: Animals; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Design; Humans; Molecular Structure; Nocturnal Enuresis; Patents as Topic; Receptors, Vasopressin; Structure-Activity Relationship

Xanthoma disseminatum (XD) is a rare and potentially progressive non-Langerhans-cell histiocytosis. To date, a few cases of XD with spontaneous complete resolution have been described. The present report describes a 16-year-old girl who presented with yellow to red-brown papules and nodules on her eyelids, cheeks, axillae, back and buttocks. Indirect laryngoscopy showed multiple xanthomatous plaques on the larynx, posterior pharynx, epiglottis, and vocal cords. Additional findings were polyuria, polydipsia, and amenorrhea. Skin biopsy and electron microscopy results confirmed the diagnosis of XD. The patient was treated with fenofibrate, simvastatin, desmopressin, and sex-hormone replacement therapy. Her skin lesions began to slowly fade 6 years after disease onset, eventually resolving spontaneously and completely, but leaving an atrophic scar, frank anetoderma, and persisting diabetes insipidus. This case report together with a review of the English-language literature on the long-term follow-up of XD patients provides additional information on the natural history of this disease.

Topics: Adolescent; Amenorrhea; Anetoderma; Antidiuretic Agents; Biopsy; Cicatrix; Deamino Arginine Vasopressin; Dermatologic Agents; Diabetes Insipidus; Female; Fenofibrate; Gadolinium DTPA; Histiocytosis, Non-Langerhans-Cell; Hormone Replacement Therapy; Humans; Radionuclide Imaging; Remission, Spontaneous; Simvastatin

Over the past two decades, the genetic and molecular basis of familial forms of diabetes insipidus has been elucidated. Diabetes insipidus is a clinical syndrome characterized by the excretion of abnormally large volumes of diluted urine (polyuria) and increased fluid intake (polydipsia). The most common type of diabetes insipidus is caused by lack of the antidiuretic hormone arginine vasopressin (vasopressin), which is produced in the hypothalamus and secreted by the neurohypophysis. This type of diabetes insipidus is referred to here as neurohypophyseal diabetes insipidus. The syndrome can also result from resistance to the antidiuretic effects of vasopressin on the kidney, either at the level of the vasopressin 2 receptor or the aquaporin 2 water channel (which mediates the re-absorption of water from urine), and is referred to as renal or nephrogenic diabetes insipidus. Differentiation between these two types of diabetes insipidus and primary polydipsia can be difficult owing to the existence of partial as well as complete forms of vasopressin deficiency or resistance. Seven different familial forms of diabetes insipidus are known to exist. The clinical presentation, genetic basis and cellular mechanisms responsible for them vary considerably. This information has led to improved methods of differential diagnosis and could provide the basis of new forms of therapy.

Topics: Animals; Aquaporin 2; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Insipidus, Nephrogenic; Diabetes Insipidus, Neurogenic; Diagnosis, Differential; Female; Humans; Male; Mutation; Phenotype; Polydipsia; Polyuria; Receptors, Vasopressin; Vasopressins

We report a case of a woman with a preexisting diabetes insipidus (DI), who had two consecutive uncomplicated pregnancies. Both pregnancies resulted after spontaneous conception and had a similar uneventful course. At the time of conception the patient was receiving 1-desamino-8D-arginine-vasopressin (DDAVP) 30 microg/d which maintained a urinary volume of 2-3 l/day. Pre-existing DI can be handled carefully and result in an uncomplicated pregnancy. In such cases careful monitoring of the patient's fluid balance and liver enzymes, as well as monitoring for pre-eclampsia and oligohydramnios during pregnancy are essential.

Topics: Adult; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications; Pregnancy Outcome

Topics: Adrenal Cortex Hormones; Adult; Biopsy, Needle; Brain Diseases; Brain Mapping; Deamino Arginine Vasopressin; Diabetes Insipidus; Disease Progression; Drug Therapy, Combination; Follow-Up Studies; Histiocytosis, Non-Langerhans-Cell; Humans; Immunohistochemistry; Magnetic Resonance Imaging; Male; Monitoring, Physiologic; Risk Assessment; Severity of Illness Index; Skin

To review the etiology, diagnosis, and management of diabetes insipidus during pregnancy.. A search of the literature was performed in PubMed using key word searching and citation snowballing to identify articles published in English between January 1, 1980, and December 31, 2008, on the subject of diabetes insipidus during pregnancy. Once the articles were identified, a thorough review of all results was conducted. Results and conclusions were compiled and summarized.. We reviewed 50 studies selected using the following key words: diabetes insipidus, pregnancy, arginine vasopressin, vasopressinase.. Gestational diabetes insipidus is underdiagnosed because polyuria is often considered normal during pregnancy. Clinicians caring for pregnant women should consider screening for gestational diabetes insipidus, because it could be associated with serious underlying pathology.

Topics: Antidiuretic Agents; Body Water; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes, Gestational; Diuretics; Female; Humans; Hydrochlorothiazide; Magnetic Resonance Imaging; Pituitary Gland, Posterior; Pregnancy; Puerperal Disorders; Ultrasonography, Prenatal; Vasopressins

In this article, the authors highlight the circumstances surrounding the death of a young adult neurosurgical patient, recently reported to ISMP Canada. The incident signals the need for enhanced safeguards for patients receiving desmopressin (also known as dDAVP) and intravenous therapy. The authors present information from a recent ISMP Canada Safety Bulletin relevant to critical care, including an outline of potential contributing factors and suggested recommendations.

Topics: Adverse Drug Reaction Reporting Systems; Brain Neoplasms; Canada; Critical Care; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Monitoring; Fatal Outcome; Humans; Hyponatremia; Hypotonic Solutions; Infusions, Intravenous; Medication Errors; Nursing Assessment; Postoperative Care; Renal Agents; Safety Management

Gestational diabetes insipidus (GDI) is a rare disorder characterised by polyuria, polydypsia, and excessive thirst usually manifesting in the third trimester of pregnancy. The etiology is thought to depend on excessive vasopressinase activity, a placental enzyme that degrades arginine-vasopressin (AVP), but not 1-deamino-8-D: -arginine vasopressin (dDAVP), which is a synthetic form. This is a transient syndrome and may be associated with acute fatty liver of pregnancy and preeclampsia. The use of dDAVP in symptomatic cases has been proven as a safe method for both the mother and the fetus during the pregnancy. We report a case of recurrent gestational diabetes insipidus in successive pregnancies, which responded to dDAVP and subsided after delivery.

Topics: Adult; Cesarean Section, Repeat; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes, Gestational; Female; Humans; Magnetic Resonance Imaging; Pregnancy

DDAVP is a drug that should be used with caution for each patient individually. Particular care is needed to avoid fluid overload and rapid fluctuations in sodium concentration. Not only families but physicians as well should be educated and aware of the adverse effects of DDAVP, especially in high risk patients. Extreme caution is needed in children with severe neurological and developmental problems who cannot control their fluid intake themselves. Similarly, caution is needed in patients with hypodipsia and DI who have difficulty in balancing water intake and DDAVP dose. The treatment of DI is water; however, DDAVP is given to avoid a large fluid intake which can result in medullary washout. Frequent home monitoring of body weight and regular determinations of serum sodium may help to disclose the early phase of over-hydration or dehydration. DDAVP therapy should be temporarily interrupted during acute illness, febrile episodes, hot days and other conditions with increased water intake. It should be used with considerable caution in patients with cystic fibrosis, or renal or cardiovascular diseases. In patients with enuresis, it is recommended that DDAVP medication should not be continued for longer than 3 months without stopping for 1 week for full reassessment. Fluid intake should be limited 1 hour before and 8 hours after the dose. Generally, undertreatment with vasopressin analogue is safer than overtreatment. A simple measure to avoid overtreatment is to miss one dose once a week; a rapid onset diuresis ('washout' effect) provides considerable reassurance.

Topics: Adolescent; Antidiuretic Agents; Brain Edema; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Drinking; Enuresis; Hemostatics; Humans; Hyponatremia; Myelinolysis, Central Pontine; Sodium; Water Intoxication

We report an uncommon case of an intrasellar plasmacytoma presenting as a non-functional invasive pituitary macro-adenoma as the first manifestation of multiple myeloma. A 57 year old woman was referred to our department with a presumed diagnosis of a non-functioning pituitary macro-adenoma. She reported a 3 month history of headaches and a 2 week history of sudden onset of right facial numbness. Preoperative endocrine evaluation was remarkable only for a modestly elevated serum prolactin. A magnetic resonance imaging (MRI) scan revealed 3.6 x 5 x 4 cm enhancing homogeneous intrasellar mass with extension into the sphenoid and cavernous sinuses bilaterally; the optic chiasm was not displaced. She underwent transphenoidal surgery of the sellar lesion. The surgical specimen was heavily infiltrated with abnormal plasma cells, which stained almost exclusively for Kappa light chain immunoglobulins. An extensive investigation was undertaken to look for occult myelomatous disease. A diagnosis of multiple myeloma was made 1 month later based on a combination of clinical, pathological and radiologic features. She underwent radiation therapy directed towards the residual sellar tumor, followed by chemotherapy and autologous stem cell transplantation. Review of the world literature revealed only 22 previous reports of patients in whom a solitary plasmacytoma or multiple myeloma first presented as a sellar mass; in all cases mimicking clinically and radiologically a non-functioning invasive pituitary adenoma however with additional cranial nerve involvement. Intrasellar plasma cell tumors are rare tumors which may mimic non-functioning invasive pituitary tumors. The diagnosis should be suspected in patients with well preserved anterior pituitary function and cranial nerve neuropathies in the presence of significant sellar destruction.

Topics: Adenoma; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Female; Humans; Middle Aged; Pituitary Neoplasms; Plasmacytoma; Postoperative Complications; Treatment Outcome

Water homeostasis in the body is finely balanced by the release of the antidiuretic hormone vasopressin and the stimulation of thirst. Vasopressin acts in the kidneys to concentrate urine and reduce plasma osmolality. Diabetes insipidus is a disorder of water balance characterized by a failure to concentrate urine. There are two types of diabetes insipidus: central and nephrogenic. Central diabetes insipidus is caused by insufficient production of vasopressin, while nephrogenic diabetes insipidus is caused by an impaired response of the kidneys to vasopressin. Patients with central diabetes insipidus respond to treatment with vasopressin or its synthetic analogue, desmopressin; however, caution should be utilized in treating infants with vasopressin or analogues-infants can be treated successfully with fluids alone. Treatment of nephrogenic diabetes insipidus involves removing the underlying cause, if possible, reducing solute load or therapy with a diuretic agent.

Topics: Animals; Antidiuretic Agents; Body Water; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Homeostasis; Humans; Infant; Vasopressins

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans

In this paper we have reviewed the position of desmopressin in the treatment of diabetes insipidus. Desmopressin is a synthetic analog of vasopressin, with more pronounced antidiuretic effect. It is treatment of choice in substitution therapy of diabetes insipidus. Its application before sleeping time can reduce nocturnal enuresis, so it has a place in the treatment of enuresis nocturna. Antidiuretic effect of desmopressin is the result of agonistic effect on V2 receptors in the renal tubules. The efficacy and safety of desmopressin in mentioned indications was confirmed in clinical studies.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Renal Agents; Safety; Treatment Outcome

Topics: Adolescent; Biopsy; Deamino Arginine Vasopressin; Diabetes Insipidus; Histiocytosis, Langerhans-Cell; Humans; Hypercalcemia; Hypothalamic Diseases; Magnetic Resonance Imaging; Muscle Weakness; Testosterone

Hypothermia has been demonstrated to induce pancytopenia in animals, but whether this association exists in humans is unknown. The authors report the case of an 8-year-old girl in whom hypothermia (temperature 33 degrees C-35 degrees C) is the cause of pancytopenia. The patient developed thermoregulatory dysfunction subsequent to surgical resection of a craniopharyngioma. Her recurrent cytopenias could not be explained by any etiology except chronic hypothermia. The pancytopenia improved upon rewarming the patient to a temperature of 36 degrees C. This association between hypothermia and pancytopenia has rarely been reported in humans and may be underdiagnosed especially in cases of transient or milder presentations. The authors recommend careful hematologic monitoring of patients with thermoregulatory dysfunction.

Topics: Adrenal Insufficiency; Blood Cell Count; Cerebral Infarction; Child; Chronic Disease; Consciousness Disorders; Craniopharyngioma; Deamino Arginine Vasopressin; Dehydration; Diabetes Insipidus; Female; Frontal Lobe; Humans; Hyponatremia; Hypophysectomy; Hypopituitarism; Hypothalamus; Hypothermia; Hypothyroidism; Pancreatitis; Pancytopenia; Pituitary Neoplasms; Postoperative Complications; Seizures; Sleep Stages

Diabetes insipidus is a disorder of the water retaining ability of the organism. It is a polydipsic-polyuric syndrome caused by partial or complete vasopressin deficiency (central diabetes insipidus) or vasopressin resistance of the kidney tubules (nephrogenic diabetes insipidus) or increased water intake due to oversensitivity of the thirst centre (dipsogenic diabetes insipidus = primary polydipsia). The pathogenetic factors may affect the osmoreceptors, the vasopressinergic magnocellular nuclei of the hypothalamus, the median eminence, the pituitary stalk, the vasopressin release from the neurohypophysis, the vasopressin inactivating mechanisms and the renal structures mediating the antidiuretic effect of vasopressin. In the evaluation of the results of the diagnostic procedures, it is to be considered that long-term overhydration of any origin suppresses the vasopressin secretion and the "washout" effect of the long-term water-diuresis decreases the concentration gradient of the renal medulla leading to blunted sensitivity towards vasopressin. This is, why the differential diagnostics of central, nephrogenic and dipsogenic diabetes insipidus seems sometimes to be enigmatic. Central diabetes insipidus can be excluded only on the basis of proportional parallel increase of plasma osmolality and plasma vasopressin level. Similarly, nephrogenic diabetes insipidus will be excluded when plasma vasopressin increases proportionately with the increase of urinary osmolality. In equivocal cases T1-weighted MRI of the pituitary may be of help in the establishment of an exact diagnosis. As far as possible, the therapy is to be focused on the diabetes insipidus evoking basal diseases. In central diabetes insipidus, diuresis can be decreased by vasopressin substitution. The first choice compound for this purpose is 1-desamino-8-D-arginine-vasopressin. The non-vasopressin containing oral antidiuretics have become outdated in the treatment of central diabetes insipidus. There is no specific treatment for nephrogenic and dipsogenic diabetes insipidus, so far. Nephrogenic diabetes insipidus can be influenced by non-steroidal antiinflammatory agents or diuretics. Their combined administration is even more effective, however, still does not exceed a 50-percent mitigation in diuresis.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Magnetic Resonance Imaging; Osmolar Concentration; Pituitary Gland, Posterior; Renal Agents; Vasopressins

The development of transsphenoidal microsurgery and the refinement of endocrinological and radiological diagnostic procedures have afforded therapeutic options appropriate for each individual case in patients with pituitary-dependent hypercortisolism. Compared with other secreting pituitary tumors, the corticotroph adenoma seems to be the most biologically active tumor. Clinical evidence of hypercortisolism mainly occurs at an early stage of tumor growth when the tumor is very small, below the detection threshold of modern imaging techniques. While the treatment of large tumors remains difficult due to the non-discrete boundary lines of the tumor and extension or invasion, surgical removal of very tiny tumors requires reliable preoperative or peroperative identification in order to achieve total tumor resection for clinical remission and pituitary preservation to prevent hypopituitarism. We reviewed all the current surgical techniques or clever surgical procedures used to achieve both goals with the lowest complication rate. We report here the state-of-the-art of surgical management of corticotroph pituitary adenoma focusing on preoperative radiological and biological data required for performing guided intrasellar surgical exploration and reliable tumor identification. Different technical aspects of the nasosphenoidal approaches are reported as well as the modified transdiaphragmatic or transtubercular transcisternal approaches to tumors in a suprasellar localization or lying along the pituitary stalk. The advantages of minimally invasive surgical techniques such as intrasellar endoscopic surgery are discussed. Adapted surgical techniques for second transnasal surgery indicated for recurrent tumors are described. Guidelines are given for peroperative tumor identification with macroscopic assessment or histological control with frozen section biopsies. Different techniques for tumor removal are discussed from selective microadenomectomy to enlarged pituitary resection and total hypophysectomy. Methods for preoperative guidance of total tumor removal are proposed including histological or biological assessment of normal adjacent pituitary tissue. the strategy of surgical intrasellar exploration and tumor resection is outlined using a set of algorithms. The first is devoted to positive preoperative documentation of the tumor. The second is proposed for the surgical scenario where there is no preoperative MRI evidence of the tumor. Special strategies are dis

Topics: ACTH Syndrome, Ectopic; Adenoma; Adrenocorticotropic Hormone; Anti-Bacterial Agents; Cortisone; Cushing Syndrome; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnostic Imaging; Endoscopy; Humans; Hypophysectomy; Magnetic Resonance Imaging; Petrosal Sinus Sampling; Pituitary Neoplasms; Postoperative Complications; Premedication; Reoperation

Hyponatraemia is a common finding in patients with acute cerebral insults. The main differential diagnosis is between syndrome of inappropriate ADH secretion and cerebral salt wasting. Our aim is to review the topic of hyponatraemia in patients with acute cerebral insults and suggest a clinical approach to diagnosis and management.

Topics: Acute Disease; Algorithms; Brain Diseases; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Female; Fluid Therapy; Humans; Hyponatremia; Hypothalamic Neoplasms; Inappropriate ADH Syndrome; Postoperative Complications; Renal Agents; Sodium

Synthetic 1-deamino-8-D-arginine-vasopressin (DDAVP) is used in the management of diabetes insipidus (DI). We conducted a systematic literature review of DDAVP use during pregnancy, with particular attention to its safety for both mother and infant. Studies were identified through Ovid MEDLINE from 1976 to July 1997 using the combined terms "desmopressin," "DDAVP," and "pregnancy". Review articles and published letters were also explored. One hundred one articles were retrieved, of which 20 met all the inclusion criteria. Included in the 20 articles were 53 cases with the use of DDAVP for the management of DI. The therapeutic daily dose of DDAVP was approximately 29 micrograms intranasally (range 7.5-100 micrograms), with adequate DI control observed. Three of 14 women with sufficient information developed preeclampsia, a nonsignificant difference from the expected rate of 5 percent (the Fisher exact test, 2-P = .08). The mode of delivery was defined for 22 cases, with 16 uneventful vaginal births, and six cesarean delivery. There was no evidence of a drug interaction among the five women who received both DDAVP and intravenous oxytocin. Information was available on 49 live births born to DI mothers on DDAVP. The mean gestational age at delivery was 37.4 weeks (SD 1.3 weeks), with an estimated mean birth weight of 2963.8 gm (range 2000-4420 gm). Forty-three offspring were reported as healthy (event rate 87.8 percent; 95 percent CI 77.2-95.3 percent). Of the remaining six infants, one developed DI at 18 months of age; a second was under 2500 gm at birth, but survived; the third developed hypotonia and failure to thrive at 21 months, two others had Down syndrome; and the sixth died of severe cardiac anomalies. Similar data were seen among the 41 infants whose mothers had used DDAVP throughout pregnancy. In conclusion, DDAVP use during pregnancy seems to be safe for both mother and child. Delivery does not seem to be augmented by its use, nor are there likely any associated adverse neonatal effects. A large database of DDAVP use during pregnancy is needed to confirm these findings.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal Exposure Delayed Effects; Renal Agents; Safety

Topics: Adolescent; Adult; Body Water; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Drinking; Homeostasis; Humans; Infant; Magnetic Resonance Imaging; Polyuria; Renal Agents; Vasopressins

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Humans; Pituitary Function Tests; Pituitary Gland, Anterior; Vasoconstrictor Agents; Vasopressins

Topics: Bone Marrow Transplantation; Brain Diseases; Cyclosporine; Deamino Arginine Vasopressin; Demyelinating Diseases; Diabetes Insipidus; Drug Therapy, Combination; Female; Humans; Infant; Leukemia, Promyelocytic, Acute; Magnetic Resonance Imaging; Pons

Nonketotic hyperglycemic hyperosmolar coma is an uncommon, but significant, complication of type II diabetes mellitus with a high overall mortality rate. Treatment of this entity is controversial but mandates aggressive fluid resuscitation and strict control of serum glucose levels. In the patient described, nonketotic hyperglycemic hyperosmolar coma complicated by diabetes insipidus was successfully treated with desmopressin acetate. To the authors' knowledge, this is the first reported case of nonketotic hyperglycemic hyperosmolar coma associated with partial central diabetes insipidus.

Topics: Aged; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hyperglycemic Hyperosmolar Nonketotic Coma; Hypoglycemic Agents

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Humans; Pituitary Function Tests

Topics: Animals; Blood Coagulation Disorders; Cat Diseases; Cats; Deamino Arginine Vasopressin; Diabetes Insipidus; Dog Diseases; Dogs; Humans; Polyuria; von Willebrand Diseases

We describe a case of spontaneous muscle necrosis of the anterior tibial compartment occurring in a patient who had a hypophysectomy for a craniopharyngioma five years previously. We know of no other reported cases of spontaneous muscle necrosis in association with diabetes insipidus and feel that there should be increased awareness of the association between the two.

Topics: Adult; Biopsy; Compartment Syndromes; Craniopharyngioma; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hypophysectomy; Leg; Male; Pituitary Neoplasms; Postoperative Complications

There have only been thirty cases of total post-partum hypopituitarism published in the literature and these have nearly all been secondary to Sheehan's syndrome. The authors report a case of partial anterior hypopituitarism associated with diabetes insipidus which arose after an uneventful Caesarean operation and the origin of which seems to lie in auto-immune hypophysitis. The authors first describe the morphological and endocrine changes that the hypophysis undergoes during pregnancy and then point out that auto-immune hypophysitis seems to have been only recently recognised. This can be used to explain some cases of post-partum hypophyseal insufficiency occurring almost silently without any history of third haemorrhage. Research has been made systematically for anti-hypophyseal antibodies and for specific antibodies of the organ, but has not always been positive. So the diagnosis of auto-immune hypophysitis is often made only after eliminating other reasons for it. A brief review of the physiopathological mechanisms of diabetes insipidus makes it possible to suggest that vasopressinase coming from the placenta together with prostaglandins could play a role.

Topics: Adult; Autoimmune Diseases; Cesarean Section; Cystinyl Aminopeptidase; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Female; Humans; Hypopituitarism; Magnetic Resonance Imaging; Pituitary Gland, Anterior; Pregnancy; Prostaglandins; Puerperal Disorders

Recent progress in the diagnosis and treatment of diabetes insipidus (DI) is reviewed. Response of plasma vasopressin (AVP) to 5% hypertonic saline can be a new indicator of the capacity of AVP response to osmotic stimuli. Marked progress in the imaging analysis by computed tomography and magnetic resonance imaging (MRI) has made it possible to evaluate hypothalamic-pituitary lesions in detail. Especially, signal intensity on T1-weighted MR image of neurohypophysis is suggested to reflect its function. Sequencing analysis of genes encoding AVP-neurophysin precursor or AVP receptor is expected to be a most useful method for the diagnosis of inherited DI. Intranasal administration of DDAVP (1-deamino-8-D-AVP) is recommended as a standard therapy for DI.

Topics: Administration, Intranasal; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Humans; Neurophysins; Sequence Analysis

The authors describe several useful surgical techniques from our experiences in transsphenoidal microsurgery for pituitary adenomas. Intentional two-staged transsphenoidal removal with open sella floor and intrasellar drainage is available for most of giant adenomas with suprasellar extension. The open sella floor method and intrasellar drainage after first transsphenoidal adenomectomy accelerate to decrease the suprasellar tumor extension. In four of six patients in our series, macroscopically total selective adenomectomy was achieved by a second transsphenoidal operation without complications. As for extremely small microadenomas, represented in patients with Cushing's disease, stepwise systemic search is required to identify a subcortical microadenoma, preserving postoperative pituitary function. Edge resection around the microadenoma is also necessary for normalization of hormonal hypersecretion and permanent cure.

Topics: Adenoma; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hydrocortisone; Hypophysectomy; Pituitary Neoplasms; Postoperative Care; Vasopressins

Topics: Animals; Deamino Arginine Vasopressin; Diabetes Insipidus; Hypothalamus; Protein Precursors; Rats; Rats, Brattleboro; Sodium Chloride; Vasopressins

A 20-year-old woman with a history of pituitary resection complicated by diabetes insipidus was able to fully breastfeed for three months despite apparent hyposecretion of pituitary hormones. This case report adds to the growing body of evidence that control of milk production shifts from endocrine to autocrine control shortly after delivery. Autocrine control allows efficient regulation of milk supply to match the needs of the infant. A recently discovered factor in human milk that inhibits lactose and casein synthesis in vitro is believed to be responsible for local, short term control of milk production. This study suggests that practices which result in infrequent or incomplete removal of milk from the breast lead to decreased milk production and should be abandoned.

Topics: Abscess; Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant, Newborn; Lactation; Oxytocin; Patient Education as Topic; Pituitary Diseases; Postoperative Complications; Pregnancy; Prolactin

Topics: Administration, Oral; Adolescent; Animals; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant, Newborn

A 57-year-old man with pituitary metastasis from renal cell carcinoma is reported. He underwent right nephrectomy and total pancreatectomy for renal cell carcinoma and its pancreatic metastasis, respectively. Imaging studies showed an intrasellar mass lesion. The examination revealed panhypopituitarism, diabetes insipidus and bitemporal hemianospia. Metastatic renal cell carcinoma was diagnosed by the biopsy of the pituitary tumor. Metastatic renal cell carcinoma to the pituitary gland, which is extremely rare, appears to have unique features of presenting with hypopituitarism and visual disturbance more frequently than other metastatic pituitary tumors.

Topics: Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Carcinoma, Renal Cell; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hypopituitarism; Kidney Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Pancreatic Neoplasms; Pituitary Gland; Pituitary Neoplasms; Tomography, X-Ray Computed

To review the pathophysiology, diagnosis, and treatment of the syndromes of diabetes insipidus with an emphasis on those situations likely to be encountered in the critical care setting.. Extensive clinical experience and relevant publications from the English literature identified via MEDLINE search, citation in reviews, publications of original data, and endocrine texts.. Landmark papers pertaining to all aspects of diabetes insipidus were selected. Reviews, primary articles, and case reports pertaining to diabetes insipidus in the critical care setting were identified and selected according to their content of clinically useful information.. Diabetes insipidus may result from impaired synthesis and release of vasopressin from the hypothalamic-pituitary unit (neurogenic) or renal insensitivity to circulating vasopressin (nephrogenic). A number of interventions, diseases, and drugs commonly encountered in the critical care setting may result in the development or exacerbation of diabetes insipidus. The diagnosis of diabetes insipidus requires the exclusion of other causes of polyuria and a systematic demonstration of the response of homeostatic mechanisms to controlled dehydration. The treatment of diabetes insipidus depends on many factors, including the clinical setting, degree and pathophysiologic classification, ability of the patient to compensate for free water losses, and expected duration of the abnormality. Underlying disorders should be treated appropriately whenever possible.

Topics: Blood Volume; Critical Care; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Hemodynamics; Humans; Hydrochlorothiazide; Osmolar Concentration; Plasma; Urinalysis; Vasopressins; Water Deprivation

A 32 year old I P II G with preexisting diabetes insipidus was treated with 1-(3-mercaptopropionic acid)-8-d-arginine vasopressin (DDAVP) during pregnancy. An otherwise normal pregnancy was marked only with an excessive weight increase. A healthy girl was delivered by secondary cesarean section at term. Postoperative the mother developed a water intoxication accompanying oxytocin-infusion. During nursing the diabetes insipidus improved significantly whereby DDAVP doses could be reduced to 20-10 percent. We suppose an overreaction to endogene oxytocin with an antidiuretic effect.

Topics: Administration, Intranasal; Cesarean Section; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant, Newborn; Oxytocin; Postoperative Complications; Pregnancy; Pregnancy Complications; Water Intoxication; Water-Electrolyte Balance

Arginine vasopressin preparations have been used in the treatment of diabetes insipidus for many years. Compared with older antidiuretic agents, the synthetic analog desmopressin is more potent, longer acting and easier to use. It is available for intravenous, subcutaneous and intranasal administration. Desmopressin may be useful in the treatment of hemostatic disorders such as von Willebrand's disease and hemophilia A. It has also been used for nocturnal enuresis. The vasopressor effects of arginine vasopressin preparations have been exploited for use as a temporizing measure in controlling acute gastrointestinal bleeding. Side effects such as hyponatremia and water intoxication are uncommon when these drugs are used with proper precautions.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Enuresis; Gastrointestinal Hemorrhage; Hemorrhagic Disorders; Humans; Vasopressins

This is the first report of the association of transitory diabetes insipidus with acute infective polyneuritis (landry Guillain-Barre Syndrome) occurring in pregnancy. The authors try to establish the inter-relationship between each pathological condition and pregnancy. Polyneuritis in its severe form does not seem to increase the risk of prematurity significantly. The severe forms of more generalised neurological condition as compared with the more limited condition has been noted in the literature but it is not possible to state how pregnancy effects the outcome. Plasma exchange procedures are now possible in pregnant women and the benefits of this treatment have been illustrated in severe forms of polyneuritis. There is difficulty still in selecting what criteria are sufficient to start on a therapy that is not without risk. Finally, the association between transitory diabetes insipidus and pregnancy has been reviewed in the literature and a description is given of the many physiopathological mechanisms associated with it. Diabetes insipidus is rarely found in pregnancy. All authors describe a placental factor with these troubles. The most recent theories suggest that prostaglandins and placental vasopressin are implicated. Treatment is suggested and consists of DDAVP (deamino 8-d-arginine vasopressin), which seems to be the most effective. Close collaboration between the obstetrician, the recovery services and the paediatrician is necessary to get the best results for this very severe pathological condition occurring in pregnancy.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Paralysis; Paraplegia; Polyradiculoneuropathy; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics

Since the pressor and antidiuretic properties of the native hormone were characterized, chemists have been working to synthesize vasopressin analogues selective for particular biologic activities. Desmopressin has had the longest clinical track record. Subsequently, three more analogues have been formulated and have found specific clinical application. Their actions and uses are reviewed.

Topics: Blood Platelet Disorders; Cardiac Surgical Procedures; Deamino Arginine Vasopressin; Diabetes Insipidus; Hemophilia A; Humans; Liver Cirrhosis; Uremia; von Willebrand Diseases

Because of its selective antidiuretic activity, desmopressin is recognized as the drug of choice for central diabetes insipidus. Compared with previously available treatments, it has a greatly enhanced therapeutic profile, allowing more specific antidiuresis without adverse reactions. Its selective antidiuretic activity is used with advantage in the treatment of nocturnal enuresis and as a diagnostic test of tubular function. Desmopressin is available for intranasal and parenteral administration; antidiuretic doses range from 10 to 40 micrograms intranasally and from 2 to 4 micrograms intravenously or subcutaneously. For its hemostatic effect, a single infusion of desmopressin at a dose of 0.3 microgram/kg has been used in most studies. Well-documented evidence shows that desmopressin is safe and efficacious as a selective antidiuretic agent for the treatment of central diabetes insipidus and nocturnal enuresis and as a diagnostic test of tubular function. Even at the 15-fold higher doses used in bleeding disorders, desmopressin appears to be well tolerated.

Topics: Adult; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Enuresis; Hemostatics; Humans; Kidney Concentrating Ability; Osmolar Concentration

Transient diabetes insipidus (DI) is a disease of late pregnancy, that has been reported with increasing frequency. Although initially thought to be nephrogenic, the etiology of this syndrome is most likely excess vasopressinase activity. The disease is associated with preeclampsia with liver involvement. Infants of mothers with the syndrome are predominantly male. Management may be with deamino D arginine vasopressin (dDAVP) during gestation and postpartum since vasopressinase does not break down dDAVP. The copious urine output may disguise preeclampsia. Fluid restriction should be avoided as it will lead to dehydration and hemoconcentration.

Topics: Adult; Cystinyl Aminopeptidase; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hypertension; Infant, Newborn; Liver; Polyuria; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Syndrome

Neonatal diabetes insipidus (DI) is extremely rare. An efficacious substitutive treatment can be particularly difficult to ensure. We have treated two children with central DI, revealed during the neonatal period, successively with an intranasal preparation of desmopressin at one month of age and with an oral preparation at one and 3 years respectively. We conclude that oral treatment with desmopressin is possible, secure and effective in DI presenting in the first months of life. This new form of administration seems even better for younger children when the difficulties of intranasal administration can be responsible for severe complications. As with the intranasal form, the doses given orally are very variable and individual.

Topics: Administration, Intranasal; Administration, Oral; Animals; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Growth Hormone; Humans; Infant; Infant, Newborn; Infant, Premature; Male; Pituitary Diseases; Pregnancy

Topics: Benzothiadiazines; Chlorpropamide; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuretics; Humans; Hypothalamo-Hypophyseal System; Pituitary Diseases; Postoperative Complications; Prognosis; Prostaglandin Antagonists; Sodium Chloride Symporter Inhibitors; Vasopressins

Desmopressin (dDAVP), a synthetic analog of the neurohypophyseal nonapeptide arginine vasopressin, has enhanced antidiuretic potency, markedly diminished pressor activity, and a prolonged half-life and duration of action compared to the natural hormone. Desmopressin is the treatment of choice for central diabetes insipidus and can be administered either intranasally or parenterally. A newly approved indication is treatment of mild classical hemophilia and von Willebrand's disease, in which deficient concentrations of factor VIII and von Willebrand's factor are transiently increased to levels that allow minor surgery.

Topics: Anemia, Sickle Cell; Animals; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Synergism; Enuresis; Hemophilia A; Humans; Kidney Concentrating Ability; Learning; Memory Disorders; Structure-Activity Relationship; Urinary Incontinence; von Willebrand Diseases

The total restoration of urinary concentrating ability of the DI rat given daily injections of vasopressin takes several weeks, although complete osmotic equilibrium across the collecting duct is manifest within hours. This suggests that there may be other deficiencies of the renal concentrating mechanism that, if corrected by vasopressin treatment, are corrected more slowly. I have focussed on just three possibilities. First, the morphology of the medullary interstitium is different from normal rats. Perhaps associated with this finding are alterations in the levels of medullary glycosaminoglycans which may have a role to play in water balance. Functional and morphological changes in the juxtamedullary nephrons are also evident. Second, the possibility exists that the countercurrent multiplier of the DI rat operates less efficiently than in the normal animal. Finally, reduced synthesis of PGs in the renal medulla of DI rats may also influence the concentrating mechanism, although in a favorable direction. While most (if not all) of these differences are secondary to the lack of vasopressin, in some instances it appears that it is the high water turnover (possibly the altered chemical composition of the medullary interstitium) that is the primary culprit. While the DI rat remains an excellent model for the study of water balance and the action of vasopressin, the presence of multiple defects within the system should be borne in mind. This is particularly true when comparing data obtained following acute treatment with vasopressin versus that following chronic treatment.

Topics: Adenylyl Cyclases; Animals; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Disease Models, Animal; Glomerular Filtration Rate; Glycosaminoglycans; Kidney; Kidney Concentrating Ability; Kidney Medulla; Loop of Henle; Nephrons; Osmolar Concentration; Prostaglandins; Rats; Rats, Brattleboro; Rats, Mutant Strains; Vasopressins; Water-Electrolyte Imbalance

Topics: Anesthesia; Brain Neoplasms; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Humans; Hypothalamus; Postoperative Complications; Tomography, X-Ray Computed

Topics: Animals; Deamino Arginine Vasopressin; Diabetes Insipidus; Dogs; Glomerular Filtration Rate; Humans; Kidney; Lypressin; Prostaglandins; Prostaglandins E; Prostaglandins F; Regional Blood Flow; Renin; Stimulation, Chemical; Urodynamics; Water

Topics: Animals; Arginine Vasopressin; Chlorpropamide; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Inappropriate ADH Syndrome; Lypressin; Vasopressins; Water-Electrolyte Imbalance

A synthetic vasopressin analog, 1-desamino-8D-arginine vasopressin (DDAVP also known as desmopressin), was found to be highly effective in the treatment of seven children and one adult with vasopressin-sensitive diabetes insipidus. The average duration of action of DDAVP was 10 to 11 hours, and with proper adjustment of dose, the subjects were able to control their symptoms satisfactorily with one or two inhalations daily. The youngest child in whom adequate control was achieved was 2 years of age. All subjects found the use of intranasal DDAVP superior to other forms of therapy, and none experienced any known side-effects after six months of treatment. All subjects in this study are currently using 2.5 mug to 10 mug of DDAVP once or twice daily.

Topics: Adolescent; Adult; Arginine Vasopressin; Child; Child, Preschool; Clinical Trials as Topic; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Infant; Osmolar Concentration; Vasopressins

The authors present a brief review of the problem of diabetes insipidus in neurosurgical patients, with particular emphasis on the differential diagnosis of postoperative and posttraumatic polyuria and the management of diabetes insipidus in these periods. A listing of drugs currently used in its treatment is given.

Topics: Administration, Intranasal; Benzothiadiazines; Brain Injuries; Carbamazepine; Chlorpropamide; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Mellitus; Diagnosis, Differential; Diuretics; Humans; Hypothalamo-Hypophyseal System; Lypressin; Methods; Polyuria; Postoperative Complications; Sodium Chloride Symporter Inhibitors; Vasopressins; Water-Electrolyte Balance

Desmopressin is usually administered intranasally in the treatment of central diabetes insipidus or nocturnal enuresis. The sublingual administration of desmopressin is expected to be an alternative to the intranasal route with advantages to children and to patients with allergic rhinitis or chronic rhinosinusitis. Therefore, the present study was carried out to explore the time-versus-concentration profile of desmopressin in plasma after sublingual administration to healthy volunteers.. A total of 16 healthy male volunteers were enrolled in this open, exploratory, 1-period, randomized, dose-escalation study. Volunteers received a single sublingual dose of either 20, 40, 80, 160, 240 or 320 microg of desmopressin acetate. Desmopressin plasma concentrations were measured over a 12-hour period using a validated radioimmunoassay method. Safety and tolerability were assessed simultaneously.. Plasma concentrations of desmopressin were below the lower limit of quantification (LLOQ) of 5 pg/ml for doses lower than 80 microg. For the doses of 160 - 320 microg the time-versus-concentration profiles were higher than the LLOQ. The area under the curve from 0 - 12 h (AUC0-12h) was 54.66 +/- 25.92 pg x h/ml after the 160 microg dose, 104.38 +/- 79.10 pg x h/ml following the 240 microg dose and 133.18 +/- 181.84 pg x h/ml following the 320 microg dose. Given the data from previous experiments, the time-versus-concentration profile of desmopressin in plasma after a sublingual dose of 240 microg appeared to be in the range of previously published data on an intranasal dose of 20 microg. Sublingual administration of desmopressin proved to be safe and was well tolerated by all volunteers.. A very high inter-individual variability in desmopressin plasma concentrations was detected after sublingual administration. A sublingual dose of 240 microg of desmopressin appeared to result in a pharmacokinetic profile comparable to 20 microg administered intranasally. These data, however, need to be verified in a separate well-designed prospective clinical study.

Topics: Administration, Oral; Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Dose-Response Relationship, Drug; Hemostatics; Humans; Male

The antidiuretic effect of oxytocin in humans is controversial. Urinary excretion of aquaporin-2 (AQP2) can be used as an index of the action of vasopressin on the kidney. We investigated whether exogenous oxytocin affects urinary concentration and urinary AQP2 excretion in human beings.. Oxytocin was administered intravenously at a rate of 20 mU/min in 10 healthy volunteers, seven patients with central diabetes insipidus (CDI) and three patients with nephrogenic diabetes insipidus (NDI). On the next day, 2 micro g of 1-desamino-8-d-arginine vasopressin (dDAVP) was injected subcutaneously. Two-hour urine was collected before and after the administration of oxytocin and dDAVP, and urinary AQP2 was measured semi-quantitatively by western analysis.. Urine volume and free water clearance were decreased, and urine osmolality was increased by the administration of oxytocin or dDAVP in the normal volunteers and CDI patients. Urinary AQP2 excretion was increased by oxytocin infusion in the normal volunteers (from 34+/-12 to 326+/-120 densitometry unit (DU)/2 h) and in the CDI group (from 8+/-2 to 227+/-92 DU/2 h) (P<0.05), but not in the NDI group. dDAVP also had a similar but more potent effect on the urinary excretion of AQP2 in the normal and CDI groups.. Oxytocin has an antidiuretic effect and increases the urinary excretion of AQP2 in humans whose urinary concentration mechanism is preserved. These results suggest that AQP2 might have a regulatory role in the antidiuretic action of oxytocin in humans.

Topics: Adult; Aquaporin 2; Aquaporins; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Insipidus, Nephrogenic; Diuresis; Humans; Immunoblotting; Infusions, Intravenous; Male; Osmolar Concentration; Oxytocin; Renal Agents

Desmopressin is a synthetic vasopressin analogue mainly used in treatment of diabetes insipidus and nocturia. Studies in rats have revealed a sex difference in the response to a vasopressin infusion, which was diminished after treatment with an NSAID. This study was performed in man to investigate the influence of sex and concomitant treatment of piroxicam on the pharmacokinetics and dynamics of desmopressin, and to validate a previously described indirect response model. Eight healthy males and eight healthy females participated in the trial, which was conducted in a pharmacokinetic (PK) part followed by a pharmacodynamic (PD) part. Desmopressin was administered intravenously as a single dose (PK = dose 2 microg, PD = dose 0.2 microg). Piroxicam was administered to achieve steady state. The pharmacokinetic parameters of desmopressin were estimated and calculated by means of two-compartmental analysis. In the dynamic part a study design based on an oral hydration model was used. Parameters for urine flow and urine osmolality were estimated. Individual estimates of the pharmacokinetic parameters served as input to the indirect response model that subsequently was fitted to urine osmolality data. The pharmacokinetics of desmopressin after a fixed bolus injection was neither influenced by piroxicam nor sex of the subject. The pharmacodynamics of desmopressin showed a sex difference where females exhibited a more pronounced antidiuretic effect than males, which was statistically significant when the effects were submaximal (>4.5 h after dose). The sex differences were diminished after pre-treatment with piroxicam, indicating a prostaglandin PGE(2)-mediated mechanism. The indirect response model was confirmed, although the modelling could not distinguish a sex difference, indicating a limitation of this model compared with traditional descriptive statistics.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Area Under Curve; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Interactions; Female; Hemostatics; Humans; Injections, Intravenous; Male; Middle Aged; Models, Theoretical; Piroxicam; Sex Factors

The prophylactic efficacy of desmopressin acetate (DDAVP) on diabetes insipidus (DI) after hypophysectomy was investigated in the dog. In the control group, hypernatremia with a plasma level of 155 mEq/l or higher persisted for 12 hr from the 4th to the 16th hour after hypophysectomy, and symptoms of DI developed within five days after surgery. In the DDAVP treatment group, these changes were not observed, showing that administration of DDAVP (4 microg, installation, twice daily) effectively prevented hypernatremia that develops immediately after surgery and DI-like symptoms that persists for about one week after surgery.

Topics: Animals; Deamino Arginine Vasopressin; Diabetes Insipidus; Dog Diseases; Dogs; Female; Hypophysectomy; Male; Pituitary Diseases; Pituitary Gland; Renal Agents; Time Factors

Diabetes insipidus is common among brain-dead donors and may lead to decreased graft function. The use of desmopressin to limit the consequences of diabetes insipidus is controversial. We assessed the effects of desmopressin administered to brain-dead donors on early and long-term graft function in kidney recipients.. In a randomised controlled study, 97 brain-dead donors received desmopressin as 1 microg bolus every 2 h when diuresis was more than 300 mL/h (desmopressin group n=49) or no desmopressin (control group n=48). In 175 kidney recipients (controls n=89, desmopressin group n=86) we measured serum concentrations of creatinine and haemodialysis requirements to assess early renal function in the first 15 days after transplantation. We assessed long-term results of transplantation (median time 45 months) for a homogeneous subgroup of 95 recipients (48 in the desmopressin group).. We found no significant differences between the two groups of brain-dead donors, except for final diuresis, which was lower in the desmopressin group than among controls. Haemodialysis requirement in controls and the desmopressin group (20 vs 23%, p=0.63) and serum creatinine concentrations (decrease from 903 micromol/L to 206 micromol/L vs 814 micromol/L to 193 micromol/L, p=0.14) did not differ significantly in the first 15 days after transplantation. Long-term graft survival was similar in the two groups (88 vs 87%).. Desmopressin can be given to brain-dead donors to limit the harmful effects of diabetes insipidus without any substantial effects to graft function in recipients.

Topics: Adult; Brain Death; Creatinine; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Graft Survival; Humans; Kidney Transplantation; Male; Middle Aged; Renal Agents; Renal Dialysis; Time Factors; Tissue Donors; Treatment Outcome

To assess the efficacy of treatment with oral desmopressin (DDAVP), 20 patients, aged 5-20 y, with central diabetes insipidus were studied during 3 d of hospitalization and for 3 months at the outpatient clinic. At baseline the median rate of diuresis was 12.7 ml kg-1 h-1. Urinary output decreased significantly under treatment with an increase in urinary osmolality, normalization of plasma osmolality and absence of nocturia. Patients were discharged from hospital with a median dose of 500 micrograms d-1 (100-1200 micrograms d-1). An adjustment in dosage was necessary in seven patients during follow-up, resulting in a final dose of 600 micrograms d-1. Body weight and DDAVP doses (r = 0.75, p = 0.001) and body surface and DDAVP doses (r = 0.72, p < 0.001) were significantly correlated. The average dosage was 474 +/- 222 micrograms m-2 d-1 (mean +/- SD). The oral DDAVP treatment remained effective during the 3 months of follow-up. This therapy offers an alternative for the treatment of central diabetes insipidus in children.

Topics: Administration, Oral; Adolescent; Adult; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Hospitalization; Humans; Hypoglycemic Agents

Topics: Administration, Intranasal; Adolescent; Adult; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Male; Nebulizers and Vaporizers; Solutions

Arginine vasopressin (AVP) exerts a potentiating effect on the responses of cortisol and ACTH to ovine CRF (oCRF). A stimulation test using AVP plus oCRF to assess ACTH reserve has been proposed. In central diabetes insipidus, long-term substitution therapy is commonly undertaken with desmopressin (DDAVP), an analogue of the natural hormone which has a greater antidiuretic action but whose effects on the ACTH-cortisol axis are still controversial. The aim of our study was to evaluate the variations in the responses of ACTH and cortisol to oCRF in various phases of the treatment of central diabetes insipidus: no treatment, endonasal treatment with DDAVP solution and oral treatment with DDAVP in tablet form. Seven patients suffering from central diabetes insipidus underwent testing with oCRF during the various phases of treatment. In the absence of DDAVP treatment, normal responses were registered for cortisol (basal 164.1 +/- 29.4 ng ml-1, peak 396.1 +/- 37.9 ng ml-1; P < 0.05) and ACTH (basal 20.4 +/- 3.9 pg ml-1, peak 86.3 +/- 20.9 pg ml-1; P < 0.05) in all patients. During oral treatment with DDAVP, no variation in cortisol response to oCRF was seen. By contrast, when DDAVP was administered endonasally, a significant reduction in cortisol responsiveness to oCRF (secretory area: 2429 +/- 548 ng ml-1 120 min) was noted in comparison with that found during the other two tests (no treatment: 3070 +/- 704 ng ml-1 120 min; oral DDAVP: 3419 +/- 650 ng ml-1 120 min; P < 0.05) performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Intranasal; Administration, Oral; Adolescent; Adrenocorticotropic Hormone; Adult; Corticotropin-Releasing Hormone; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hydrocortisone; Injections, Intravenous; Male; Middle Aged

In healthy subjects, intravenous infusion of the selective V2-vasopressin receptor agonist 1-desamino-8-D-arginine vasopressin (DDAVP, 400 ng/kg in 10 min) causes a marked increase in heart rate with a slight decrease in diastolic blood pressure. These haemodynamic responses are associated with increments in the plasma levels of renin, noradrenaline (NA), clotting factor VIII (FVIII:C), von Willebrand factor (vWF:ag), and tissue-type plasminogen activator (t-PA), and a fall in the plasma level of plasminogen activator inhibitor (PAI). None of these changes was observed in 3 patients with congenital nephrogenic diabetes insipidus (NDI), who had a genetic defect of the V2-receptor. Plasma AVP levels in these patients were normal or slightly elevated, which makes it unlikely that the lack of DDAVP responsiveness was caused by down-regulation of vasopressin V1-receptors. In one NDI patient, arginine vasopressin (AVP) was given in incremental doses (62.5-4000 pg/kg/min). The heart rate and blood pressure responses to AVP were normal, indicating the absence of a V1-receptor defect. The responses of vWF:ag and t-PA to venous occlusion in the patients with NDI were similar to those in 5 healthy volunteers, which indicates that in NDI the endothelial release of both vWF:ag and t-PA is normal. We conclude that DDAVP causes its effects on heart rate and blood pressure, and on the plasma levels of renin, noradrenaline, FVIII:C, vWF:ag, and t-PA through V2-receptor stimulation.

Topics: Adult; Blood Coagulation; Deamino Arginine Vasopressin; Diabetes Insipidus; Factor VIII; Fibrinolysis; Hemodynamics; Humans; Infusions, Intravenous; Male; Norepinephrine; Plasminogen Inactivators; Receptors, Vasopressin; Renin; Tissue Plasminogen Activator; von Willebrand Factor

Transdermal drug delivery seems a promising way of achieving complete, predictable absorption, but the epidermis is a barrier for most drugs. A new technique for transdermal drug delivery, in which a small patch of epidermis was removed, was tested in seven healthy volunteers by means of the antidiuretic peptide 1-deamino-8-D-arginine vasopressin (DDAVP). The epithelium of a small area of forearm skin (diameter 5 mm) was removed painlessly, and in a standard way, by a simple device operating at a present vacuum. DDAVP was given by way of improvised occlusive reservoirs. Plasma DDAVP concentration/time curves conformed closely with zero-order kinetics, which suggests that the bioavailability approached 100%, corresponding to that for direct intravenous infusion. Four volunteers were given DDAVP daily for 4 days by way of the de-epithelialised site; there were no signs that re-epithelialisation hindered permeation. All plasma DDAVP values substantially exceeded the lowest effective therapeutic concentration for patients with diabetes insipidus. The vacuum removal of the epithelium caused pronounced hyperaemia in the de-epithelialised dermis (assessed by laser doppler flow measurement); the hyperaemia persisted, unaffected by DDAVP, and may have contributed to the efficient permeation. The skin spot appeared normal at 6 weeks.

Topics: Administration, Cutaneous; Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Evaluation Studies as Topic; Female; Humans; Injections, Intradermal; Male; Microcirculation; Middle Aged; Skin Absorption; Suction

Management of early postneurosurgical diabetes insipidus (DI) requires parenteral vasopressin before intranasal administration of desmopressin-1 desamino-8 D arginine vasopressin (dDAVP) can be initiated. We have evaluated in 15 neurosurgical patients the effect and the tolerance of a 3-day regimen of dDAVP administered im every 12 h. Patients were randomly ascribed to one of 3 treatment groups: 1 microgram (N = 6), 2 micrograms (N = 5) or 4 micrograms (N = 4) were administered twice daily. dDAVP was effective whatever the dose, and DI was corrected by the 6th h of treatment. Effects were maximal on diuresis and urinary osmolality from the 18th h onwards. The effects were sustained throughout the treatment period. Reversal to pretreatment status occurred 24 h after the last injection. Moreover, 72 h after the last injection, natremia and osmolality reached values significantly below pretherapeutic values. The tolerance was excellent: hyponatremia which occurred in 11 patients, either occasionally or throughout the treatment period, remained mild and never had clinical consequences. In conclusion, before initiation of intranasal dDAVP, a 3-day treatment by 1, 2 or 4 micrograms of dDAVP injected im twice daily in neurosurgical patients corrected DI. Mild overhydration owing to a positive fluid balance was a side-effect which is also encountered in other therapeutic methods necessitating meticulous control of water intake.

Topics: Adolescent; Adult; Clinical Trials as Topic; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Injections, Intravenous; Male; Middle Aged; Osmolar Concentration; Postoperative Complications

Hormonal and cardiovascular responses to 1-desamino-8-D-arginine vasopressin (DDAVP) were investigated in six normal adult volunteers. After overnight fluid deprivation, an intravenous injection of either DDAVP (0.4 microgram/kg) or the same volume of normal saline was administered. One hour later an intravenous infusion of hypertonic saline was commenced and continued over two hours. Five minutes following the DDAVP injection, facial flushing, a fall in diastolic blood pressure by an average of 13% and a rise in pulse rate by an average of 18% were observed. There was a significant increase in plasma renin activity and plasma cortisol concentration, but no significant changes were observed in plasma concentrations of LH, FSH, TSH, prolactin or GH. Following osmotic stimulation by hypertonic saline plasma AVP rose to the same extent in both the DDAVP and control studies. DDAVP (0.4 microgram/kg) was also administered to five subjects with cranial diabetes insipidus. Again facial flushing, increased facial temperature, a fall in diastolic pressure and a rise in heart rate were all observed, suggesting that DDAVP exerts its cardiovascular actions by a mechanism other than antagonism of circulating endogenous AVP.

Topics: Adult; Arginine Vasopressin; Blood Pressure; Cardiovascular System; Deamino Arginine Vasopressin; Diabetes Insipidus; Flushing; Humans; Hydrocortisone; Male; Osmolar Concentration; Pituitary Hormones, Anterior; Pulse; Renin; Water Deprivation

1-deamino-8-D-arginine-vasopressin, or DDAVP, a potent long acting antidiuretic analogue of AVP, is the treatment of choice in central diabetes insipidus (DI). We have studied the clinical and biological effect in 10 children with DI treated with peroral administration of DDAVP. During a dose ranging study in hospital, followed by 6 months of treatment at home, this peroral DDAVP tablet proved to be as effective as the intranasal administration of DDAVP and was preferred by the patients. Even doses as small as 12.5 micrograms, have an effect on diuresis and urinary osmolality. Therapeutic effects start at above 100 micrograms. During the dose ranging study 200 micrograms peroral DDAVP produced antidiuresis varying from 8 to 12.5 hours, in different patients. The recommended dose is 100-300 micrograms 2-3 times a day. This treatment offers an important alternative to that traditionally used and constitutes one of the first examples of a peptide conserving its biological activity after gastrointestinal transport.

Topics: Administration, Oral; Adolescent; Child; Child, Preschool; Clinical Trials as Topic; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Longitudinal Studies; Male; Urine

The balance examinations in 10 patients with a neurohypophyseal diabetes insipidus under various forms of parenteral application (s.c., i.m., i.v.) of the 1-desamino-8-D-arginine-vasopressin show universally the very good antidiuretic effect also under these conditions. Identically with the course of action after intravenous application the maximum of action as obtained after 1 to 2 hours, the duration of action depends on the dosage, in parenteral application of 1 microgram 18 to 24 hours, on an average 20 hours. According to the results demonstrated there are no references to a specific influence of the excretion of sodium, potassium and urea. The particular dynamics of the excretion rates of these substances, of the osmolarity clearance and the osmolarity of the urine is the sequel of the restitution of the renal concentration ability under the application of the antidiuretic hormone.

Topics: Administration, Intranasal; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Mellitus; Glomerular Filtration Rate; Humans; Injections, Intramuscular; Injections, Intravenous; Injections, Subcutaneous; Water-Electrolyte Balance

Topics: Arginine Vasopressin; Clinical Trials as Topic; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male

Topics: Adolescent; Adult; Arginine Vasopressin; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Male; Middle Aged; Nose; Osmolar Concentration; Tablets; Urine

A synthetic vasopressin analog, 1-desamino-8D-arginine vasopressin (DDAVP also known as desmopressin), was found to be highly effective in the treatment of seven children and one adult with vasopressin-sensitive diabetes insipidus. The average duration of action of DDAVP was 10 to 11 hours, and with proper adjustment of dose, the subjects were able to control their symptoms satisfactorily with one or two inhalations daily. The youngest child in whom adequate control was achieved was 2 years of age. All subjects found the use of intranasal DDAVP superior to other forms of therapy, and none experienced any known side-effects after six months of treatment. All subjects in this study are currently using 2.5 mug to 10 mug of DDAVP once or twice daily.

Topics: Adolescent; Adult; Arginine Vasopressin; Child; Child, Preschool; Clinical Trials as Topic; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Infant; Osmolar Concentration; Vasopressins

Topics: Clinical Trials as Topic; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Evaluation; Humans; Vasopressins

Topics: Clinical Trials as Topic; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Kidney Function Tests; Vasopressins

The antidiuretic effects of graded intravenous and intranasal doses of a new vasopressin analogue (DDAVP) were investigated in two groups of patients with pituitary diabetes insipidus. In the first group, three patients with a high requirement of maintenance doses of peroral anti-diuretic drugs were included; and in the second group, ten patients with a normal (usual) requirement were included. Comparing the antidiuretic responses during 24-hour collection periods, DDAVP, on a microgram basis, was less effective in the "high peroral-dose requirement" patients. The duration of action of single intravenous doses (0.04-24 micrograms) of DDAVP was significantly shortened in the "high peroral-dose requirement" group. However, comparing the peak responses induced by increasing doses of DDAVP in the two groups, there was no demonstrable diminution in the anti-diuretic ability of DDAVP in the "high peroral-dose requirement" patients. Although the possibility of a smaller remnant reserve of ADH was also considered, shortened duration of action ot DDAVP suggests more probably enhanced metabolic breakdown of vasopressin in "high peroral-dose requirement" patients.

Topics: Adult; Clinical Trials as Topic; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Male; Middle Aged; Osmolar Concentration; Time Factors; Vasopressins

Topics: Adolescent; Child; Clinical Trials as Topic; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Evaluation; Female; Humans; Male; Vasopressins

Topics: Adult; Clinical Trials as Topic; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Evaluation; Female; Humans; Vasopressins

Hypothalamic-pituitary region lymphoma is rare and diabetes insipidus (DI) represents one of the most common endocrine manifestations. We report the first case of hypothalamic lymphoma associated with both the syndrome of inappropriate antidiuresis (SIAD) and DI.. A 64-year-old woman with a history of stage IV large B-cell non-Hodgkin lymphoma, underwent atypical right lung resection for pulmonary nodules. A few days after surgery, the patient presented severe normovolemic hyponatremia and serum hypo-osmolarity, therefore, we suspected a paraneoplastic syndrome (SIAD) related to the lung neoplasm, histologically diagnosed as typical carcinoid. The brain magnetic resonance imaging (MRI) showed a 9 mm lesion in the hypothalamic region that significantly increased one month later with the onset of neurological symptoms. A trans-sphenoidal biopsy showed localization of the large B-cell lymphoma. After surgery, the patient presented with polyuria and polydipsia, so desmopressin therapy was started. In the following days, serum osmolarity and sodium fluctuated between normal and low values, then DI was excluded, and SIAD became more likely. Desmopressin therapy was discontinued and hyponatremia was treated with sodium infusion. Hypothalamic lymphoma was treated with chemotherapy and radiotherapy with substantial shrinkage. The hyponatremia persisted during anticancer treatments and improved only after radiotherapy, confirming paraneoplastic SIAD.. Lymphomas of the hypothalamic region can cause electrolyte imbalance for various causes. The differential diagnosis between SIAD, DI and impaired thirst centers may not be straightforward and the electrolyte disorders must be evaluated step by step in all different stages of the disease.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Mellitus; Electrolytes; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Lymphoma; Middle Aged; Sodium

Topics: Arginine; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Diabetes Mellitus; Humans; Oxytocin

Dipsogenic polydipsia (DP), a distinct variety of primary polydipsia, is characterised by selective diminution of osmotic threshold for thirst leading to polydipsia and subsequent hypotonic polyuria. Seen in patients without underlying psychiatric illness, DP closely mimics central diabetes insipidus (CDI), making it difficult for clinicians to discriminate these two conditions from each other. Carefully performed osmotic stimulation study, incorporating objective assessment of threshold for thirst and arginine vasopressin (AVP) release is the key to differentiate DP from CDI or psychogenic polydipsia, also termed compulsive water drinking (CWD). Low thirst threshold and high AVP release threshold separate DP from CDI and CWD, respectively. Unlike CWD, desmopressin may be successfully used in DP without concomitant risk of hyponatremia. We describe a child, in whom an initial diagnosis of partial CDI was subsequently revised to DP based on osmotic stimulation test. The child was treated successfully with desmopressin therapy with a target to keep serum osmolality close to thirst threshold.

Topics: Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Osmolar Concentration; Polydipsia; Thirst

Familial pituitary diabetes insipidus has been described only in an autosomal dominant or recessive mode of inheritance.. This work aims to determine the cause of a novel form of familial diabetes insipidus (DI) that is controlled by desmopressin therapy but segregates in an X-linked recessive manner.. Thirteen members from 3 generations of the kindred with familial DI were studied. Water intake, urine volume, urine osmolality, plasma osmolality, and plasma vasopressin were measured under basal conditions, during fluid deprivation, 3% saline infusion, and water loading. Magnetic resonance images of the posterior pituitary also were obtained. In affected males, the effects of desmopressin therapy and linkage of the DI to markers for chromosome Xq28 were determined. In addition, the genes encoding vasopressin, aquaporin-2, the AVPR2 receptor, and its flanking regions were sequenced.. This study showed that 4 males from 3 generations of the kindred have DI that is due to a deficiency of vasopressin, is corrected by standard doses of desmopressin, and segregates with markers for the AVPR2 gene in Xq28. However, no mutations were found in AVPR2 or its highly conserved flanking regions. Exome sequencing confirmed these findings and also revealed no deleterious variants in the provasopressin and aquaporin-2 genes. The 4 obligate female carriers osmo-regulated vasopressin in the low normal range.. X-linked recessive transmission of DI can be due to a defect in either the secretion or the action of vasopressin. Other criteria are necessary to differentiate and manage the 2 disorders correctly.

Topics: Aquaporin 2; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Insipidus, Nephrogenic; Diabetes Mellitus; Female; Humans; Male; Receptors, Vasopressin; Vasopressins

Topics: Adult; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hypernatremia; Male; Postoperative Complications; Saline Solution, Hypertonic; Sodium

There is growing recognition of morbidity and mortality that can occur in patients with cranial diabetes insipidus (CDI) during hospitalisation, due to prescribing errors and dysnatraemia, often related to confusion between CDI and diabetes mellitus among non-specialists. We aimed to investigate this.. Data for each hospitalisation in patients with CDI attending Oxford University Hospital (OUH) were collected retrospectively. The same cohort were invited to complete a questionnaire by telephone.. One hundred and nine patients were included, median age was 42 (range: 6-80) years. Route of desmopressin was tablet, melt and nasal spray in 74%, 7% and 17% of patients, respectively, while two patients used a combination of tablet and nasal spray. There were 85 admissions to OUH by 38 patients between 2012 and 2021. Daily measurement of serum sodium was performed in 39% of admissions; hyponatraemia and hypernatraemia occurred in 44 and 15% of admissions, respectively. Endocrine consultation was sought in 63% of admissions post-2018. Forty-five of 78 patients (58%) self-reported ≥1 admission to any hospital since diagnosis. Of these, 53% felt their medical team did not have a good understanding of the management of CDI during hospital admission. Twenty-four per cent reported delay in administration of desmopressin, while 44% reported confusion between CDI and diabetes mellitus, often leading to unnecessary blood glucose monitoring.. Dysnatraemia is common in hospitalised patients with CDI. More than half of patients perceived their medical team's understanding of CDI to be poor when admitted with intercurrent illness. A coordinated approach, including early consultation of specialists, frequent serum sodium monitoring, and education of hospital specialists is needed to address this.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Blood Glucose; Blood Glucose Self-Monitoring; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Diabetes Mellitus; Humans; Middle Aged; Nasal Sprays; Perception; Retrospective Studies; Sodium; Tablets; Young Adult

Central diabetes insipidus is a rare neuroendocrine condition. Data on treatment-associated side-effects, psychological comorbidities, and incorrect management are scarce. The aim of this study was to investigate patients' perspectives on their disease.. This study used a cross-sectional, web-based, anonymous survey, developed by endocrinologists and patient representatives, to collect the opinions of patients with central diabetes insipidus on management and complications of their disease, psychological comorbidities, degree of knowledge and awareness of the condition among health-care professionals, and renaming the disease to avoid confusion with diabetes mellitus (diabetes).. Between Aug 23, 2021, and Feb 7, 2022, 1034 patients with central diabetes insipidus participated in the survey. 91 (9%) participants were children and adolescents (37 [41%] girls and 54 [59%] boys; median age 10 years [IQR 6-15]) and 943 (91%) were adults (757 [80%] women and 186 [20%] men]; median age 44 years [34-54]). 488 (47%) participants had isolated posterior pituitary dysfunction and 546 (53%) had combined anterior and posterior pituitary dysfunction. Main aetiologies were idiopathic (315 [30%] of 1034 participants) and tumours and cysts (pre-surgical 217 [21%]; post-surgical 254 [25%]). 260 (26%; 95% CI [0·23-0·29]) of 994 patients on desmopressin therapy had hyponatraemia leading to hospitalisation. Patients who routinely omitted or delayed desmopressin to allow intermittent aquaresis had a significantly lower prevalence of hyponatraemia compared with those not aware of this approach (odds ratio 0·55 [95% CI 0·39-0·77]; p=0·0006). Of patients who had to be hospitalised for any medical reason, 71 (13%; 95% CI 0·10-0·16) of 535 patients did not receive desmopressin while in a fasting state (nil by mouth) without intravenous fluid replacement and reported symptoms of dehydration. 660 (64%; 0·61-0·67) participants reported lower quality of life, and 369 (36%; 0·33-0·39) had psychological changes subjectively associated with their central diabetes insipidus. 823 (80%; 0·77-0·82) participants encountered a situation where central diabetes insipidus was confused with diabetes mellitus (diabetes) by health-care professionals. 884 (85%; 0·83-0·88) participants supported renaming the disease; the most favoured alternative names were vasopressin deficiency and arginine vasopressin deficiency.. This is the largest survey of patients with central diabetes insipidus, reporting a high prevalence of treatment-associated side-effects, mismanagement during hospitalisation, psychological comorbidities, and a clear support for renaming the disease. Our data are the first to indicate the value of routinely omitting or delaying desmopressin.. Swiss National Science Foundation, Swiss Academy of Medical Sciences, and G&J Bangerter-Rhyner-Foundation.

Topics: Adolescent; Adult; Arginine; Child; Cross-Sectional Studies; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Diabetes Mellitus; Female; Humans; Hyponatremia; Internet; Male; Middle Aged; Morbidity; Quality of Life

Water and electrolyte disturbances are common after pituitary surgery and can generally be classified into transient hypotonic polyuria and transient or permanent diabetes insipidus (DI). The prevalence varies in the literature between 31-51% for transient hypotonic polyuria, 5.1-25.2% for transient DI, and 1-8.8% for permanent DI.. The aim of this study was to identify the prevalence of water and electrolyte disturbances with polyuria and the preoperative and postoperative predictive factors in patients undergoing surgery with an extended endoscopic endonasal approach.. The overall prevalence of water and electrolyte disorders was 30.5% (62), and the prevalence of postoperative polyuria was 23.6% (48). The median number of desmopressin doses administered to patients with postoperative polyuria was one dose (interquartile range [IQR] 1-2), and thus the median duration of treatment was 0 days. The median initiation of desmopressin was the second day after surgery (IQR 1-2). The overall prevalence of DI was 6.89%. Among the patients with transient DI, the duration was less than 3 months in three patients (1.47%), and between 3 and 6 months in two (0.98%). Nine patients had permanent DI (4.43%). (4.43%).. The prevalence of electrolyte disturbances in our study was high, although similar to that found in the literature. Most of the cases were transient hypotonic polyuria that resolved within one day. The prevalence of transient DI in our cohort was lower than that described in the literature, while permanent DI was similar.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Pituitary Neoplasms; Polyuria; Postoperative Complications; Retrospective Studies; Water-Electrolyte Imbalance

Presented case demonstrates a rare diencephalic pathology - adipsic diabetes insipidus (ADI) with severe hypernatremia in a 58-year-old woman after ttranssphenoidal removal of stalk intraventricular craniopharyngioma. ADI was diagnosed because of hypernatremia (150-155 mmol/L), polyuria (up to 4 liters per day) and absence of thirst. Normalization of water-electrolyte balance occurred on the background of desmopressin therapy and sufficient hydration in postoperative period. After release from the hospital, the patient independently stopped desmopressin therapy and did not consume an adequate amount of fluid of the background of polyuria. This led to severe hypernatremia (155-160 mmol/L) and rough mental disorders.Patients with ADI need closely monitoring of medical condition and water-electrolyte parameters, appointment of fixed doses of desmopressin and adequate hydration.

Topics: Central Nervous System Cysts; Craniopharyngioma; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Mellitus; Female; Humans; Hypernatremia; Middle Aged; Neurosurgical Procedures; Polyuria; Postoperative Complications

We present a 9-year-old boy with diabetes insipidus. The boy is treated with desmopressin (DDAVP) therapy. Under this therapy, the drinking quantity and the laboratory parameters were normal. No nocturia occurred any more. In the context of a clinically mild infection with SARS-CoV-2, the duration of action of DDAVP was significantly prolonged (approximately +50%). The original dosage was then reintroduced and was still sufficient until months later. A possible connection to the infection with SARS-CoV-2 can be suspected. Our case report should make physicians who care for patients with diabetes insipidus aware of such a possible prolongation of the effect of DDAVP. More frequent monitoring may be needed in such patients to assess the risk of symptomatic dilutional hyponatremia.

Topics: Child; COVID-19; COVID-19 Drug Treatment; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Diabetes Mellitus; Half-Life; Humans; Male; SARS-CoV-2

We herein report a rare case of advanced lung adenocarcinoma with central diabetes insipidus due to pituitary metastasis. Although treatment with gefitinib was dramatically effective, the symptoms of diabetes insipidus did not improve. Radiotherapy for pituitary metastasis was effective to control diabetes insipidus; however, we could not cease the administration of 1-deamino-8-D-arginine vasopressin (DDAVP). It is important for physicians to positively consider radiotherapy for pituitary metastases even if favorable tumor control is achieved with chemotherapy when diabetes insipidus becomes clinically overt. Furthermore, continuous DDAVP administration may be needed to treat central diabetes insipidus.

Topics: Adenocarcinoma of Lung; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Diabetes Mellitus; Gefitinib; Humans; Lung Neoplasms

Diabetes insipidus (DI) develops commonly after endoscopic transsphenoidal surgery (ETS). We retrospectively investigated the incidence, onset, duration and predictors of DI after ETS in patients with non-functioning pituitary adenoma (NFPA).. A total of 168 patients who underwent ETS to remove NFPAs were included. Various perioperative data on demographics, comorbidities, previous treatments, perioperative hormone deficiencies, tumor characteristics, surgery, anesthesia, intraoperative fluid balance, perioperative laboratory findings, postoperative complications, readmission and hospital length of stay were collected and analyzed. Patients were diagnosed with DI and treated with desmopressin when they showed urine output > 5 mL/kg/hr with a serum sodium concentration > 145 mmol/L or an increase ≥ 3 mmol/L in serum sodium concentration between two consecutive tests after surgery. DI was considered permanent when desmopressin was prescribed for > 6 months after surgery.. Seventy-seven (45.8%) patients experienced postoperative DI and 10 (6.0%) patients suffered from permanent DI. The median onset of DI and the median duration of transient DI were postoperative day 1 and 5 days, respectively. In multivariable logistic regression analysis, cephalocaudal tumor diameter (odds ratio [95% confidence interval] 2.59 [1.05-6.36], P = 0.038) was related to postoperative DI. In receiver operating characteristic analysis, its area under the curve was 0.68 (95% confidence interval 0.59-0.76, P < 0.001). Its optimal cutoff value that maximized the sum of sensitivity and specificity for postoperative DI was 2.7 cm.. Postoperative DI was observed in 45.8% of patients undergoing ETS to remove NFPAs. A large cephalocaudal tumor diameter was predictive of postoperative DI in such patients.

Topics: Adenoma; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Mellitus; Humans; Pituitary Neoplasms; Postoperative Complications; Retrospective Studies; Sodium

Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans

COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counseling, with relevance for patients with diabetes insipidus (DI) or hyponatraemia. The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Patients should measure their body weight daily. Patients with DI admitted to the hospital with COVID-19 have a high risk for mortality due to volume depletion. Specialists must supervise fluid replacement and dosing of desmopressin. Patients after pituitary surgery should drink to thirst and measure their body weight daily to early recognize the development of the postoperative syndrome of inappropriate antidiuresis (SIAD). They should know hyponatraemia symptoms. The prevalence of hyponatraemia in patients with pneumonia due to COVID-19 is not yet known, but seems to be low. In contrast, hypernatraemia may develop in COVID-19 patients in ICU, from different multifactorial reasons, for example, due to insensible water losses from pyrexia, increased respiration rate and use of diuretics. Hypernatraemic dehydration may contribute to the high risk of acute kidney injury in COVID-19. IV fluid replacement should be administered with caution in severe cases of COVID-19 because of the risk of pulmonary oedema.

Topics: Antidiuretic Agents; Brain Injuries; Coronavirus Infections; COVID-19; Deamino Arginine Vasopressin; Dehydration; Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Disease Management; Fluid Therapy; Humans; Hypernatremia; Hyponatremia; Hypotonic Solutions; Inappropriate ADH Syndrome; Neurosurgical Procedures; Pandemics; Pneumonia, Viral; Postoperative Complications; Practice Guidelines as Topic; Saline Solution; Shock

Topics: Anticonvulsants; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Levetiracetam

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes, Gestational; Female; Fetal Death; Humans; Liver Function Tests; Pregnancy

Adipsic diabetes insipidus is an infrequent disease which may be associated with craniopharyngioma. It may be secondary to the tumour's extension, as well as to resection of the mass. We present the case of a 24-year-old woman with a history of delayed puberty and hypothyroidism, but no prior study reports. She consulted due to a headache with warning signs associated with altered visual acuity. Brain MRI was performed which showed signs of a non-adenomatous lesion with suprasellar and hypothalamic extension. Following transcranial surgery, she developed diabetes insipidus criteria, with absence of thirst documented during the hospitalisation. The histopathological findings confirmed the diagnosis of craniopharyngioma. The patient was treated with desmopressin and received recommendations regarding rehydration according to the quantification of losses, with electrolyte stabilisation.

Topics: Antidiuretic Agents; Craniopharyngioma; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Magnetic Resonance Imaging; Pituitary Neoplasms; Prednisolone; Sodium; Thirst; Thyroxine; Treatment Outcome; Young Adult

Different factors have been hypothesized to play a role in the cascade of events associated with the protein-induced glomerular response. However, scant data are available on the possible functional effect of vasopressin (VP) on the glomerular filtration rate (GFR) in humans with central diabetes insipidus (CDI), which was the aim of the present study.. Renal function was studied under fasting conditions (baseline) and after a meat meal in 16 patients with CDI before and after treatment with desmopressin (DDAVP) and in 16 control subjects. GFR was measured by the inulin method.. At baseline, the GFR was lower in patients with CDI. Treatment with DDAVP resulted in an insignificant increase in GFR, which was not statistically different from untreated patients. After an acute oral protein load, the GFR increased, peaking at 45 min post meal in controls, and at 135 min post meal in treated and untreated CDI patients.. After a meat meal, the peak GFR response is delayed in CDI patients suggesting that VP might indirectly affect tubule-glomerular feedback.

Topics: Administration, Oral; Adult; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Dietary Proteins; Female; Follow-Up Studies; Glomerular Filtration Rate; Humans; Kidney; Male; Retrospective Studies; Sodium; Treatment Outcome

The transcription factor RAX is a paired-type homeoprotein that plays a critical role in eye and forebrain development of vertebrate species. RAX knockout mice have anophthalmia, cleft palate, and an abnormal hypothalamus and display perinatal lethality. In humans, homozygous or compound heterozygous RAX mutations have been reported to cause bilateral microphthalmia or anophthalmia without consistent associated features. Congenital hypopituitarism can be associated with various eye or craniofacial anomalies; however, the co-occurrence of congenital hypopituitarism, anophthalmia, cleft palate, and diabetes insipidus has been very rare.. We report the case of a child with anophthalmia, congenital hypopituitarism, diabetes insipidus, and bilateral cleft lip and palate who had a homozygous frameshift truncating mutation c.266delC (p.Pro89Argfs*114) in exon 1 of the RAX gene. Rax knockout mice show loss of ventral forebrain structures, pituitary, and basosphenoid bone and palate and a misplaced anterior pituitary gland along the roof of the oral cavity.. Our patient's phenotype was more severe than that reported in other patients. Although most of the previously reported patients with RAX mutations showed either a missense or some less severe mutation in at least one of their RAX alleles, our patient was homozygous for truncating mutations that would yield a severe, null protein phenotype. The severity of the genetic defect, the precise match between the knockout mouse and the patient's endocrine phenotypes, and the prominent roles of RAX in eye and pituitary development and diencephalic patterning suggest that the RAX null mutations could fully account for the observed phenotype.

Topics: Animals; Anophthalmos; Antidiuretic Agents; Cleft Lip; Cleft Palate; Deamino Arginine Vasopressin; Diabetes Insipidus; Eye Proteins; Frameshift Mutation; Homeodomain Proteins; Hormone Replacement Therapy; Human Growth Hormone; Humans; Hydrocortisone; Hypopituitarism; Infant, Newborn; Magnetic Resonance Imaging; Male; Melatonin; Mice, Knockout; Pituitary Gland; Thyroxine; Transcription Factors

Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Endocrinology; Humans; Male; Osmolar Concentration; Polydipsia; Polyuria; United Kingdom; Young Adult

A 41-year-old man was diagnosed with hypogonadotropic hypogonadism managed with gonadotropins after routine fertility review. Eight months later he presented with new polydipsia and polyuria, lethargy and easy bruising. A full blood count showed 28% circulating blasts. A bone marrow biopsy confirmed a diagnosis of acute myeloid leukaemia with inv(3)(q21.3q26.2) with additional monosomy 7. Central diabetes insipidus (DI) was diagnosed following a water deprivation test. Pituitary magnetic resonance imaging showed a slightly thickened pituitary stalk, stable Rathke's cyst, and new absence of the pituitary bright spot. The patient was commenced on desmopressin and induction chemotherapy, subsequently requiring a bone marrow transplant. Bone marrow examination at 100 days post-transplant revealed cytogenetic remission. All symptoms of DI resolved and magnetic resonance imaging showed return of the posterior bright spot and a pituitary stalk of normal thickness. Biochemical hypogonadotropic hypogonadism persisted but was uninterpretable in the context of systemic illness and recent chemotherapy. DI is a rare complication of haematological malignancies, and the prevalence and pathophysiology of DI in this context are poorly understood. Pathogenic mechanisms proposed include leukaemic infiltration of the pituitary, interference with antidiuretic hormone synthesis, and abnormal thrombopoiesis influencing hormone levels. Particular cytogenetic abnormalities such as inv(3)(q21.3q26.2) and monosomy 7 appear to be more commonly associated with DI and also appear to confer worse outcomes. Aetiologies in the literature remain elusive but as DI is a recognised association of haematological malignancies it should be considered in a patient presenting with polydipsia and polyuria.

Topics: Adult; Chromosomes, Human, Pair 7; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Leukemia, Myeloid, Acute; Magnetic Resonance Imaging; Male; Monosomy; Pituitary Gland

Pituitary stalk sectioning is only essential in cases of craniopharyngioma originating from the stalk or metastatic tumor to the stalk. Some patients can discontinue postoperative antidiuretic hormone (ADH) supplementation with special conditions.. Sixty-three patients with craniopharyngiomas who were treated by surgery with pituitary stalk sectioning were included in this study. Great care was taken to preserve the fine arteries running along the lateral walls of the third ventricle. Removal rates, change of endocrinologic status, and magnetic resonance imaging (MRI) findings were investigated.. Total removal was achieved in 52 of 54 patients in initial surgery (96.3%), and in 5 of 9 patients in retreatment (55.6%). ADH supplementation was required in all patients from the day of surgery, but was discontinued in 29 of 54 patients among the initial surgery group (53.7%) and in 2 of 9 patients among the retreatment group (22.2%). Preservation of thyroid hormone secretion was observed in 24 of 31 patients who could discontinue ADH (77.4%), but only in 12 of 32 patients who could not discontinue ADH (37.5%). Recovery from diabetes insipidus (DI) was significantly associated with preservation of thyroid function (P < 0.01). Postoperative MRI showed that part of the hypothalamus was enhanced in patients with recovery from DI.. Total removal was achieved in 91% of all cases. Half of the patients could discontinue ADH supplementation, which was associated with preservation of thyroid function. The findings of hypothalamic enhancement on postoperative MRI may be associated with recovery from DI.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antidiuretic Agents; Child; Child, Preschool; Craniopharyngioma; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Glucocorticoids; Hormone Replacement Therapy; Humans; Hypopituitarism; Hypothalamo-Hypophyseal System; Hypothyroidism; Magnetic Resonance Imaging; Male; Middle Aged; Neurosurgical Procedures; Pituitary Gland; Pituitary Neoplasms; Postoperative Complications; Prognosis; Recovery of Function; Thyroid Hormones; Young Adult

Topics: Adult; Antidiuretic Agents; Cesarean Section; Deamino Arginine Vasopressin; Delayed Diagnosis; Diabetes Insipidus; Female; Humans; Oligohydramnios; Polyuria; Postpartum Period; Pregnancy

Gestational diabetes insipidus (GDI) is a rare endocrine complication during pregnancy that is associated with vasopressinase overproduction from the placenta. Although increased vasopressinase is associated with placental volume, the regulation of placental growth in the later stage of pregnancy is not well known.. A 16-year-old pregnant woman was urgently transferred to our hospital because of threatened premature labor when the Kumamoto earthquakes hit the area where she lived. During her hospitalization, she complained of gradually increasing symptoms of polyuria and polydipsia. The serum level of arginine vasopressin (AVP) was 1.7 pg/mL, which is inconsistent with central DI. The challenge of diagnostic treatment using oral 1-deamino-8-D-AVP (DDAVP) successfully controlled her urine and allowed for normal delivery. DDAVP tablets were not necessary to control her polyuria thereafter. Based on these observations, clinical diagnosis of GDI was confirmed. Pathophysiological analyses revealed that vasopressinase expression was more abundant in the GDI patient's syncytiotrophoblast in placenta compared with that in a control subject. Serum vasopressinase was also observed during gestation and disappeared soon after delivery. Vasopressinase is reportedly identical to oxytocinase or insulin regulated aminopeptidase (IRAP), which is an abundant cargo protein associated with the glucose transporter 4 (GLUT4) storage vesicle. Interestingly, the expression and subcellular localization of GLUT4 appeared to occur in a vasopressinase (IRAP)-dependent manner.. Because placental volume may be associated with vasopressinase overproduction in GDI, vasopressinase (IRAP)/GLUT4 association appears to contribute to the growth of placenta in this case.

Topics: Adolescent; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Neurophysins; Pregnancy; Pregnancy Complications; Prognosis; Protein Precursors; Vasopressins

The indirect water-deprivation test is the current reference standard for the diagnosis of diabetes insipidus. However, it is technically cumbersome to administer, and the results are often inaccurate. The current study compared the indirect water-deprivation test with direct detection of plasma copeptin, a precursor-derived surrogate of arginine vasopressin.. From 2013 to 2017, we recruited 156 patients with hypotonic polyuria at 11 medical centers to undergo both water-deprivation and hypertonic saline infusion tests. In the latter test, plasma copeptin was measured when the plasma sodium level had increased to at least 150 mmol per liter after infusion of hypertonic saline. The primary outcome was the overall diagnostic accuracy of each test as compared with the final reference diagnosis, which was determined on the basis of medical history, test results, and treatment response, with copeptin levels masked.. A total of 144 patients underwent both tests. The final diagnosis was primary polydipsia in 82 patients (57%), central diabetes insipidus in 59 (41%), and nephrogenic diabetes insipidus in 3 (2%). Overall, among the 141 patients included in the analysis, the indirect water-deprivation test determined the correct diagnosis in 108 patients (diagnostic accuracy, 76.6%; 95% confidence interval [CI], 68.9 to 83.2), and the hypertonic saline infusion test (with a copeptin cutoff level of >4.9 pmol per liter) determined the correct diagnosis in 136 patients (96.5%; 95% CI, 92.1 to 98.6; P<0.001). The indirect water-deprivation test correctly distinguished primary polydipsia from partial central diabetes insipidus in 77 of 105 patients (73.3%; 95% CI, 63.9 to 81.2), and the hypertonic saline infusion test distinguished between the two conditions in 99 of 104 patients (95.2%; 95% CI, 89.4 to 98.1; adjusted P<0.001). One serious adverse event (desmopressin-induced hyponatremia that resulted in hospitalization) occurred during the water-deprivation test.. The direct measurement of hypertonic saline-stimulated plasma copeptin had greater diagnostic accuracy than the water-deprivation test in patients with hypotonic polyuria. (Funded by the Swiss National Foundation and others; ClinicalTrials.gov number, NCT01940614 .).

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Female; Glycopeptides; Humans; Hyponatremia; Male; Middle Aged; Osmolar Concentration; Polydipsia; Polyuria; ROC Curve; Saline Solution, Hypertonic; Sensitivity and Specificity; Urine; Water Deprivation

Neonatal central diabetes insipidus (NCDI) remains a therapeutic challenge, as extremely low doses of enteral desmopressin cannot be titrated with current preparations. The aim of this study was to describe the use of orally administered dilute desmopressin in NCDI.. Nasal desmopressin (100 μg/mL) was diluted in 0.9% saline to 10 μg/mL. Infants were treated with 1-5 μg and doses were titrated to a twice-daily regimen. The feed volume was 150 mL/kg/day and titrated according to weight gain.. Five infants aged 6-105 days were included. Stabilizing treatment doses ranged from 2 to 5 μg twice daily in neonates, and 12 μg twice daily in the older infant who was diagnosed at 105 days.. Dilution of nasal desmopressin with saline facilitates safe administration and dose titration in NCDI. We recommend considering this therapeutic approach to NCDI, particularly in small infants or where alternative treatment regimens have been unsuccessful.

Topics: Administration, Intranasal; Administration, Oral; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant; Infant, Newborn; Male; Retrospective Studies; Treatment Outcome

During pregnancy, physiological changes in osmotic homeostasis cause water retention. If excessive, this can cause gestational diabetes insipidus (DI), particularly in patients with already impaired vasopressin secretion. We present the case of a 34-year-old patient with pre-existing hypopituitarism who experienced a transient exacerbation of her DI during a twin pregnancy. In contrast to typical gestational DI, polyuria and polydipsia occurred during the first trimester and remained stable thereafter. This case highlights a challenging clinical entity of which pathophysiology, diagnostic approach and treatment will be discussed.

Topics: Adenoma; Adult; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Disease Progression; Female; Humans; Hypopituitarism; Pituitary Neoplasms; Pregnancy; Pregnancy Complications; Pregnancy Trimester, First; Pregnancy, Twin

Topics: Adolescent; Antidiuretic Agents; Child; Child, Hospitalized; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant; Infant, Newborn; Male

Diabetes insipidus is a rare but recognized complication of meningitis. The occurrence of diabetes insidipus has been previously attributed to Streptococcus pneumoniae (S. pneumoniae) in a handful of patients and only once within the pediatric subpopulation. We present the clinical course of a previously healthy 2-year, 8-month-old male child ultimately diagnosed with central diabetes insipidus (CDI) secondary to S. pneumoniae meningitis. Permanent CDI following S. pneumoniae meningitis is unique to our case and has not been previously described. Following the case presentation, we describe the etiology, pathophysiology, diagnosis, and treatment of CDI. The mechanism proposed for this clinical outcome is cerebral herniation for a sufficient duration and subsequent ischemia leading to the development of permanent CDI. Providers should be aware of CDI resulting from S. pneumoniae meningitis as prompt diagnosis and management may decrease the risk of permanent hypothalamo-pituitary axis damage.

Topics: Antidiuretic Agents; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Magnetic Resonance Imaging; Male; Meningitis, Pneumococcal

Topics: Antidiuretic Agents; Clinical Audit; Confusion; Deamino Arginine Vasopressin; Diabetes Insipidus; Electronic Prescribing; Hospitalization; Humans; Medication Errors; Patient Safety; Retrospective Studies

The pituitary bright spot is acknowledged to indicate functional integrity of the posterior pituitary gland, whilst its absence supports a diagnosis of central diabetes insipidus (DI). This feature was evaluated, together with the incidence and clinical characteristics of DI in children with suprasellar/neurohypophyseal germinomas. We performed a review of all suprasellar (SS) or bifocal (BF) germinoma pediatric patients treated in Toronto since 2000. Demographics, symptomatology, treatment outcome and imaging were evaluated. Nineteen patients fulfilled inclusion criteria (10 SS, 9 BF; median age 12.5 years (6.2-16.8 years)). All remained alive at 6.4 years median follow-up (1.2-13.7 years) after receiving chemotherapy and radiotherapy (13 focal/ventricular, four whole brain, two neuraxis), with only one progression. All had symptoms of DI at presentation with a symptom interval above one year in eight cases (42 %). Desmopressin was commenced and maintained in 16 patients (84 %). The pituitary bright spot was lost in most diagnostic interpretable cases, but was appreciated in three patients (18 %) who had normal serum sodium values compared to 'absent' cases (p = 0.013). For two such cases, spots remained visible until last follow-up (range 0.4-3.3 years), with one still receiving desmopressin. No case of bright spot recovery was observed following therapy. Protracted symptom intervals for germinoma-induced central DI may reflect poor clinical awareness. Explanations for persistence of the pituitary bright spot in symptomatic patients remain elusive. Desmopressin seldom reverses the clinical features of germinoma-induced DI to allow discontinuation, nor does treatment cause bright spot recovery.

Topics: Adolescent; Central Nervous System Neoplasms; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Follow-Up Studies; Germinoma; Hormones; Humans; Magnetic Resonance Imaging; Male; Pituitary Gland; Retrospective Studies; Sodium; Treatment Outcome

Patients with cranial diabetes insipidus (CDI) are at risk of developing both hypernatraemia and hyponatraemia, due to the condition itself or secondary to treatment with vasopressin-analogues or during administration of i.v. fluids. We aimed to assess the frequency and impact of dysnatraemias in the inpatient (INPT) and outpatient (OPT) setting in desmopressin-treated CDI, comparing those with normal thirst with those with abnormal thirst.. The study included 192 patients with cranial diabetes, who were identified from the Beaumont Pituitary Database, a tertiary referral centre. Retrospective case note audit was performed and the clinical and biochemical information of 147 patients with CDI were available for analysis.. A total of 4142 plasma sodium measurements for 137 patients with normal thirst, and 385 plasma sodium measurements for ten patients with abnormal thirst were analysed. In those with normal thirst, the most common OPT abnormality was mild hyponatraemia (pNa(+) 131-134  mmol/l) in 27%, while 14.6% had more significant hyponatraemia (pNa(+) ≤130  mmol/l). Of those patients with normal thirst, 5.8% were admitted due to complications directly related to hyponatraemia. Compared with patients with normal thirst, those with abnormal thirst were more likely to develop significant OPT hypernatraemia (20% vs 1.4%, P=0.02) and significant INPT hyponatraemia (50% vs 11.1%, P 0.02).. OPT management of CDI is complicated by a significant incidence of hyponatraemia. In contrast, OPT hypernatraemia is almost exclusively a complication seen in adipsic CDI, who also had more frequent INPT hyponatraemia. CDI associated with thirst disorder requires increased physician attention and patient awareness of potential complications.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hypernatremia; Hyponatremia; Male; Middle Aged; Retrospective Studies; Sodium; Young Adult

Diabetes insipidus (DI) results from inadequate output of Antidiuretic Hormone (ADH) from the pituitary gland (central DI) or the inability of the kidney tubules to respond to ADH (nephrogenic DI). ADH is an octapeptide produced in the supraoptic and paraventricular nuclei of the hypothalamus and stored in the posterior lobe of the pituitary gland. Cardiopulmonary Bypass (CPB) has been shown to cause a six-fold increased circulating ADH levels 12 hours after surgery. However, in some cases, ADH release may be transiently suppressed due to cardioplegia (cardiac standstill) or CPB leading to DI. We present the postoperative course of a 60-year-old man who developed transient DI after CPB. He was successfully treated by applying nasal desmopressin therapy. Relevant biochemical parameters should be monitored closely in patients who produce excessive urine after open heart surgery.

Topics: Antidiuretic Agents; Cardiopulmonary Bypass; Coronary Artery Bypass; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Male; Middle Aged; Polyuria; Postoperative Complications; Time Factors; Treatment Outcome

Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Fatigue; Female; Glucocorticoids; Humans; Hypopituitarism; Hypotension; Middle Aged; Radiotherapy; Syncope

To evaluate the effect of idiopathic orthostatic edema and the effect of thyrotoxicosis on weight fluctuation and fluid retention in the presence of surgically induced panhypopituitarism and diabetes insipidus controlled with hormone replacement.. Dextroamphetamine sulfate was used for weight gain when no other etiologic factor was found. Methimazole was used when weight loss occurred when serum T4 and free T4 indicated thyrotoxicosis.. Sympathomimetic amine therapy very effectively controlled the weight gain and methimazole controlled the weight loss.. Hypopituitarism and diabetes insipidus controlled with hormone replacement do not protect against fluid retention from idiopathic edema.

Topics: Antidiuretic Agents; Antithyroid Agents; Deamino Arginine Vasopressin; Dextroamphetamine; Diabetes Insipidus; Edema; Female; Humans; Hypopituitarism; Methimazole; Middle Aged; Posture; Sympathomimetics; Thyrotoxicosis; Weight Gain; Weight Loss

Topics: Antidiuretic Agents; Child; Chromosomes, Human, Pair 4; Deamino Arginine Vasopressin; Diabetes Insipidus; Family Health; Female; Hearing Loss, Sensorineural; Homozygote; Humans; Hydronephrosis; Membrane Proteins; Mothers; Mutation; Treatment Outcome; Uniparental Disomy; Urinary Bladder, Neurogenic; Wolfram Syndrome

Gestational diabetes insipidus is a very rare complication. However, undiagnosed and untreated may lead to serious complications in both mother and fetus. In this study, a case of 34-year-old female patient with diabetes insipidus associated with pregnancy was reported. We discussed process of diagnosis and treatment with particular emphasis on the monitoring of water-electrolyte imbalance during labor.

Topics: Adult; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Pregnancy; Pregnancy Complications

The purpose of this prospective study was to assess physiologic changes in the renal corticomedullary (23)Na-concentration ([(23)Na]) gradient with (23)Na-MRI at 3.0T in patients with central diabetes insipidus (CDI) before and after intranasal administration of 20 μg desmopressin (DDAVP).. Four patients with CDI (all male, mean age 60.2 years) were included in this IRB-approved study. For (23)Na-imaging, a 3D density adapted, radial GRE-sequence (TE = 0.55 ms; TR = 120 ms; projections = 8,000; spatial resolution = 5 × 5 × 5 mm(3)) was used in combination with a dedicated (23)Na-coil and reference phantoms. The corticomedullary [(23)Na] gradient (in mmol/L/mm) was calculated pixel-by-pixel along a linear region-of-interest (ROI) spanning from the renal cortex in the direction of the medulla. Mean ± SDs of [(23)Na] were calculated for each patient as well as for the entire group.. Mean [(23)Na] increased along the corticomedullary gradient from the cortex (pre-DDAVP 38.0 ± 6.3 mmol/L vs. post-DDAVP 30.7 ± 3.5 mmol/L) to the medulla (pre-DDAVP 71.6 ± 14.8 mmol/L vs. post-DDAVP 59.7 ± 10.8 mmol/L). The overall mean decrease of [(23)Na] after DDAVP administration was 17.1 ± 1.1 %.. (23)Na-MRI with state-of-the-art techniques at 3T depicts the physiologic renal response to the administration of desmopressin in patients with central diabetes insipidus.

Topics: Administration, Intranasal; Aged; Antidiuretic Agents; Brain; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Kidney; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Reproducibility of Results; Sodium

Anakinra is a recombinant form of interleukin-1 receptor antagonist. It is the drug of choice for Schnitzler syndrome and cryopyrin-associated periodic syndromes. It has also recently been demonstrated to have activity in the treatment of the non-Langerhans cell histiocytosis known as Erdheim-Chester disease.. To describe the activity of anakinra in a patient with co-existing lichen planus and Erdheim-Chester disease.. A 43-year-old woman with progressive Erdheim-Chester disease presented for management of her night sweats and chills, systemic skeletal bone pain, and neurologic (diabetes insipidus) manifestations. She also had widespread cutaneous lichen planus. Anakinra, 100 mg subcutaneously daily, was initiated for the treatment of her Erdheim-Chester disease.. Within 2 days of starting anakinra, there was prompt resolution of her Erdheim-Chester disease-related symptoms. Subsequently, her bone pain resolved and her diabetes insipidus improved. Also, the lichen planus-associated pruritus rapidly ceased and most of the skin lesions improved.. Our experience confirms the efficacy of anakinra for the treatment of Erdheim-Chester disease. The concomitant improvement of her lichen planus on anakinra suggests that this agent warrants additional study in this disorder.

Topics: Adult; Cetirizine; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Eruptions; Erdheim-Chester Disease; Female; Human Growth Hormone; Humans; Interleukin 1 Receptor Antagonist Protein; Lichen Planus; Progesterone; Pruritus; Radionuclide Imaging; Thyroiditis, Autoimmune; Thyroxine; Vitamin D; Vitamin D Deficiency

As neonatal central diabetes insipidus is rare in preterm neonates with intraventricular hemorrhage (IVH), very little is known about dosing and the route of administration of desmopressin treatment.. We present a preterm neonate born at 29 weeks' gestation. Within 24 h, she developed bilateral IVH with subsequent post-hemorrhagic hydrocephalus. On the 3rd postnatal day, she developed diabetes insipidus for which she was intranasally administered 0.2 mg desmopressin. This resulted in oliguria with several hours of anuria and a 25-point drop in sodium levels within 15 h.. The determination of the desmopressin dose in a preterm neonate is a challenge and there is no consistent literature about the dosing or the route of administration. We suggest starting with a low dose of intranasal desmopressin (0.05-0.1 μg) and titrate in accordance with clinical and laboratory parameters.

Topics: Administration, Intranasal; Cerebral Hemorrhage; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hydrocephalus; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases

Many complications have been reported after cardiopulmonary bypass. A common physiologic change during the early postoperative period after cardiopulmonary bypass is increased diuresis. In patients whose urine output is increased, postoperative diabetes insipidus can develop, although reports of this are rare. We present the cases of 2 patients who underwent on-pump coronary artery bypass grafting (with cardiopulmonary bypass). Each was diagnosed with diabetes insipidus postoperatively: a 54-year-old man on the 3rd day, and a 66-year-old man on the 4th day. Each patient recovered from the condition after 6 hours of intranasal therapy with synthetic vasopressin (antidiuretic hormone). The diagnosis of diabetes insipidus should be considered in patients who produce excessive urine early after cardiac surgery in which cardiopulmonary bypass has been used.

Topics: Administration, Intranasal; Aged; Antidiuretic Agents; Cardiopulmonary Bypass; Coronary Artery Bypass; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Administration Schedule; Humans; Male; Middle Aged; Recovery of Function; Time Factors; Treatment Outcome; Urination

Gestational diabetes insipidus is a rare, transient complication of pregnancy typically characterized by polyuria and polydipsia that may lead to mild electrolyte abnormalities. More severe sequelae of gestational diabetes insipidus are uncommon.. We present a case of a 25-year-old woman at 23 weeks of gestation in a dichorionic-diamniotic twin pregnancy who developed severe symptomatic gestational diabetes insipidus complicated by rhabdomyolysis and death of both fetuses.. Maternal rhabdomyolysis caused by gestational diabetes insipidus is extremely rare. Early recognition and treatment of gestational diabetes insipidus is necessary to prevent maternal and fetal morbidity and mortality.

Topics: Adult; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Fetal Death; Humans; Hypernatremia; Polyuria; Pregnancy; Pregnancy Complications; Pregnancy, Twin; Rhabdomyolysis

Exosomes are vesicles that are released from the kidney into urine. They contain protein and RNA from the glomerulus and all sections of the nephron and represent a reservoir for biomarker discovery. Current methods for the identification and quantification of urinary exosomes are time consuming and only semi-quantitative. Nanoparticle tracking analysis (NTA) counts and sizes particles by measuring their Brownian motion in solution. In this study, we applied NTA to human urine and identified particles with a range of sizes. Using antibodies against the exosomal proteins CD24 and aquaporin 2 (AQP2), conjugated to a fluorophore, we could identify a subpopulation of CD24- and AQP2-positive particles of characteristic exosomal size. Extensive pre-NTA processing of urine was not necessary. However, the intra-assay variability in the measurement of exosome concentration was significantly reduced when an ultracentrifugation step preceded NTA. Without any sample processing, NTA tracked exosomal AQP2 upregulation induced by desmopressin stimulation of kidney collecting duct cells. Nanoparticle tracking analysis was also able to track changes in exosomal AQP2 concentration that followed desmopressin treatment of mice and a patient with central diabetes insipidus. When urine was stored at room temperature, 4°C or frozen, nanoparticle concentration was reduced; freezing at -80°C with the addition of protease inhibitors produced the least reduction. In conclusion, with appropriate sample storage, NTA has potential as a tool for the characterization and quantification of extracellular vesicles in human urine.

Topics: Adolescent; Adult; Animals; Aquaporin 2; Biomarkers; Cell Line; Deamino Arginine Vasopressin; Diabetes Insipidus; Exosomes; Female; Humans; Male; Mice; Mice, Inbred C57BL; Nanoparticles; Particle Size; Urinalysis; Young Adult

Diabetes insipidus (DI) after endoscopic transsphenoidal surgery (ETSS) can lead to increased morbidity, longer hospital stays, and increased medication requirements. Predicting which patients are at high risk for developing DI can help direct services to ensure adequate care and follow-up. The objective of this study was to review our institution's experience with ETSS and determine which clinical/laboratory variables are associated with DI in this patient population. The authors wanted to see if there was an easily determined single value that would help predict which patients develop DI. This represents the largest North American series of this type. We retrospectively reviewed the charts of patients who had undergone ETSS for resection of sellar and parasellar pathology between 2006 and 2011. We examined patient and tumor characteristics and their relationship to postoperative DI. Out of 172 endoscopic transsphenoidal surgeries, there were 15 cases of transient DI (8.7%) and 14 cases of permanent DI (8.1%). Statistically significant predictors of postoperative DI (p < 0.05) included tumor volume and histopathology (Rathke's cleft cyst and craniopharyngioma). Significant indicators of development of DI were postoperative serum sodium, preoperative to postoperative change in sodium level, and urine output prior to administration of 1-deamino-8-D-arginine vasopressin. An increase in serum sodium of ≥2.5 mmol/L is a positive marker of development of DI with 80% specificity, and a postoperative serum sodium of ≥145 mmol/L is a positive indicator with 98% specificity. Identifying perioperative risk factors and objective indicators of DI after ETSS will help physicians care for patients postoperatively. In this large series, we demonstrated that there were multiple perioperative risk factors for the development of DI. These findings, which are consistent with other reports from microscopic surgical series, will help identify patients at risk for diabetes insipidus, aid in planning treatment algorithms, and increase vigilance in high risk patients.

Topics: Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Male; Neuroendoscopy; Pituitary Neoplasms; Retrospective Studies

Langerhans cell histiocytosis (LCH) is an idiopathic group of reactive proliferative diseases linked to aberrant immunity, pathologically characterized by clonal proliferation of Langerhans cells. LCH rarely involves the thymus. We report a case of thymic LCH with diabetes insipidus as the first presentation, without evidence of myasthenia gravis and without evidenced involvement of the skin, liver, spleen, bones, lungs and superficial lymph nodes. This present case may have important clinical implications. In screening for LCH lesions, attention should be attached to rarely involved sites in addition to commonly involved organs. Follow-up and imageological examination are very important to a final diagnosis.

Topics: Adolescent; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Histiocytosis, Langerhans-Cell; Humans; Immunohistochemistry; Langerhans Cells; Magnetic Resonance Imaging; Male; Pituitary Gland; Thymectomy; Thymus Gland; Tomography, X-Ray Computed; Treatment Outcome

Gestational diabetes insipidus is an uncommon clinical disease whose prevalence is approximately two to three pregnancies per 100,000. It may be isolated or associated with preeclampsia. We report a case of gestational diabetes insipidus in a twin pregnancy, originally isolated during two months, and secondarily complicated by HELLP-syndrome. We recall the specific pathophysiology of polyuric-polydipsic syndrome during pregnancy and summarize its various causes. Finally, we discuss the indications, in case of isolated gestational diabetes insipidus, of treatment by dDAVP.

Topics: Adult; Anesthesia, Obstetrical; Blood Glucose; Cesarean Section; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes, Gestational; Female; HELLP Syndrome; Humans; Hypoglycemic Agents; Infant, Newborn; Pregnancy; Pregnancy, Twin

Postpartum, diabetes insipidus (DI) can be part of Sheehan's syndrome or lymphocytic hypophysitis in combination with anterior pituitary hormone deficiencies. In contrast, acute onset of isolated DI in the postpartum period is unusual.. This patient presented at 33 weeks gestation with placental abruption, prompting a cesarean delivery of twins. Immediately after delivery, she developed severe DI. The DI could be controlled with the vasopressinase-resistant 1-deamino-8-D-arginine vasopressin (DDAVP), but not with arginine vasopressin (AVP), and it resolved within a few weeks.. The aim of this study was to demonstrate that the postpartum DI in this patient was caused by the release of placental vasopressinase into the maternal bloodstream.. Cells were transiently transfected with the AVP receptor 2 (AVPR2) and treated with either AVP or DDAVP in the presence of the patient's serum collected postpartum or 10 weeks after delivery. The response to the different treatments was evaluated by measuring the activity of a cAMP-responsive firefly luciferase reporter construct. The in vitro studies demonstrate that the patient's postpartum serum disrupts activation of the AVPR2 by AVP, but not by the vasopressinase-resistant DDAVP.. Placental abruption can rarely be associated with acute postpartum DI caused by release of placental vasopressinase into the bloodstream. This clinical entity must be considered in patients with placental abruption and when evaluating patients presenting with DI after delivery.

Topics: Abruptio Placentae; Acute Disease; Adult; Antidiuretic Agents; Arginine Vasopressin; Cesarean Section; Cystinyl Aminopeptidase; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Resistance; Female; HEK293 Cells; Humans; Postpartum Period; Pregnancy

Pituitary apoplexy during pregnancy is so rare that only 15 cases (12 pituitary adenomas, 2 lymphocytic neurohypophysitis, and 1 normal pituitary gland) have been published to date. Here, we report the case of a pregnant woman presenting with pituitary apoplexy from a nonfunctioning pituitary adenoma and provide a possible mechanism and management option for postoperative diabetes insipidus (DI).. A 26-year-old woman presented with sudden onset of headache and bitemporal hemianopsia in the 26th week of her first pregnancy. Magnetic resonance imaging clearly revealed an 18 mm pituitary mass with a fluid-fluid level component displacing the optic chiasma upward. Endonasal endoscopic transsphenoidal surgery was successfully carried out 7 days after the onset of symptoms. DI became apparent immediately after the operation and was not controllable by arginine vasopressin (AVP) but by 1-desamino-8-D-arginine vasopressin (DDAVP) instead. This finding suggests an association between DI and vasopressinase secretion from the placenta, because vasopressinase can degrade AVP but not DDAVP. DI had diminished by the time the patient delivered a healthy girl at the 40th week of gestation.. Postoperative DI associated with pituitary apoplexy during pregnancy should be treated by DDAVP, which is not affected by placental vasopressinase secretion.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Pituitary Apoplexy; Pituitary Neoplasms; Postoperative Complications; Pregnancy; Pregnancy Complications, Neoplastic

Topics: Antidiuretic Agents; Cerebral Hemorrhage; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hypernatremia; Infant, Newborn; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Male

An 8-year-old male German longhaired pointer was referred for diabetes insipidus responsive to treatment with desmopressin. The dog had polyuria and polydipsia, exercise intolerance and a dull hair coat. Plasma concentrations of thyroid-stimulating hormone, thyroxine, growth hormone (GH) and insulin-like growth factor-1 were decreased; plasma adrenocorticotropic hormone (ACTH) was slightly elevated and plasma α-melanocyte-stimulating hormone (MSH) was within the reference range. Computed tomography revealed a heterogeneously contrast-enhancing pituitary mass compressing the hypothalamus. Transsphenoidal hypophysectomy was performed and microscopical examination of the surgical biopsy samples revealed hypophysitis without evidence of pituitary adenoma. The hypophysitis was characterized by marked lymphocytic infiltration of the adenohypophysis that contained a mixed population of neuroendocrine cells expressing GH, ACTH or α-MSH. The lymphocytes were identified as T cells, resulting in a final diagnosis of lymphocytic hypophysitis strongly resembling human primary lymphocytic hypophysitis.

Topics: Adrenocorticotropic Hormone; alpha-MSH; Animals; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Dog Diseases; Dogs; Euthanasia, Animal; Fatal Outcome; Growth Hormone; Hypopituitarism; Lymphocytes; Male; Neuroendocrine Cells; Pituitary Gland, Anterior

Langerhans'cell histiocytosis (LCH) comprises a rare group of reticuloendothelial system disorders that can produce focal or systemic manifestations. Diabetes insipidus is considered to be an important indicator of serious underlying diseases in children, including LCH. We report the case of a young patient with monostotic LCH confined to the mandibular ramus, who was diagnosed with the disease after presenting symptoms of central diabetes insipidus and was satisfactorily treated with multi-agent chemotherapy. Additionally, we discuss the clinical, radiographic, histological and immunohistochemical findings, as well as the multidisciplinary approach of this important disease, which should receive attention by dental practitioners, especially when it occurs in children.

Topics: Anti-Inflammatory Agents; Antidiuretic Agents; Child, Preschool; Cytostatic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Glucocorticoids; Histiocytosis, Langerhans-Cell; Humans; Male; Mandibular Diseases; Prednisone; Vinblastine

To clarify the outcome of all cases of Rathke's cleft cysts (RCC) treated surgically and followed up in Oxford during a long-term period.. The records of all patients with RCC seen in the Department of Endocrinology between January 1978 and June 2009 were reviewed.. A total of 33 patients (20 females, median age 43 years) were identified. At presentation, major visual field defects were detected in 58% of patients and gonadotrophin, ACTH and TSH deficiency in 60, 36 and 36% of patients respectively. Desmopressin treatment was required in 18% of patients. Treatment consisted of cyst evacuation combined with or without biopsy/removal of the wall. Post-operatively, visual fields improved in 83% of patients with impairment, whereas there was no reversal of ACTH or TSH deficiency or of diabetes insipidus. All but one subject had imaging follow-up during a mean period of 48 months (range 2-267). Cyst relapse was detected in 22% of patients at a mean interval of 29 months (range 3-48 months); in 57% of them, the recurrence was symptomatic. Relapse-free rates were 88% at 24-months and 52% at 48-months follow-up. At last assessment, at least quadrantanopia was reported in 19% of patients, gonadotrophin, ACTH and TSH deficiency in 50, 42 and 47% of patients respectively. Desmopressin treatment was required in 39% of patients.. In this study of patients with RCC and long-term follow-up, we showed a considerable relapse rate necessitating long-term monitoring. Surgical intervention is of major importance for the restoration of visual field defects, but it does not improve endocrine morbidity, which in the long-term affects a substantial number of patients.

Topics: Adenoma; Adolescent; Adrenocorticotropic Hormone; Adult; Aged; Aged, 80 and over; Central Nervous System Cysts; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Male; Middle Aged; Neoplasm Recurrence, Local; Pituitary Neoplasms; Thyrotropin; Treatment Outcome; Visual Fields

Topics: Adult; Anti-Inflammatory Agents; Antidiuretic Agents; Azathioprine; Biopsy; Central Nervous System Diseases; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Drug Therapy, Combination; Humans; Image Enhancement; Immunosuppressive Agents; Lung; Magnetic Resonance Imaging; Male; Pituitary Gland; Prednisolone; Receptors, Interleukin-2; Sarcoidosis; Sarcoidosis, Pulmonary; Tomography, X-Ray Computed

There is a worldwide tendency toward the growing prevalence of diabetes insipidus due to the elevated frequency of its central form attributable to the large number of surgical brain interventions and craniocerebral injuries. The overall diabetes insipidus morbidity is estimated at 30%. During the last 100 years, the patients were treated first with pituitary posterior lobe extract then with synthetic arginine-vasopressin. The break-through came in 1974 with the advent of desmopressin, a synthetic analog of natural arginine-vasopressin, that antagonizes V2 receptors, lacks vasoconstrictor activity, and exerts strong long-term antidiuretic action.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Hormone Replacement Therapy; Humans

Patients with intracranial germ cell tumor (IGCT) often present with pituitary dysfunction, including diabetes insipidus (DI). Recent protocols have used pre-radiation chemotherapy with combinations of etoposide, carboplatin and/or cisplatin, and ifosfamide. Management of DI in these patients requires monitoring of electrolytes and fluids during chemotherapy and hyperhydration. All consecutive patients treated with chemotherapy for an IGCT during the period 1990-2007 at the Hospital for Sick Children, Toronto were reviewed. Out of 32 patients who received chemotherapy, 21 had DI. Only cycles containing cisplatin and/or ifosfamide and hyperhydration were considered. DI and non-DI patients were compared for each cycle of chemotherapy. Patients were studied for number of days in hospital per chemotherapy course, daily fluid input and output, changes in dose, schedule and route of administration of desmopressin (DDAVP) during chemotherapy, daily variations in sodium level, electrolyte monitoring requirements per day, and complications related to fluid and electrolyte disturbances. Fifty-four cycles of chemotherapy in DI patients were compared to 25 cycles in non DI patients. All 21 patients with DI required daily change in dosage and schedule of DDAVP. Marked variations in daily sodium level were observed in the DI group. Seventeen courses required prolonged admission in the DI group (one in non DI patients) and 6 patients experienced serious complications. In conclusion, DI is a risk factor for complications when cisplatin and/or ifosfamide based protocols are used. The role of these agents in the management of ICGT should be carefully evaluated and guidelines for management of DI established.

Topics: Adolescent; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Child; Child, Preschool; Cisplatin; Cohort Studies; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Administration Schedule; Female; Humans; Ifosfamide; Magnetic Resonance Imaging; Male; Neoplasms, Germ Cell and Embryonal; Retrospective Studies; Sodium; Time Factors; Treatment Outcome

We report a case of eclampsia in a twin pregnancy complicated by HELLP syndrome and diabetes insipidus. This confluence of disease processes suggests that a modification of common magnesium sulfate treatment protocols may be appropriate in a certain subset of patients.

Topics: Adolescent; Anticonvulsants; Antidiuretic Agents; Cesarean Section; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes, Gestational; Eclampsia; Female; HELLP Syndrome; Humans; Magnesium Sulfate; Pregnancy; Twins

Topics: Adrenal Insufficiency; Antidiuretic Agents; Breast Neoplasms; Carcinoma, Ductal, Breast; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Dizziness; Fatal Outcome; Female; Humans; Hydrocortisone; Hypernatremia; Lymphatic Diseases; Middle Aged; Muscle Weakness; Tomography, X-Ray Computed

A 29-year-old man was referred to a multidisciplinary pituitary clinic with a 3.5-year history of central diabetes insipidus, initially presumed to be idiopathic based on a normal MRI scan of the pituitary gland. Subsequent scanning revealed a suprasellar mass, which demonstrated progressive enlargement on serial imaging. He also developed hypogonadotropic hypogonadism.. Measurement of levels of serum morning fasting cortisol, adrenocorticotropic hormone, total testosterone, luteinizing hormone, follicle-stimulating hormone, prolactin, insulin-like growth factor 1, TSH and free T(4), MRI of the pituitary gland and a transsphenoidal biopsy of a pituitary mass were performed.. Lymphocytic hypophysitis presenting with diabetes insipidus, with development of hypogonadotropic hypogonadism and a suprasellar mass.. The patient was treated with intranasal desmopressin and transdermal testosterone. The underlying lymphocytic hypophysitis was initially managed conservatively with serial MRI and visual field testing. No immunosuppressant medication was given and, aside from the diagnostic transsphenoidal biopsy, no surgical intervention was required. He subsequently developed secondary hypothyroidism, secondary adrenal insufficiency and growth hormone deficiency. These disorders were managed with levothyroxine and prednisone.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hypogonadism; Male; Pituitary Diseases; Testosterone

A 5.5-year-old sexually intact female African Grey parrot (Psittacus erithacus) was evaluated for a 1-year history of pronounced polyuria and polydipsia. The bird also had a 1-month history of signs of mild depression and mydriasis.. Physical examination revealed a thin body condition and incomplete bilateral mydriasis. Other examination findings as well as CBC and screening radiography results were unremarkable. Plasma biochemical analysis revealed mild hypernatremia. The bird had a 3.3% loss in body weight over 170 minutes during a water deprivation test, and urine osmolality remained low. After IM administration of 0.9 microg of desmopressin, the rate of weight loss decreased substantially and urine osmolality increased 300% over the following 200 minutes.. Initial attempts to treat the bird with orally administered desmopressin failed to correct the polydipsia and polyuria. Ultimately, IM administration of 24 microg of desmopressin/kg (10.9 microg/lb) every 12 hours yielded a noticeable reduction in water consumption and urine production over a 6- to 8-hour period. Eight months later, the bird was returned for a recheck examination, at which time it was in good health and continued to respond to the medication. Despite continued response to the medication, right-sided internal ophthalmoparesis was detected 16 months after the initial diagnosis.. To the authors' knowledge, central diabetes insipidus in birds has not been reported. The condition should be considered in birds with clinical signs of disease similar to those in mammals. Long-term IM administration of desmopressin may be a viable treatment option.

Topics: Animals; Antidiuretic Agents; Bird Diseases; Deamino Arginine Vasopressin; Diabetes Insipidus; Dose-Response Relationship, Drug; Female; Parrots

Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Electrolytes; Fluid Therapy; Humans; Hyperglycemic Hyperosmolar Nonketotic Coma

Central nervous system (CNS) sarcoidosis is a crucial disease and has a poor prognosis. A 58-year-old woman had acute development of polydipsia and polyuria. Her pituitary MRI demonstrated a swelling of pituitary gland and hypophyseal stalk. She was diagnosed as central diabetes insipidus (CDI) due to CNS sarcoidosis based on the examinations and pituitary MRI findings as well as a result of cutaneous biopsy. Uveitis and bilateral hilar lymphadenopathy were observed mildly throughout. However, CDI and pituitary MRI findings were getting recovered spontaneously without steroid treatment in a couple of months, suggesting an atypical clinical course of CNS sarcoidosis.

Topics: Antidiuretic Agents; Central Nervous System Diseases; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Middle Aged; Remission, Spontaneous; Sarcoidosis

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antidiuretic Agents; Cefotaxime; Deamino Arginine Vasopressin; Diabetes Insipidus; Escherichia coli Infections; Female; Gentamicins; Humans; Hydrocephalus; Infant, Newborn; Infant, Premature; Injections, Intravenous; Magnetic Resonance Imaging; Meningitis, Escherichia coli; Ventriculostomy

Topics: Adult; Antidiuretic Agents; Biopsy; Deamino Arginine Vasopressin; Diabetes Insipidus; Drainage; Erdheim-Chester Disease; Female; Humans; Pericardial Effusion; Pericardium; Polyuria

Peptides with agonist activity at the vasopressin V(2) receptor are used clinically to treat fluid homeostasis disorders such as polyuria and central diabetes insipidus. Of these peptides, the most commonly used is desmopressin, which displays poor bioavailability as well as potent activity at the V(1b) receptor, with possible stress-related adverse effects. Thus, there is a strong need for the development of small molecule chemistries with selective V(2) receptor agonist activity. Using the functional cell-based assay Receptor Selection and Amplification Technology (R-SAT((R))), a screening effort identified three small molecule chemotypes (AC-94544, AC-88324, and AC-110484) with selective agonist activity at the V(2) receptor. One of these compounds, AC-94544, displayed over 180-fold selectivity at the V(2) receptor compared to related vasopressin and oxytocin receptors and no activity at 28 other G protein-coupled receptors (GPCRs). All three compounds also showed partial agonist activity at the V(2) receptor in a cAMP accumulation assay. In addition, in a rat model of central diabetes insipidus, AC-94544 was able to significantly reduce urine output in a dose-dependent manner. Thus, AC-94544, AC-88324, and AC-110484 represent novel opportunities for the treatment of disorders associated with V(2) receptor agonist deficiency.

Topics: Animals; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Dose-Response Relationship, Drug; Humans; Male; Mice; NIH 3T3 Cells; Peptides; Pharmaceutical Preparations; Rats; Rats, Brattleboro; Receptors, Vasopressin; Vasopressins

Topics: Adult; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Erdheim-Chester Disease; Female; Humans; Skin Diseases

Topics: Adult; Antidiuretic Agents; Brain; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Female; Histiocytosis, Langerhans-Cell; Humans; Magnetic Resonance Imaging; Water-Electrolyte Imbalance

To investigate the clinical feature, treatment and prognosis of both the mother and the fetus with gestational diabetes insipidus.. A total of 7 cases of gestational diabetes insipidus collected in the First Affiliated Hospital of Wenzhou Medical College, Wenzhou Combination of Traditional Chinese Medicine with Western Medicine Hospital, and Zhejiang Taizhou Hospital from June 1993 to June 2006 were analyzed retrospectively.. Seven cases symptoms all characterized by excessive thirst polydipsia and polyuria. The average 24 h urinary output was between 11 L to 13 L and manifested of hypobaricuria. After effective treatment (three cases were treated with 1-deamino-8-D-arginine vasopressin, another three patients were managed with hydrochlorothiazide, and the last one was cured with antisterone), seven patients with gestational diabetes insipidus did not have any severe consequences. Their symptoms of excessive thirst, polyuria, and polydypsia disappeared from 7 days to 3 months after parturition. Urinary volume returned to normal standard of 1000-2000 ml during 24 hours. Specific gravity of urine recovered normally between a range 1.015-1.025 and serum sodium recovered between 135-147 mmol/L. The average duration of illness was 52 days. Eight newborn infants survived. Two of them were sent to neonatal intensive care unit for treatment. One was because of premature delivery caused by antepartum eclampsia, and the other case was one of the twins who had hydronephrosis. The baby of the first case left hospital after 3 weeks' treatment. The latter one's symptom disappeared 2 weeks after delivery. No obvious symptom was discovered among all the babies through follow-up telephone calls 42 days after childbirth.. Gestational diabetes insipidus is a rare endocrinopathy complicating pregnancy. This disorder is characterized by excessive thirst, polydypsia, polyuria, hypobaric urine and electrolyte disturbances usually manifesting in the third trimester of pregnancy or puerperium. This is a transient syndrome. The first treatment of choice in patients with gestational diabetes insipidus is 1-deamino-8-D-arginine vasopressin and the second-choice is hydrochlorothiazide. Early diagnosis and appropriate management of the disease may reduce the hazard for both the mother and the fetus during perinatal period.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hydrochlorothiazide; Infant, Newborn; Polyuria; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prognosis; Retrospective Studies; Sodium; Vasopressins; Young Adult

Bronchuscarcinoma ist the most frequent death cause with tumor patients. At time of diagnosis the stadium is often already advanced, the patient is inoperable. We present a patient (non-smoker) with polydipsia, visual troubles and polyuria. The lab results confirmed diabetes insipidus, but the following x-rays proved multiple intracerebral spots. And also multiple spots in the lungs, the mediastinum, in the liver, the coloumn and the adrenals. Histological diagnosis was non small cell lung cancer (NSCLC).

Topics: Antidiuretic Agents; Antineoplastic Agents; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Carboplatin; Carcinoma, Non-Small-Cell Lung; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Humans; Lung; Lung Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Palliative Care; Polyuria; Radiography, Thoracic; Radiotherapy Dosage; Vinblastine; Vinorelbine

Topics: Adult; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infertility, Female; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Primary Ovarian Insufficiency

Germinoma represents 7.8% of cerebral tumors in pediatric age and 50-65% of germ cell cerebral tumors. Generally it is a definite lesion of the pineal gland or suprasellar region, frequently occurring in the first three decades of life. Clinical presentation depends on tumor localization. Pineal lesions generally determine symptoms due to the compression of cerebral structures, causing Parinaud syndrome, while hypothalamic lesions are often characterized by diabetes insipidus, hypopituitarism and visual defects. In the absence of these classic signs and symptoms, however, the diagnosis of germinoma can be difficult. We presented the case of an 8-year-old boy, referred to our clinic for polyuria and polydipsia. Hormonal evaluations demonstrated central diabetes insipidus (CDI), with normal anterior pituitary function. Magnetic resonance imaging (MRI) showed a lack of posterior pituitary gland and partial pituitary stalk enlargement. The patient started therapy with desmopressin (Minirin) with good hydro-electrolytic balance. During follow-up the pituitary function became insufficient with low growth velocity. A second MRI demonstrated a bifocal lesion with dyshomogeneous and cystic appearance, suggesting the diagnosis of germinoma. On the basis of this case report we would like to point out the importance of an early diagnosis in order to improve the prognosis of the disease and the necessity of a careful follow-up of these patients.

Topics: Antidiuretic Agents; Antineoplastic Combined Chemotherapy Protocols; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Drug Therapy, Combination; Germinoma; Humans; Male; Pituitary Neoplasms; Treatment Outcome

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Disseminated Intravascular Coagulation; Female; Humans; Hypogonadism; Pituitary Diseases; Pituitary Gland; Pregnancy

In this case report we describe the management of severe hypernatraemia following inadvertent water restriction. A 21-year-old woman with no reported medical history presented on transfer from an outside hospital with a complex volar upper extremity injury. Management both operatively and postoperatively involved a prolonged period of fasting which limited her access to drinking water Collateral history revealed that she had previously drunk copious amounts of water during the course of any given day and this had served to alleviate the dramatic symptoms of hypernatraemia that were rapidly manifest when her normal intake was curtailed. We outline the fluid management, administration of desmopressin and her subsequent recovery. A literature review of the management of central diabetes insipidus is also covered.

Topics: Adult; Brain; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hypernatremia; Intraoperative Complications; Magnetic Resonance Imaging; Osmolar Concentration; Renal Agents; Resuscitation; Sodium; Tendon Injuries

A recent study has revealed that acute and chronic administration of the vasopressin V2 receptor (V2R) agonist dDAVP induced a marked increase of urinary albumin excretion (UAE) in healthy rats and humans (Bardoux P et al. Nephrol Dial Transplant 2003; 18: 497-506). The occurrence of an elevation of UAE among patients with chronic syndromes of inappropriate antidiuresis has not been reported.. We looked for the elevation of UAE in 24-h urine samples of the following patients: nine chronic SIADH patients, two patients with acute post-operative SIADH, three patients of the same family with nephrogenic syndrome of inappropriate antidiuresis (NSAID) and two patients with hyponatraemia due to surdosage of dDAVP in the setting of central diabetes insipidus.. There was no elevation of UAE in our patients (whether they presented with hyponatraemia or not), apart from a patient treated with supra-physiological doses of dDAVP. When she received 80 microg/day of dDAVP, her UAE was 42 mg/day. In this patient, UAE returned to the normal range (21 mg/day) when doses of dDAVP were tapered (20 microg/day).. The present study shows that chronic V2R stimulation generally does not result in a rise in UAE. The discrepancy between our results and those of the above-mentioned study could be explained by a dose-dependent effect of V2R stimulation on UAE.

Topics: Adult; Aged; Aged, 80 and over; Albuminuria; Antidiuretic Agents; Chronic Disease; Circadian Rhythm; Deamino Arginine Vasopressin; Diabetes Insipidus; Dose-Response Relationship, Drug; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Incidence; Male; Middle Aged; Mutation; Receptors, Vasopressin

Symptomatic metastases to the pituitary (MP) from renal cell carcinoma (RCC) are rare. In this largest case series reported, we describe the clinical features, treatment and outcome of 5 patients. Over a 6-year period (2000-2006), we treated 5 patients (3 males; mean age 61 years) with large sellar masses and RCC. Four patients had a history of RCC, while in one, RCC was diagnosed after surgery. RCC was diagnosed a median of 11 years prior to diagnosis of MP (range 0-27 years). Four patients had previously developed distant metastases. Clinical presentation included bitemporal hemianopia (3 patients), lethargy (3), headaches (2) and diabetes insipidus (DI) (2). Panhypopituitarism was present in 3 patients and the other two had deficiency of at least ACTH and gonadotropin axes. Elevated prolactin was seen in 3 patients. MRI showed an enhancing sellar mass with suprasellar extension and chiasmal compression in all; prominent vascular flow voids were seen in 2. Three patients underwent transsphenoidal surgery and radiation, while 2 underwent radiotherapy alone. Four patients are alive (follow up 6-46 months); 1 patient died due to systemic metastases at 12 months. Metastases to the pituitary from RCC cause more severe hypopituitarism and visual dysfunction compared to those from other primaries, whereas DI is less common. MRI shows contrast enhancement, stalk involvement, sclerosis and/or erosion of sella and presence of vascular flow voids. Combined treatment using decompressive surgery and stereotactic radiotherapy may result in better outcomes.

Topics: Aged; Carcinoma, Renal Cell; Combined Modality Therapy; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Headache; Hemianopsia; Hormones; Humans; Hydrocortisone; Kidney Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Nephrectomy; Pituitary Neoplasms; Thyroxine; Treatment Outcome

We present a case of nephrogenic diabetes insipidus that occurred after on-pump coronary artery bypass grafting in a patient taking long-term lithium carbonate. Lithium toxicity (2.79 mmol/L) was identified on postoperative day 9. Serum sodium peaked at 175 mmol/L on postoperative day 21. Serum osmolality peaked at 384 mOsm/kg H2O, with a urinary osmolality of 403 mOsm/kg H2O. The patient was ultimately managed with hemofiltration and high-dose 1-desamino-8-D-arginine-vasopressin. Recommendations are made based on our experience of this case. In patients on long-term lithium therapy, the potentially life-threatening complication of lithium-induced nephrogenic diabetes insipidus should be specifically anticipated and managed.

Topics: Bipolar Disorder; Coronary Artery Bypass; Coronary Disease; Deamino Arginine Vasopressin; Diabetes Insipidus; Hemofiltration; Humans; Lithium Carbonate; Male; Middle Aged; Postoperative Complications; Treatment Outcome

Following secretion from the posterior pituitary, the neuropeptide vasopressin (AVP) stimulates the kidney to retain water, and when released centrally it can contribute to anxiety- and depression-like behaviours. We hypothesized that CD1 mice bred for low trait anxiety (LAB) suffer from a deficit in AVP. Both osmotically stimulated peripheral secretion and intra-paraventricular nucleus (PVN) release of AVP were found decreased in LAB animals compared with normal anxiety (NAB) or high anxiety (HAB) controls. Consequently, in addition to their extreme non-anxiety, LAB mice showed signs of central diabetes insipidus (cDI), including increased fluid intake and reduced urine osmolality, as well as a pathological increase in plasma osmolality upon water deprivation. These cDI symptoms were attenuated by administration of a selective AVP V2 receptor agonist. A single nucleotide polymorphism (SNP) in exon 1 (C(+40)T) of the Avp gene of LAB animals causes an amino acid substitution in the signal peptide of the AVP precursor, and is likely to impair processing and trafficking of the precursor, as suggested by reduced axonal transport of AVP from the hypothalamic PVN, finally contributing to cDI symptoms and low trait anxiety. In an F2 panel, this SNP co-segregated with fluid intake and showed a partial contribution to low anxiety-related behaviour, indicated by its co-segregation with time spent on the open arms of the elevated plus-maze in a subset of F2 mice. Thus, the SNP-associated deficit in plasma and central AVP contributes to signs of cDI and, at least partially, to low trait anxiety, both features being typical of LAB animals.

Topics: Animals; Anxiety; Arginine Vasopressin; Behavior, Animal; Deamino Arginine Vasopressin; Diabetes Insipidus; Drinking; Exons; Exploratory Behavior; Hemostatics; Male; Maze Learning; Mice; Osmolar Concentration; Paraventricular Hypothalamic Nucleus; Plasma; Polymorphism, Single Nucleotide; Radioimmunoassay; Urine; Water Deprivation

Topics: Adult; Antidiuretic Agents; Comorbidity; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Pre-Eclampsia; Pregnancy; Pregnancy in Diabetics; Pregnancy Trimester, Second

Disorders of fluid and sodium regulation, often termed "diabetes insipidus," are a frequent occurrence following surgery for pituitary adenomas. The present study was undertaken to identify the incidence of diabetes insipidus after pituitary surgery and its associated factors.. A retrospective review of the medical records 300 patients who underwent transsphenoidal surgery for pituitary adenoma was undertaken. Information regarding patient gender, perioperative serum sodium levels and urinary output volumes, tumor size, previous pituitary surgery, tumor subtype, and the use of DDAVP was gathered. A multivariate statistical analysis was performed.. Follow-up data were available on 288 patients. During the inpatient postoperative hospital stay, DDAVP was administered to 19% of all patients and 16% of patients not taking DDAVP preoperatively. Of patients with normal fluid/sodium regulation preoperatively, DDAVP was prescribed for 9% at discharge and 4% at 6 weeks postoperatively. Only 1.4% of patients were taking vasopressing replacement at the time of last follow-up. Significant correlations were found between gender, previous surgery, serum sodium levels, and urine volumes at various time points. Immunohistochemical type of tumor and tumor size were not related to DDAVP requirement.. Transient hypotonic polyuria is frequently encountered after pituitary surgery. However, only a small number of patients will develop a long-term requiring for ongoing medical treatment. Previous surgery, female gender, and elevated serum sodium and urine volumes in perioperative period were associated with DDAVP requirement.

Topics: Adenoma; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Kidney Concentrating Ability; Male; Neoplasm Recurrence, Local; Neurosurgical Procedures; Pituitary Gland; Pituitary Neoplasms; Polyuria; Postoperative Complications; Reoperation; Retrospective Studies; Sex Factors; Sodium; Sphenoid Bone; Treatment Outcome; Water-Electrolyte Balance

Topics: Adult; Arginine Vasopressin; Cardiomyopathy, Dilated; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant, Newborn; Kidney; Magnesium Deficiency; Male; Osmolar Concentration; Polyuria; Pregnancy; Pregnancy Complications; Tachycardia, Ventricular; Thirst; Water Deprivation

Dipsogenic diabetes insipidus is a syndrome of disordered thirst, in patients without psychiatric disease, which may be confused with partial central diabetes insipidus. Distinguishing these entities involves monitored water testing. Therapy with antidiuretic hormone in patients with dipsogenic diabetes insipidus is thought to be contraindicated for fear of inducing water intoxication. We report a case of a 26-year-old woman without psychiatric illness referred for longstanding polyuria and polydipsia. Otherwise healthy, she complained of near-constant thirst and frequent urination, causing severe disruption of her personal and professional life. She had been consistently eunatremic and polyuric, with low urine osmolality. Results of extensive water testing revealed intact urinary concentrating and diluting capacity, physiologic though blunted antidiuretic hormone (ADH) release, and an abnormally low thirst threshold, consistent with the diagnosis of dipsogenic diabetes insipidus. To control her polyuria we initiated treatment with intermittent, low-dose, intranasal desmopressin and strict water restriction during drug dosing. In follow-up she reported excellent control of polyuria and significant functional improvement. The reviewed literature demonstrates a limited number of reports about dipsogenic diabetes insipidus, and no prior report of a similar treatment strategy. Dipsogenic diabetes insipidus is an uncommonly (and not universally) recognized disorder, requiring monitored testing in order to distinguish it from incomplete forms of central diabetes insipidus. Though therapy with desmopressin cannot be recommended based on the results of a single case, the outcome presented here is intriguing and suggests that larger studies in such patients is warranted to assess the broader application of such an intervention.

Topics: Adult; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Drinking; Female; Humans; Polyuria; Thirst

We present a 5 day-old male newborn with isolated central diabetes insipidus due to congenital toxoplasmosis. This patient was referred to us for hydrocephalus. As we investigated the aetiology of the hydrocephalus, the patient's serum and cerebrospinal fluid tested positive for toxoplasmosis via ELISA and polymerase chain reaction. Computed tomography showed obstructive hydrocephalus and disseminated cranial calcifications. Central diabetes insipidus developed on the 10th day, apparently as a result of the toxoplasmosis infection, and was treated successfully with oral desmopressin.

Topics: Administration, Oral; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hydrocephalus; Infant, Newborn; Male; Tomography, X-Ray Computed; Toxoplasmosis, Congenital; Treatment Outcome

We report a case of pituitary dwarfism and diabetes insipidus due to pituitary stalk transection in a pregnant Japanese woman, 138 cm in height, born by breech delivery with no evidence of ante- or intrapartum asphyxia. The patient had no central nervous disturbance, was diagnosed with pituitary dwarfism during childhood and was treated at another hospital with growth hormone supplement from 5 to 14 years of age. This patient was referred to our department at 17 weeks' gestation due to a change of residence. At 30 weeks' gestation, she was hospitalized for assessment of hydronephrosis and polyuria (15-20 L/day). Analysis of a 24-h urine sample showed creatinine clearance of 157 mL/min and urine osmolality of 38 mOsm/L. The patient's urine output decreased after receiving a test dose of 0.75 g of 1-desamino-8-D-arginine vasopressin (DDAVP). Cranial magnetic resonance imaging showed transection of the pituitary stalk. Subsequently, the patient's urine output was well controlled by a maintenance dose of 0.275 mL/day intranasal DDAVP. A cesarean section was performed at 37 weeks, as the patient height was 138 cm, and a pelvic X-ray showed cephalopelvic disproportion. She delivered a female baby weighing 2302 g, and both 1- and 5-min Apgar scores were 9. The patient was followed up after 4 months and showed no visual deterioration or polyuria while on DDAVP therapy, while the neonate grew favorably.

Topics: Adult; Breech Presentation; Deamino Arginine Vasopressin; Diabetes Insipidus; Dwarfism, Pituitary; Female; Human Growth Hormone; Humans; Hydronephrosis; Magnetic Resonance Imaging; Pituitary Gland; Pituitary Hormones; Polyuria; Pregnancy; Pregnancy Complications; Pregnancy Outcome

Adipsic diabetes insipidus (ADI) is a rare condition in which thirst, an essential clinical feature for the prevention of hypernatraemic dehydration, is absent. We report the first case of adipsic diabetes insipidus to occur following surgery for a pituitary macroprolactinoma, with loss of both osmoregulated and baroregulated vasopressin release. Following extensive surgery for a vision threatening macroprolactinoma a 14-year-old boy developed profound hypernatraemia with absent thirst sensation. Detailed investigation, with hypertonic saline infusion and trimetaphan infusion, revealed absence of both osmoregulatory and baroregulatory release of vasopressin. We discuss the investigation and management of such patients and the physiology of hypothalamic-neurohypophyseal dysfunction in such patients.

Topics: Adolescent; Deamino Arginine Vasopressin; Diabetes Insipidus; Fluid Therapy; Humans; Magnetic Resonance Imaging; Male; Pituitary Neoplasms; Postoperative Complications; Prolactinoma; Treatment Outcome

Diabetes insipidus in pregnancy has different causes. The association of diabetes insipidus with disturbances of liver function has been reported, however, diabetes insipidus has rarely been reported in HELLP syndrome. We present a 23-year-old primigravida with a singleton gestation complicated by HELLP syndrome who developed postpartum diabetes insipidus. Labor was induced promptly to terminate pregnancy because of intrauterine fetal death and liver dysfunction. 1-deamino-8-D-arginine-vasopressin was administered. Diabetes insipidus and liver dysfunction resolved within 2 weeks. Development of diabetes insipidus may result from increased vasopressinase activity mainly caused by deterioration of liver functions caused by HELLP syndrome. In pregnant women with liver disease as a result of any cause, the development of diabetes insipidus should be assessed with particular attention.

Topics: Adult; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Fetal Death; Glucocorticoids; HELLP Syndrome; Humans; Liver Diseases; Plasma Exchange; Postpartum Period; Pregnancy

Transient diabetes insipidus may rarely present during late pregnancy and/or the immediate puerperium, and if unrecognized, may cause neurologic injury and threaten the lives of mother and fetus. However, when recognized early and treatment is initiated with desmopressin acetate, an analog of vasopressin that is resistant to vasopressinase, water loss in the urine is eliminated and complications may be abrogated. This report aims to increase the awareness of this disorder and describes appropriate treatment.. Two cases of diabetes insipidus, believed to be due to excess vasopressinase, are presented to demonstrate the clinical features, pathogenesis, and treatment of this syndrome.. Awareness of the syndrome of transient diabetes insipidus may lead to early diagnosis and appropriate treatment that will reduce the risks of maternal and fetal morbidity.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Follow-Up Studies; Humans; Maternal Age; Polyuria; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy Trimester, Third; Risk Assessment; Treatment Outcome; Vasopressins

Topics: Adolescent; Antidiuretic Agents; Brain Diseases; Deamino Arginine Vasopressin; Diabetes Insipidus; Electroencephalography; Enuresis; Female; Humans; Hyponatremia; Male; Middle Aged

In addition to its effect on water permeability, vasopressin, through its V2 receptors (AVPR2), stimulates Na reabsorption in the collecting duct by increasing the activity of the amiloride-sensitive sodium channel ENaC. This study evaluated whether dDAVP (a potent AVPR2 agonist) reduces sodium excretion in healthy humans (n = 6) and in patients with central (C; n = 2) or nephrogenic (N) diabetes insipidus (DI) as a result of mutations of either the aquaporin 2 gene (AQP2; n = 3) or AVPR2 (n = 10). dDAVP was infused intravenously (0.3 microg/kg body wt in 20 min), and urine was collected for 60 min before (basal) and 150 min after the infusion. dDAVP markedly reduced both urine flow rate and sodium excretion in healthy individuals. A reduction in sodium excretion was also observed in CDI and NDI-AQP2 patients but not in NDI-AVPR2 patients. The magnitude of the fall in sodium excretion correlated with the rise in urine osmolality and the fall in urine output but not with the simultaneously observed fall in mean BP. These results suggest that the dDAVP-induced antinatriuresis is due to a direct V2 receptor-dependent stimulation of sodium reabsorption in the collecting duct and is not secondary to a hemodynamic effect. In conclusion, this study reveals a potent V2-dependent antinatriuretic effect of vasopressin in humans. The possibility that an inappropriate stimulation of ENaC by vasopressin might lead to significant sodium retention in chronic situations remains to be determined.

Topics: Adolescent; Adult; Aquaporin 2; Aquaporins; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Male; Receptors, Vasopressin; Renal Agents; Sodium; Sodium Channels

A decrease in urine volume is considered the therapeutic goal of the treatment of central diabetes insipidus (DI) with desmopressin (dDAVP). A low urine volume is a risk factor for kidney stone formation. This is the first report of nephrolithiasis in association with DI. It is likely that successful therapy with dDAVP and the patient's own purposeful decreased fluid intake contributed to calcium oxalate stone formation. Prevention of stone recurrence requires an increase in urine volume. The patient's compliance with this recommendation led to an episode of acute hyponatremia, a well-known complication of dDAVP therapy. The challenge of the management of stones in the setting of DI requires balancing the conflicting goals of both decreasing and increasing urine volume.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hyponatremia; Kidney Calculi

We present a case of late recurrence of breast cancer manifested with diabetes insipidus caused by isolated intracranial metastases. A 57-year-old postmenopausal woman was diagnosed with breast cancer and underwent radical mastectomy, without any adjuvant therapy. Seventeen years later, she presented with polyuria, polydipsia, weight loss, weakness, diffuse bone pain, hoarseness and mild dyspnoea. Cranial CT revealed several dural masses in the frontal, parietal and occipital lobes and along the falx cerebri. The diagnosis of central diabetes insipidus without impairment of anterior pituitary function was based on the clinical symptoms, laboratory tests and imaging findings. The patient was successfully treated with desmopressin acetate and letrozole, and remained alive and ambulating 22 months after initial presentation with diabetes insipidus.

Topics: Antineoplastic Agents; Breast Neoplasms; Deamino Arginine Vasopressin; Diabetes Insipidus; Fatal Outcome; Female; Humans; Letrozole; Magnetic Resonance Imaging; Meningeal Neoplasms; Middle Aged; Nitriles; Pituitary Neoplasms; Renal Agents; Triazoles

Thrombotic thrombocytopenic purpura (TTP) is a rare and often fatal disorder characterized by thrombocytopenia, microangiopathic hemolytic anemia, mental status changes, and renal dysfunction. Central diabetes insipidus (CDI) is a rare disease due to anatomic lesions of the hypothalamicpituitary system associated with various underlying diseases, or trauma. We present an unusual case of TTP and CDI in a 47 year-old African American female who was admitted to our hospital with crampy abdominal pain and nausea. The patient had tachycardia, fever and hypotension. The patient subsequently became confused, developed seizures, and her renal function deteriorated. Bone marrow analysis showed adequate megakaryocytes while a peripheral smear revealed severe thrombocytopenia, polychromasia and schistocytes. The diagnosis of thrombotic thrombocytopenic purpura (TTP) was made and plasmapharesis initiated. Over the next few days, the patient developed severe polyuria with a rise in serum sodium. Central diabetes insipidus was diagnosed and DDAVP (desmopressin acetate, 1-deamino-8-D-arginine vasopressin) was given. However, DDAVP was stopped several times due to worsening thrombocytopenia. Renal function worsened and the patient expired. A review of the literature revealed only one case of report of TTP and central diabetes insipidus. Our case was the only one reporting the use of DDAVP in such a setting.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Fatal Outcome; Female; Humans; Hypoglycemic Agents; Middle Aged; Plasmapheresis; Purpura, Thrombotic Thrombocytopenic; Respiration, Artificial

Managing children with diabetes insipidus (DI) in the perioperative period is complicated and frequently associated with electrolyte imbalance compounded by over- or underhydration. In this study the authors developed and prospectively evaluated a multidisciplinary approach to the perioperative management of DI with a comparison to 19 historical control children. Eighteen children either with preoperative DI or undergoing neurosurgical operations associated with a high risk for developing postoperative DI were identified and managed using a standardized protocol. In all patients in whom DI occurred during or after surgery, a continuous intravenous infusion of aqueous vasopressin was initiated and titrated until antidiuresis was established. Intravenous fluids were given as normal saline and restricted to two thirds of the estimated maintenance rate plus amounts necessary to replace blood losses and maintain hemodynamic stability. In all children managed in this fashion, perioperative serum sodium concentrations were generally maintained between 130 and 150 mEq/L, and no adverse consequences of this therapy developed. In the 24-hour period evaluated, the mean change in serum sodium concentrations between the historical controls was 17.6 +/- 9.2 mEq/L versus 8.36 +/- 6.43 mEq/L in those children managed by the protocol. Hyponatremia occurred less frequently in the children managed with this protocol compared with historical controls.

Topics: Adolescent; Child; Child, Preschool; Clinical Protocols; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hyponatremia; Hypotonic Solutions; Infusions, Intravenous; Male; Neurosurgical Procedures; Perioperative Care; Postoperative Complications; Prospective Studies; Renal Agents; Seizures; Sodium; Vasopressins; Water-Electrolyte Balance

The effect of oral administration of desmopressin (DDAVP) solution was investigated in a very low birth weight premature infant with central diabetes insipidus that was associated with grade four germinal matrix hemorrhage. As an alternative to the nasal route, long-term successful management resulting in favorable growth and development during infancy was achieved using the oral route.

Topics: Administration, Oral; Cerebral Hemorrhage, Traumatic; Cerebral Ventriculography; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hypoglycemic Agents; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Male; Tomography, X-Ray Computed; Weight Gain

Managing children with diabetes insipidus (DI) in the perioperative period is complicated and frequently associated with electrolyte imbalance compounded by over- or underhydration. In this study the authors developed and prospectively evaluated a multidisciplinary approach to the perioperative management of DI with a comparison to 19 historical control children. Eighteen children either with preoperative DI or undergoing neurosurgical operations associated with a high risk for developing postoperative DI were identified and managed using a standardized protocol. In all patients in whom DI occurred during or after surgery, a continuous intravenous infusion of aqueous vasopressin was initiated and titrated until antidiuresis was established. Intravenous fluids were given as normal saline and restricted to two thirds of the estimated maintenance rate plus amounts necessary to replace blood losses and maintain hemodynamic stability. In all children managed in this fashion, perioperative serum sodium concentrations were generally maintained between 130 and 150 mEq/L, and no adverse consequences of this therapy developed. In the 24-hour period evaluated, the mean change in serum sodium concentrations between the historical controls was 17.6 +/- 9.2 mEq/L versus 8.36 +/- 6.43 mEq/L in those children managed by the protocol. Hyponatremia occurred less frequently in the children managed with this protocol compared with historical controls.

Topics: Adolescent; Child; Child, Preschool; Clinical Protocols; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hyponatremia; Hypotonic Solutions; Infusions, Intravenous; Male; Neurosurgical Procedures; Perioperative Care; Postoperative Complications; Prospective Studies; Renal Agents; Seizures; Sodium; Vasopressins; Water-Electrolyte Balance

Diabetes insipidus (DI) is a rare complication of pregnancy. In cases related to pregnancy, the condition is thought to result from enhanced placental clearance of arginine vasopressin secondary to placental vasopressinase production. In such cases careful monitoring of the patient's fluid balance during and after pregnancy is essential. If treatment is necessary, desmopressin is the drug of choice. In the present article, we present three cases of pregnancy complicated by DI.

Topics: Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Polyuria; Pregnancy; Pregnancy Complications; Renal Agents; Water-Electrolyte Balance

Four patients with sarcoidosis presented as hypothalamic-hypophyseal syndrome including diabetes insipidus (DI) were followed up for more than 8 years from the onset of clinical manifestation. The mean age was 26 years, male : female ratio was 3 : 1 and the mean disease duration of 10 years. All patients had hypogonadism, hyperprolactinemia. Pituitary enlargement with thickening of the pituitary stalk were detected by magnetic resonance imaging (MRI) with gadolinium enhancement and attenuation in the intensity of the posterior lobe of the pituitary was detected without enhancement. Corticosteroid therapy resulted in the initial improvement of symptoms and gradual decrease in the tumor size but failed to cure polyuria due to DI. The use of desmopressin was necessary for a long period. None of these patients died from DI or central neurosarcoidosis.

Topics: Adrenal Cortex Hormones; Adult; Brain Diseases; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Hemostatics; Humans; Hyperprolactinemia; Hypogonadism; Hypothalamic Diseases; Magnetic Resonance Imaging; Male; Pituitary Gland; Prognosis; Sarcoidosis; Time Factors; Treatment Outcome

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Enuresis; Humans; Nurse's Role; Patient Education as Topic; Patient Selection; Renal Agents; Teaching Materials

An increase in urinary albumin excretion (UAE) represents an early predictor of glomerular damage in diabetes mellitus (DM) and a risk factor for cardiovascular complications in hypertension. Vasopressin is elevated in DM and in some forms of hypertension. Previous studies in rats suggested that this hormone could play a role in the albuminuria observed in chronic renal failure or diabetic nephropathy, but no information is available concerning the mechanism of these effects and the possible influence of vasopressin on UAE in the healthy kidney. The present study was thus designed to evaluate whether vasopressin influences UAE in normal rats and humans, whether this effect is V(2)-receptor-dependent, and whether it is mediated by the renin-angiotensin system.. UAE was measured in normal Wistar rats and healthy humans, or in subjects with various forms of diabetes insipidus (DI), before and after acute or chronic infusion of the vasopressin V(2) receptor agonist dDAVP. Chronic dDAVP administration was also performed in normal Wistar rats previously submitted to either chronic angiotensin-converting enzyme inhibition (ACEI) or chronic blockade of AT1 receptors (ARB).. In rats, acute or chronic dDAVP infusion increased UAE significantly and reversibly (4-fold and 6-fold, respectively). In healthy subjects, acute infusion of dDAVP tripled UAE (P<0.01) but did not change creatinine and beta(2)-microglobulin excretion, thus suggesting that the rise in UAE was due to an increased glomerular leakage of albumin. dDAVP also increased UAE in patients with central DI and in patients with hereditary nephrogenic DI bearing AQP2 mutations. However, UAE was not increased in patients with hereditary nephrogenic DI bearing mutations of the V(2) receptor. In rats, ACEI and ARB blunted the dDAVP-induced rise in UAE by 70% (P<0.05) and 50% (NS), respectively.. The present studies reveal for the first time that vasopressin induces a marked increase in UAE in healthy rats and humans. This albuminuric effect seems to result from increased glomerular leakage, requires functional vasopressin V(2) receptors, and is, at least in part, mediated by the renin-angiotensin system. These results bring additional support for an involvement of vasopressin in the albuminuria observed in pathological states such as diabetes mellitus or hypertension.

Topics: Adult; Albuminuria; Animals; Blood Pressure; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Male; Rats; Receptors, Vasopressin; Reference Values; Renal Agents; Renin-Angiotensin System; Vasopressins

Topics: Administration, Intranasal; Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Hemostatics; Histiocytosis, Langerhans-Cell; Humans; Hyponatremia; Severity of Illness Index; Water Intoxication

Topics: Antigens, CD1; Biopsy, Needle; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Follow-Up Studies; Histiocytosis, Langerhans-Cell; Humans; Immunohistochemistry; Male; Pituitary Diseases; Risk Assessment; Sensitivity and Specificity; Treatment Outcome

Transient diabetes insipidus is an uncommon complication of pregnancy, usually manifesting with polydipsia and polyuria. This condition is considered to result from excess placental vasopressinase activity and is managed with deamino D arginine vasopressin.. While on restricted oral intake after cesarean delivery, the patient gradually became disoriented and agitated in conjunction with markedly increased urine output disproportional to her intravenous crystalloid fluid intake. Marked hypernatremia of 178 mEq/dL was noted. Urine osmolality was low at 248 mOsm/L. The clinical presentation and electrolyte abnormalities were considered consistent with transient diabetes insipidus of pregnancy. The patient responded well to nasal-spray-administered deamino D arginine vasopressin and increased intravenous fluid intake, with resolution of symptoms and gradual normalization of serum sodium levels.. Transient diabetes insipidus of pregnancy should be considered in the differential diagnosis of severe hypernatremia in obstetric patients with restricted oral intake after operative delivery.

Topics: Adult; Cesarean Section; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Fluid Therapy; Humans; Hypernatremia; Postoperative Care; Postoperative Complications; Pregnancy; Pregnancy Complications

Gestational diabetes insipidus is a rare disorder characterized by polyuria and polydipsia due to the inability of the kidneys to concentrate urine. We report two cases of transient gestational diabetes insipidus in which patients responded to intranasal DDAVP (1-deamino-8-D-arginine vasopressin) with greater than 50% increase in urine osmolality and marked reduction in urine output. Intranasal DDAVP was discontinued after their discharge and both patients maintained normal urine output and appropriate urine osmolality. In determining whether diabetes insipidus is present in a patient who is polyuric and hypernatremic, a urine osmolality below that of the plasma suggests the presence of diabetes insipidus. Understanding of the pathophysiology may soon lead to improved methods of prevention, diagnosis and treatment.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes, Gestational; Female; Humans; Pregnancy; Pregnancy Complications; Renal Agents; Urination

Diabetes insipidus during pregnancy is an uncommon medical problem, and its cause is not entirely clear. We present a woman with twin pregnancy associated with HELLP syndrome, who developed diabetes insipidus during postpartum period. A hypertonic saline infusion study with measurement of plasma arginine vasopressin concentrations confirmed the diagnosis. She had mild response to 1-desamino-8-d-arginine-vasopressin (dDAVP) during the immediate postpartum period. On the 3rd postpartum day two doses of 100 microliters of dDAVP were administered, and her urinary volume gradually decreased. We could stop dDAVP on the 30th postpartum day. This exacerbation may result from increased vasopressinase activity caused by the excessive production in the placenta due to twin pregnancy, together with the insufficient degradation in the liver due to HELLP syndrome.

Topics: Adult; Cesarean Section; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Gestational Age; HELLP Syndrome; Humans; Pregnancy; Puerperal Disorders; Twins

Topics: Animals; Deamino Arginine Vasopressin; Diabetes Insipidus; Hemodynamics; Hemostatics; Liver Transplantation; Rats; Rats, Brattleboro

In recent years synthetic vasopressin analogues (particularly desmopressin) emerged as safe and effective representatives of this class of drugs for same clinical indications as natural hormone. It was imperative to create intranasal drug form using synthetic desmopressin compound. The purpose of this work was to develop formulations of intranasal desmopressin drug using synthetic active compound with optimal composition. Aquatic desmopressin intranasal solution was prepared in 0.05 mg/ml concentration using phosphate buffer (pH 4.5-5.5) and following preservatives: nipagin-nipazol 7:3--0.1% or benzalkonium chloride 0.01%. Sterility is the main condition for intranasal drops and hormones as a raw material are thermolabile so it is not possible to apply a thermic sterilisation. Polymeric membrane filters of 0.22 micron pore size were employed as sterilizing filters. In order to control the quality, to determine the stability of desmopressin intranasal drops at long-lasting storage (24 months) and to evaluate the influence of the technological factors we have developed the analytical methods of quality control. According to our quality control data, desmopressin intranasal drops are stable for two years and remain sterile during storage and administration of the drug.

Topics: Administration, Intranasal; Chemistry, Pharmaceutical; Child; Data Interpretation, Statistical; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuretics; Drug Stability; Drug Storage; Enuresis; Filtration; Humans; Renal Agents; Sterilization; Temperature; Time Factors

We report the case of a 53 year old patient who was admitted with polyuria, polydipsia associated with fatigue, depression and sexual dysfunction. Central diabetes insipidus with hypogonadotrophic hypogonadism was diagnosed by a water restriction test and different static and dynamic hormonal dosages. Nodular thickening of the pituitary stalk was noted on the MRI and the biopsy permitted a histological diagnosis of infundibulitis.

Topics: Biopsy; Deamino Arginine Vasopressin; Diabetes Insipidus; Drinking; Humans; Hypogonadism; Male; Middle Aged; Pituitary Diseases; Pituitary Function Tests; Pituitary Gland, Posterior; Polyuria; Renal Agents

A strong relationship has been found between arginine-vasopressin (AVP) and hypothalamus-pituitary-adrenal axis in humans. The aim of the current study was to evaluate baseline and CRH-stimulated ACTH and F levels in patients with central diabetes insipidus (CDI), before and after replacement therapy with desamino-D-AVP (DDAVP). Twenty-five patients with CDI, and 25 sex- and age- and BMI-matched healthy subjects entered the study. A standard CRH test (measurement of plasma ACTH and serum F before and every 15 min for 2 h after the administration of 100 microg of human CRH) was performed in all subjects. In patients with CDI, CRH test were repeated after 1 week of DDAVP at standard doses. At study entry, ACTH and F levels were significantly higher in patients with CDI than in controls either at baseline (ACTH: 45.5+/-4.8 vs 18.5+/-3.3 ng/l, p<0.05; F: 375.1+/-55.7 vs 146.6+/-19.4 microg/l, p<0.05) or after CRH test considered as a peak (ACTH: 90.8+/-14.4 vs 42.5+/-7.4 ng/l, p<0.05; F: 501.6+/-65.7 vs 226.3+/- 25.6 microg/l, p<0.05) and AUC (ACTH: 3997.0+/-571.7 vs 2136.0+/-365.8 ng/l/120 min, p<0.05; F: 31,489.0+/-4299.4 vs 14,854.5+/-1541.5 microg/l/120 min, p<0.05). In patients with CDI, 1 week of replacement with DDAVP brought down ACTH (peak: 56.9+/-9.3 ng/l; AUC: 2390.7+/-480.7 ng/l/120 min) and F (peak: 310.3+/-39.5 microg/l; AUC: 17,555.5+/-2008.7 microg/l/120 min) responses to CRH to normal but did not significantly modify baseline hormone levels (ACTH: 29.6+/-3.6 ng/l; F: 239.0+/-32.3 microg/l). In conclusion, CDI is associated to increased baseline ACTH and F levels and increased responsiveness of ACTH and F to CRH administration. In addition, replacement treatment with DDAVP normalized CRH-induced but not baseline ACTH and F secretion.

Topics: Adolescent; Adrenal Glands; Adrenocorticotropic Hormone; Adult; Body Mass Index; Corticotropin-Releasing Hormone; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hydrocortisone; Hypothalamus; Kinetics; Male; Middle Aged; Osmolar Concentration; Pituitary Gland; Urine

A 48-year-old woman presented with a history of premature menopause, polyuria, polydipsia, fever, and diffuse bony tenderness. Her evaluation revealed central diabetes insipidus, hypothalamic amenorrhea, an elevated free calcium on multiple occasions with an elevated 1,25 dihydroxyvitamin D level, and osteoporosis by densitometry. Skeletal series revealed multiple lytic lesions involving the long bones. The diagnosis of Langerhans' cell granulomatosis was made. She was treated with hormone replacement therapy, radiotherapy, and vinblastine, with a dramatic improvement in her pain and a near normalization of her free calcium. Whereas hypercalcemia has been described in several granulomatous disorders and is secondary to unregulated extrarenal production of 1,25 dihydroxyvitamin D, it is, however, extremely rare in Langerhans' cell granulomatosis. This is the first case report of Langerhans' cell granulomatosis with hypercalcemia and documented elevated increased 1,25 dihydroxyvitamin D level that responded to the treatment of her primary disease.

Topics: Antineoplastic Agents, Phytogenic; Calcitriol; Calcium; Deamino Arginine Vasopressin; Diabetes Insipidus; Estrogen Replacement Therapy; Female; Histiocytosis, Langerhans-Cell; Humans; Hypercalcemia; Middle Aged; Osteoporosis; Vinblastine

Besides its effects on water balance, arginine vasopressin (AVP) increases peripheral vascular resistance and decreases cardiac output, mainly by decreasing heart rate. The current study was designed to evaluate cardiac performance in patients with central diabetes insipidus (CDI), focusing on the acute effects of desmopressin replacement withdrawal and its subsequent reinstatement in patients with CDI. Twelve patients with CDI and 12 sex- and age-matched healthy subjects entered the study. All patients were receiving treatment with intranasal desmopressin at standard doses. All patients and controls were assessed for water balance, by measuring plasma osmolality and total body water, anterior pituitary function, heart rate, systolic and diastolic blood pressure. Left ventricular (LV), end-diastolic and end-systolic diameters (LVEDD, LVESD) and volumes (LVEDV, LVESD), end-diastolic and end-systolic interventricular septum thickness (EDIVST, ESIVST) and posterior wall thickness (LVEDPWT, LVESPWT), and mass (LVM) were measured by echocardiography. Moreover, LV systolic function was assessed by measuring the ejection fraction (EF), the fractional shortening (FS), the Suga index, the stroke volume and the cardiac output, while LV diastolic function was assessed by measuring early (M1) and late (M2) maximal transmitral blood flow velocities, the ratio between M1 and M2, the mitral deceleration time (MDT) and the isovolumetric relaxation time. All parameters were assessed in the patient group 24 h after discontinuing treatment with nasal desmopressin (baseline study) and 1 week after re-starting replacement treatment, while in the control group before (baseline study) and after 1-week of a nasally administered placebo. At baseline, compared to controls, patients with CDI had increased plasma osmolality (P < 0.01), plasma ACTH (P < 0.01), serum (P < 0.01) and urinary cortisol (P < 0.01) levels, and heart rate (P < 0.05), and decreased total body water (P < 0.05). Systolic and diastolic blood pressure and the other anterior pituitary hormones were similar in patients and controls. At echo-cardiography, EDIVST (P < 0.05), ESIVST (P < 0.01), LVEDPWT (P < 0.05) and LVESPWT (P < 0.01), EF (P < 0.01), Suga index (P < 0.05), FS (P < 0.05), M2 (P < 0.01) and IRT (P < 0.05) were significantly higher while LVESD (P < 0.01), LVESV (P < 0.01), LVEDD (P < 0.05), LVEDV (P < 0.05), M1 (P < 0.05), and M1/M2 (P < 0.01) were significantly lower in patients than in controls. LVM,

Topics: Administration, Intranasal; Adult; Cardiac Output; Case-Control Studies; Deamino Arginine Vasopressin; Diabetes Insipidus; Diastole; Echocardiography, Doppler; Female; Heart; Heart Rate; Hemodynamics; Humans; Male; Middle Aged; Myocardial Contraction; Osmolar Concentration; Pituitary Function Tests; Stroke Volume

We describe three cases of acute myeloid leukaemia revealed by diabetes insipidus. The patients were 42, 38 and 39 yr old and they had marked hyperleukocytosis, circulating immature granular cells and a normal or elevated platelet count. The leukaemia was type AML-M2 according to the FAB classification. Cytogenetic studies showed inversion of chromosome 3 (q21;q26) in 2 cases and a translocation (3;3)(q21;q29?) in the remaining case, both associated with monosomy 7. All the cerebral CT scans were normal. Complete remission was never achieved, and all three patients survived less than 14 months. Desmopressin therapy was active but treatment could not be reduced. The association of dysmegakaryopoiesis with a chromosome 3 abnormality and diabetes insipidus is probably not fortuitous and could represent a new entity.

Topics: Adult; Chromosome Aberrations; Chromosome Inversion; Chromosomes, Human, Pair 3; Chromosomes, Human, Pair 7; Deamino Arginine Vasopressin; Diabetes Insipidus; Fatal Outcome; Female; Humans; Leukemia, Myeloid, Acute; Leukocytosis; Male; Monosomy; Platelet Count; Thrombocytosis; Translocation, Genetic

A water deprivation test or a hypertonic saline infusion test with the measurement of plasma osmolality and plasma vasopressin are the gold standard tests in the differential diagnosis of polyuric syndromes. Because commercially available vasopressin kits are too insensitive for this approach, and the concentration of vasopressin in urine is much higher than in plasma, urinary vasopressin measurements may be an alternative to the more difficult plasma vasopressin measurement.. The diagnostic value of the measurement of urinary vasopressin with a rather insensitive commercially available vasopressin kit was compared with plasma vasopressin measurement by a highly sensitive radioimmunoassay (RIA).. Thirteen normal subjects and 27 patients with polyuria/polydipsia were examined by an 8-h fluid deprivation test. In all blood samples (0800 h, 1200 h, 1400 h and 1600 h) and in all urine collections (2-hourly fractions), osmolality as well as vasopressin were measured.. Using plasma vasopressin measurement with a highly sensitive RIA as gold standard test, nine patients were classified as having primary polydipsia, whereas 18 had partial or complete cranial diabetes insipidus. Whereas the substitution of plasma vasopressin measurement by urinary vasopressin measurement alone did not provide 100% separation between both groups, the product of urinary vasopressin and urinary osmolality related to plasma osmolality completely separated the patients with primary polydipsia from those with diabetes insipidus. Urinary measurement of vasopressin and osmolality alone, which was recommended as a noninvasive diagnostic procedure in children, was too insensitive for exact differential diagnosis in our adult patients.. The simultaneous measurement of plasma vasopressin and plasma osmolality in a dehydration test is the most powerful diagnostic tool in the differential diagnosis of polyuria/polydipsia. However, if highly sensitive assays for plasma vasopressin measurements are not available, the measurement of urinary vasopressin with commercially available, less sensitive RIAs may be a diagnostic alternative, which showed nearly the same sensitivity as plasma vasopressin measurement in our study population.

Topics: Adult; Aged; Case-Control Studies; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Drinking; Female; Humans; Male; Middle Aged; Osmolar Concentration; Polyuria; Predictive Value of Tests; Radioimmunoassay; Vasopressins

Protective effects of desmopressin in brain dead organ donors oppose reports on a hypercoagulatory potential and an increased leukocyte-endothelial interaction (LEI) after application of the drug. The aim was to evaluate the effect of desmopressin on organ donor's pancreas and early graft function.. Donor microcirculation was evaluated via intra-vital microscopy (IVM) in 24 BR (di/di) rats with central diabetes insipidus, randomly assigned to groups I (control without desmopressin application), II (single i.v. application, no pretreatment) or group III (single i.v. desmopressin application, s.c. pretreatment for 3 days). Microcirculation in recipients was evaluated 1 hr and 6 hr after syngenic pancreas transplantation. Groups III and I served as organ donors. After IVM specimens were taken for histology and immunohistochemistry.. Desmopressin in II vs. I led to temporarily (30') increased LEI (Sticker 274.3+/-87.7 vs. 76.5+/-31.1/mm2 endothelial surface; P<0.01) and impaired microcirculation (MCEV 0.43+/-0.07 vs. 0.99+/-0.06 mm/s; P<0.01). Repeated application reduced MCEV and increased LEI for up to 12 hr. Histology in I vs. III showed increased inflammation (n.s.), necrosis (P<0.05) and vacuolization (P<0.01). Immunohistochemistry revealed increased endothelial P-selectin 20' after application. 6 hr after reperfusion organs from III showed reduced MCEV and increased LEI (P<0.01).. Repeated application of desmopressin impairs graft microcirculation. Perfusion of the pancreas is significantly reduced at the beginning of organ tissue conservation as well as after reperfusion. These disturbances might partly be due to observed endothelial P-selectin expression. Application of desmopressin up to 12 hr prior to organ explantation may impact graft quality.

Topics: Animals; Blood Flow Velocity; Blood Platelets; Capillaries; Deamino Arginine Vasopressin; Diabetes Insipidus; Endothelium, Vascular; Hematocrit; Hemodynamics; Hemostatics; Leukocytes; Microcirculation; Pancreas; Pancreas Transplantation; Rats; Rats, Mutant Strains; Reperfusion; Tissue Donors; Transplantation, Isogeneic; Venules

To report an unusual case of leukemia presenting as both bilateral exudative retinal detachment (ERD) and central diabetes insipidus (DI), we evaluate the clinical hematological records including bone marrow aspirations and CSF tapping, both osmolarity and electrolytes concentration of the serum and urine, brain MRI, fundus photographs and fluorescein angiographs in this 25-year-old female patient. Examinations of peripheral blood and bone marrow aspiration confirmed the diagnosis of acute myelogenous leukemia (AML-M0). Fluorescein angiography (FA) revealed bilateral ERD, dense choroidal leukemia cell infiltration with overlying retinal pigment epithelium (RPE) dysfunction and focal areas of choroidal infarction. Changes in both osmolarity and electrolytes concentration of the serum and urine from vasopressin test supported the diagnosis of central DI. Central DI and ERD may be presenting signs of acute leukemia and both may represent CNS involvement. In our case, dense choroidal leukemic cell infiltration results in devitalization of RPE and choroidal infarction. Leukemic disruption of hypothalamic pituitary area may lead to complete or partial deficiency of antidiuretic hormone (ADH). Rapid improvement in visual acuity and partial symptom relief of DI may ensue from appropriate chemotherapy and nasal DDAVP (1-desamino-8-D-arginine vasopressin) supply.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Leukemia, Myeloid, Acute; Retinal Detachment

Hypodipsic hypernatremia (HH) represents a pathological increase in serum sodium due to a lack of thirst and defect in hypothalamic osmoreceptors. While 15% of patients with HH have a vascular aetiology, few cases have been described. Moreover, the presence of such abnormalities in the amnestic patient can have particularly threatening implications, as HH tends to recur unless the patient complies with a regimen of water intake. This study reports the case of a 46-year-old male admitted for rehabilitation of functional deficits following subarachnoid haemorrhage (SAH), with clipping of an anterior communicating artery (ACoA) aneurysm. Clinical examination was remarkable for profound short-term memory loss and inability to retain new information. Blood chemistry on admission showed a serum sodium level of 160 mEq/L, increasing to 167 mEq/L the following day. The patient denied thirst, and showed no clinical signs of dehydration. Neuroendocrine evaluation revealed diabetes insipidus (DI) and HH. Treatment initially included DDAVP and intravenous hydration, later supplemented with chlorpropramide. Stabilization of serum sodium and osmolality did not ensue until the treatment regimen included hydrochlorothiazide and supervision of enforced fluid intake. Endocrine abnormalities may be encountered among patients with vascular lesions adjacent to the hypothalamus. Rehabilitation interventions include establishing a structured medication regimen with fluid administration in the amnestic patient with hypothalamic dysfunction.

Topics: Amnesia, Anterograde; Chlorpropamide; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuretics; Drinking Behavior; Drug Administration Schedule; Fluid Therapy; Humans; Hydrochlorothiazide; Hypernatremia; Hypoglycemic Agents; Intracranial Aneurysm; Male; Middle Aged; Postoperative Complications; Renal Agents; Subarachnoid Hemorrhage; Thirst

We report a 28-year-old male patient with a pituitary insufficiency after a simple fracture of the sella turcica. He was injured by a long nail that punctured the lower jaw. No fracture other than that of the sella turcica was detected. An endocrinological examination revealed both anterior and pituitary dysfunction and diabetes insipidus that continued for about two months.

Topics: Adult; Construction Materials; Deamino Arginine Vasopressin; Diabetes Insipidus; Head Injuries, Penetrating; Humans; Hypopituitarism; Male; Pituitary Gland, Anterior; Sella Turcica; Skull Fractures; Treatment Outcome

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Drinking Behavior; Humans; Magnetic Resonance Imaging; Osmolar Concentration; Prognosis; Renal Agents

The herbicide BASTA (AgrEvo, Germany), containing glufosinate ammonium (20%) and an anionic surfactant, polyoxyethylene alkylether sulfate (33%), is widely used. In acute oral BASTA poisoning, patients develop a variety of clinical signs, including disturbed consciousness, convulsions, and apnea. These effects are suspected to be due to the effects of glufosinate on the central nervous system.. A 60-year-old man ingested 500 mL of BASTA herbicide in a suicide attempt. He developed not only unconsciousness, respiratory distress, and convulsions but also an increase in urine output (7885 mL/d), elevated serum sodium (167 mEq/L), elevated plasma osmolality (332 mOsm/kg), and a decrease in both urine osmolality (200 mOsm/kg) and urine specific gravity (1.003), which suggested the development of diabetes insipidus. The plasma level of antidiuretic hormone remained within the normal range (1.3 pg/mL), despite high plasma osmolality. The administration of desmopressin was successful in normalizing urine volume, specific gravity, and osmolality. Serum sodium corrected gradually within 48 hours. The possible mechanisms causing the diabetes insipidus are discussed.

Topics: Aminobutyrates; Deamino Arginine Vasopressin; Diabetes Insipidus; Hemoperfusion; Herbicides; Humans; Male; Middle Aged; Poisoning; Renal Dialysis; Suicide, Attempted; Urine; Vasopressins

We report a case of a premature very low birth weight infant who presented shortly after birth with idiopathic central diabetes insipidus that persisted beyond the neonatal period and has been successfully managed with intranasal 1-desamino-8-D-arginine vasopressin. Although this condition is rare in neonates, early recognition, evaluation, and therapy may prevent more severe morbidity. Long-term successful management resulting in normal growth and development during infancy can be achieved with intranasal 1-desamino-8-D-arginine vasopressin therapy.

Topics: Administration, Intranasal; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Male; Renal Agents

We describe an 8 year-old girl with established diabetes insipidus who developed cyclophosphamide-associated antidiuresis. The patient had received cyclophosphamide as part of a high-dose chemotherapy regimen for recurrent suprasellar dysgerminoma prior to autologous bone marrow transplantation. Urinary output decreased and specific gravity increased shortly after a 1 hour i.v. infusion of 50 mg/kg cyclophosphamide and the effect lasted some 5 hours. No other drug could be implicated. This response, occurring in a patient with no ability to secrete vasopressin, suggests a direct tubular effect of one or more cyclophosphamide metabolites. Administering i.v. cyclophosphamide requires careful monitoring of fluid balance in order to avoid water intoxication. Further research is warranted both into the mechanism of this effect and the metabolite responsible for it.

Topics: Antineoplastic Combined Chemotherapy Protocols; Central Nervous System Neoplasms; Child; Cyclophosphamide; Deamino Arginine Vasopressin; Diabetes Insipidus; Dysgerminoma; Female; Humans; Urinary Retention

Growing evidence suggests that the interstitial hyaluronan (HA) content is a determinant of the fluid exchange barrier in tissues through its high resistance to water flow. This study addressed the possible involvement of renal papillary HA in water balance regulation.. In anesthetized rats during different states of renal water handling (euvolemia, water diuresis, antidiuresis), in desert rodents, and in Brattleboro rats (diabetes insipidus) with a hereditary difference in water handling, regional renal HA and water contents were measured.. The intrarenal HA distribution is heterogeneous, with 100 times larger amounts in the papilla than in the cortex. Compared with control rats, two hours of water diuresis increased the papillary HA content by 48% and that in the outer medulla by 52%, leaving the cortex unaffected. After 24 hours of water deprivation, papillary HA was decreased by 17%, while outer medullary HA remained unchanged. In gerbils, papillary and outer medullary HA contents were only 25 and 13%, respectively, of those in normal rats, while the cortical content was similar. In Brattleboro rats, the outer medullary HA content was significantly higher (285%) than in the normal rat, while the papillary content was similar. Generally, papillary HA was positively correlated to water content but was inversely related to urine osmolality.. The amount of renal papillary HA changes in response to water balance of the organism. When excess water needs to be excreted, increased papillary interstitial HA could antagonize water reabsorption. The opposite occurs during water conservation. HA may play a role in renal water handling by affecting physicochemical characteristics of the papillary interstitial matrix and influencing the interstitial hydrostatic pressure, thereby determining interstitial water diffusion.

Topics: Animals; Body Water; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Gerbillinae; Hyaluronic Acid; Kidney; Male; Rats; Rats, Brattleboro; Rats, Sprague-Dawley; Reference Values; Renal Agents; Water Deprivation

Spontaneous diabetes insipidus (DI) is an uncommon disorder. This study analysed aetiology and response to treatment in patients with spontaneous DI admitted to the endocrinology service of a teaching hospital.. Twenty patients were seen over a eight year period (1991-1998). The diagnosis of DI was confirmed in each case by the standard water deprivation test. Appropriate diagnostic procedures were carried out to determine aetiology.. Sixteen patients had complete DI and four patients had partial DI. Eighteen had central DI and two nephrogenic DI. The etiology in sixteen of the eighteen patients with central DI included: histiocytosis--three, eosinophilic granuloma--two, neurosarcoidosis--three, viper-bite--one, head injury--two, germinoma--one, post RT--one, tuberculous meningitis--one, acute-sphenoid sinusitis--one and hypothalamic tumour--one. Eleven patients (61%) responded to tab. carbamazepine, while nine (45%) required intra-nasal DDAVP. One of the two patients with nephrogenic DI responded to thiazide diuretic.. We identified the aetiology in 88% of our patients with central DI. Histiocytosis and sarcoidosis accounted for 40%. Most patients (61%) responded to treatment with oral carbamazepine, others required intra-nasal DDAVP.

Topics: Adolescent; Adult; Age Distribution; Carbamazepine; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Incidence; India; Male; Middle Aged; Prognosis; Retrospective Studies; Risk Factors; Severity of Illness Index; Sex Distribution

Central diabetes insipidus frequently occurs due to tumours in the region of pituitary or hypothalamus or following surgical trauma to these regions. Rarely it has been reported following cranial irradiation. We report the case of a middle aged woman who underwent surgical removal of a frontal capillary hemangioblastoma and received cranial irradiation. She presented ten months later with features of diabetes insipidus which was confirmed to be of central origin. She responded well to desmopressin nasal spray. Radiation induced damage to the hypothalmo-pituitary axis presents usually with anterior pituitary hormone deficiencies, most commonly that of growth hormone. Presentation as central diabetes insipidus is very uncommon.

Topics: Cerebellar Neoplasms; Cranial Irradiation; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Follow-Up Studies; Hemangioblastoma; Humans; Middle Aged; Risk Assessment

The incidence of diabetes insipidus secondary to Langerhans' cell histiocytosis (LCH) varies among different reports, ranging from 9.5 to 50%, but it has never been reported in literature in Taiwan. Therefore, we presented a case suffering from polyuria, polydipsia, body weight loss for more than one year and seborreic dermatitis-like skin lesions over the scalp and trunk for more than two years. Her body weight and body length were both less than 3 percentile. Fluid restriction and vasopressin test were performed to differentiate nephrogenic from neurogenic diabetes insipidus. Skin biopsy revealed picture of LCH and LCH with complete central diabetes insipidus was diagnosed. Brain MRI and other laboratory examinations were all within normal limits. She received nasal DDAVP treatment and chemotherapy with TPOG-H 94 protocol. After 3 months treatment, her skin lesions disappeared and daily urine amount returned to normal range.

Topics: Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Histiocytosis, Langerhans-Cell; Humans; Magnetic Resonance Imaging

This report describes a German shepherd dog that was presented with proportionate dwarfism and coat changes typical of hypopituitarism but that was also profoundly polydipsic and polyuric. Investigations established a diagnosis of concurrent central diabetes insipidus. Treatment with desmopressin was successful in managing the polyuria and polydipsia.

Topics: Animals; Deamino Arginine Vasopressin; Diabetes Insipidus; Dog Diseases; Dogs; Drinking Behavior; Hypopituitarism; Magnetic Resonance Imaging; Male; Polyuria; Renal Agents

We present here a case of prominent hypercalcemia accompanied by hypothalamic tumor and Graves' disease. A 24-year-old man with hypothalamic tumor showed hypopituitarism, central diabetes inspidus (DI) and hyperthyroidism. Nausea, loss of thirst and appetite, and general fatigue were found with the unveiling of hypercalcemia and hypernatremia. Parathyroid hormone (PTH) and 1alpha-dihydroxyvitamin D levels were suppressed with a normal range of PTH-related protein values. One-desamino-(8-D-arginine)-vasopressin (DDAVP) and half-saline administration normalized hypernatremia, while hypercalcemia was still sustained. Administration of cortisone acetate and thiamazole reduced the elevated serum Ca level. In the present case, concurrent hyperthyroidism was assumed to accelerate skeletal mobilization of calcium into the circulation. Hypocortisolism and central DI was also considered to contribute, to some extent, to the hypercalcemia through renal handling of Ca.

Topics: Adult; Antithyroid Agents; Calcitriol; Calcium; Cortisone; Craniotomy; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Therapy, Combination; Germinoma; Graves Disease; Humans; Hypercalcemia; Hypernatremia; Hyperthyroidism; Hypopituitarism; Hypothalamic Neoplasms; Magnetic Resonance Imaging; Male; Methimazole; Parathyroid Hormone; Parathyroid Hormone-Related Protein; Peptide Fragments; Proteins; Renal Agents; Sodium; Teratoma

Topics: Deamino Arginine Vasopressin; Dehydration; Diabetes Insipidus; Humans; Mutation; Receptors, Vasopressin; Renal Agents; Risk Factors; Water Intoxication

Cytoplasmic autoantibodies to vasopressin-cells (AVPcAb) have been detected not only in patients with overt central diabetes insipidus (CDI), but also in patients with endocrine autoimmune diseases without CDI. This suggests that complete CDI can be preceded by a preclinical stage. Among 878 patients with endocrine autoimmune diseases without CDI, 9 patients found to be AVPcAb positive and 139 AVPcAb-negative controls were enrolled in this open prospective study. They were evaluated for AVPcAb and posterior pituitary function at least yearly for about 4 yr (range, 37-48 months); during this span, magnetic resonance imaging (MRI) of posterior pituitary and stalk was performed only in the AVPcAb-positive patients. Five of the 9 AVPcAb-positive patients had normal posterior pituitary function at study entry. They were AVPcAb positive throughout the follow-up period. At later stages of the study, 3 of them developed partial CDI, and 1 developed complete CDI. The remaining 4 patients showed impaired response to the water deprivation test at study entry and were diagnosed as having partial CDI. Two of them agreed to receive desmopressin replacement for 1 yr. After this treatment, the patients became negative for AVPcAb and displayed normal posterior pituitary function until the end of the follow-up. Conversely, the 2 untreated patients with partial CDI remained AVPcAb positive. One of them developed overt CDI. None of the controls became AVPcAb positive or developed CDI. The normal hyperintense MRI signal of the posterior pituitary, present at study entry, persisted subsequently in all 9 AVPcAb-positive patients, including those developing overt CDI, only disappearing in the late phase of complete CDI. In asymptomatic subjects, the monitoring of AVPcAb, but not MRI, seems to be useful to predict a progression toward partial/overt CDI. Early desmopressin therapy in patients with partial CDI could interrupt or delay the autoimmune damage and the progression toward clinically overt CDI.

Topics: Adolescent; Adult; Autoantibodies; Autoimmune Diseases; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Longitudinal Studies; Magnetic Resonance Imaging; Male; Pituitary Gland, Posterior; Prospective Studies; Vasopressins; Water Deprivation

. To prepare and characterize a reversibly lipidized dipalmitoyl desmopressin (DPP), and to compare its anti-diuretic efficacy and biodistribution with that of unmodified desmopressin (DDAVP).. Dithiothreitol (DTT) was used to reduce the intramolecular disulfide bond in DDAVP, and the reduced DDAVP was treated with a thiopyridine-containing disulfide lipidization reagent, Pal-CPD. The product, DPP, was purified by acid precipitation and, subsequently, by size-exclusion chromatography. Reversed-phase HPLC was used to analyze the purity and to evaluate the hydrophobicity of the product. Mass spectrometry was employed to characterize its molecular structure. The biological activity of DPP was demonstrated by the antidiuretic effects in vasopressin-deficient Brattleboro rats. Preliminary pharmacokinetic and biodistribution studies of intravenously injected DDAVP and DPP were carried out in CF-1 mice.. DDAVP was readily reduced by a 2-fold molar excess of DTT at 37 degrees C for 0.5 hr. DPP was formed by the reaction of reduced DDAVP with Pal-CPD. Each DPP molecule contains two palmitic acid moieties, which link to the peptide via two disulfide bonds. After acid precipitation and size-exclusion chromatography, the purity was found to be approximately 95%, and the overall yield was 57%. When DPP was administered subcutaneously to Brattleboro rats, the potency of the anti-diuretic activity of DDAVP was enhanced to more than 250-fold. The plasma concentration of intravenously injected DDAVP in mice decreased rapidly during the first 20 min and followed by a slow elimination rate. However, in DPP administered mice, the plasma concentration actually increased in the first 20 min, followed by a slow elimination with a rate similar to that in DDAVP-injected mice. The regeneration of DDAVP was detected in the plasma of mice treated with DPP. Studies of the organ distribution in mice indicated that the liver retention of DPP was longer than that of DDAVP. On the other hand, the intestinal excretion of DPP was significantly less than that of DDAVP.. The 250-fold increase of the anti-diuretic potency in DPP is most likely due to a slow elimination and prolonged tissue retention, together with the regeneration of active DDAVP, in the animals. Our results indicate that reversible lipidization is a simple and effective approach for improving the efficacy of many peptide drugs.

Topics: Animals; Chromatography, High Pressure Liquid; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Dose-Response Relationship, Drug; Female; In Vitro Techniques; Lipids; Mass Spectrometry; Mice; Rats; Renal Agents; Tissue Distribution

Although disorders of ADH secretion associated with meningitis are usually consistent with the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), central diabetes insipidus (DI) is an exceptional complication of meningitis. Transient DI as a complication of Escherichia coli (E. coli) meningitis due to ventriculoperitoneal shunt in an 18-month-old boy is presented. Blood and spinal fluid cultures yielded E. coli, sensitive to cefotaxime. The DI arose on the day 3 after admission and continued to the day 20. Treatment comprised cefotaxime, dexamethasone, fluid adjustment and vasopressin. The course of our case supports that in cases of bacterial meningitis, initial fluid restriction may occasionally result in dangerous conditions. Therefore, all children with bacterial meningitis should be followed closely not only in terms of SIADH but also DI. To our knowledge this is the first transient DI associated with E. coli-caused meningitis case reported.

Topics: Dandy-Walker Syndrome; Deamino Arginine Vasopressin; Diabetes Insipidus; Escherichia coli Infections; Humans; Infant; Male; Meningitis, Bacterial; Polyuria; Radioimmunoassay; Renal Agents; Tomography, X-Ray Computed; Vasopressins; Ventriculoperitoneal Shunt

We present the eldest case ever reported of central diabetes insipidus (DI) associated with infundibulo-neurohypophysitis. A 77-year old woman, who complained of recent development of excessive thirst, polyuria and polydipsia, was referred to our hospital. The daily urine volume was markedly increased to 6 L. DDAVP administration effectively reduced urine volume and increased urine osmolality. The loading test using high-osmolar sodium chloride showed impaired excretion of vasopressin discordant with plasma osmolar changes. The anterior pituitary function was normal. Pituitary magnetic resonance imaging (MRI) showed thickening of the pituitary stalk and a lack of high-intensity signal of the neurohypophysis on T1-weighted images, suggestive of lymphocytic infundibulo-neurohypophysitis. The thickness of pituitary stalk on MRI improved 6 months later. DI was controlled with DDAVP for 40 days. This was followed by stabilization of the daily urine volume to less than 2.5 L without DDAVP. Our case is the eldest case of central DI associated with infundibulo-neurohypophysitis. The rapid remission of pituitary changes on MRI provides an insight that spontaneously partial remission of central DI may occur, resulting in transient polyuria and polydipsia.

Topics: Aged; Blood; Chlorides; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Headache; Humans; Lymphocytes; Magnetic Resonance Imaging; Osmolar Concentration; Pituitary Diseases; Pituitary Gland, Posterior; Potassium; Sodium; Thirst; Urine; Vasopressins

To study the role of vasopressin in osmoregulation in two successive pregnancies in a woman with Sheehan's syndrome.. Diabetes insipidus (DI) became manifest during two pregnancies in a woman with postpartum hypopituitarism.. Water deprivation-vasopressin administration tests demonstrated partial central DI, corrected with vasopressin in week 12, but only with desmopressin in the third trimester, when placental cystylamino peptidase (vasopressinase) contributes to the severity of the DI.. If DI occurs during pregnancy it may be the first manifestation of a latent central DI, which is often idiopathic, but rarely the first symptom of a pituitary or hypothalamic abnormality. It may also be part of Sheehan's syndrome.

Topics: Adult; Cystinyl Aminopeptidase; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Gestational Age; Humans; Hypopituitarism; Osmolar Concentration; Ovulation Induction; Placenta; Pregnancy; Pregnancy Complications; Urine; Vasopressins; Water Deprivation

We report 4 patients (3 of which were children) with diabetes insipidus and different degrees of hypopituitarism in whom a pituitary stalk enlargement was disclosed on imaging techniques, and in whom radiological and functional recovery was observed during follow-up. Pituitary substitution therapy with desmopressin, thyroxine, hydrocortisone, growth hormone and/or oral contraceptives was prescribed. During follow-up, regression of the stalk lesion was seen which was spontaneous in 2 cases, following a short course of corticosteroids in another and an empirical trial of tuberculostatic drugs in the fourth. A partial recovery of pituitary function was also observed. These cases illustrate that pituitary stalk enlargement and associated hypopituitarism may be reversible; however, this morphological and functional recovery has rarely been described in adults and has not been previously reported in children.

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Gonadotropin-Releasing Hormone; Human Growth Hormone; Humans; Hydrocortisone; Hypoglycemic Agents; Hypopituitarism; Magnetic Resonance Imaging; Male; Pituitary Gland; Thyrotropin-Releasing Hormone; Thyroxine; Tomography, X-Ray Computed

Meningitis is often associated with hyponatremia due to inappropriate secretion of antidiuretic hormone, and diabetes insipidus is associated with bacterial meningitis. This article describes a patient with acquired immunodeficiency syndrome who experienced recurrent episodes of central diabetes insipidus in association with recurrent fungal meningitis. Desmopressin was effective in controlling the polyuria until the episodes of meningitis resolved.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Cryptococcosis; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hypoglycemic Agents; Male; Meningitis, Fungal; Recurrence

The paper describes a patient with Asperger disorder, Neurogenic Diabetes Insipidus (NDI) and Primary Empty Sella (ES). His response to vasopressin treatment suggested a concomitant presence of primary polydipsia. This is the first reported case of an autistic spectrum disorder associated with NDI or ES. The implications of the observed co-occurrence of these relatively rare disorders are discussed in relation to diagnosis and pathogenesis.

Topics: Adult; Autistic Disorder; Comorbidity; Deamino Arginine Vasopressin; Diabetes Insipidus; Drinking; Empty Sella Syndrome; Humans; Magnetic Resonance Imaging; Male; Pituitary Gland, Posterior; Syndrome; Water Intoxication

The aim of the current study was to evaluate the biochemical parameters of bone metabolism and the bone mineral density (BMD) in patients with central diabetes insipidus, either treated or not treated with endonasal desmopressin. Eighteen patients with central diabetes insipidus and 18 sex- and age-matched healthy subjects entered the study. The patients were divided into 2 groups: patients who did not receive treatment with desmopressin for at least 1 yr (group 1), and patients chronically treated with desmopressin since the diagnosis of diabetes insipidus (group 2). Serum osteocalcin and urinary cross-linked N-telopeptide of type I collagen levels were measured in all patients and controls using RIA and enzyme-linked immunosorbent assay kits, respectively. BMD was measured at the lumbar spine (L1-L4) and at the femoral neck in all subjects, using a Hologic QDR 1000 analyzer (Hologic Inc., Waltham, MA). Serum osteocalcin concentrations were significantly lower, both in patients of group 1 and group 2, compared with healthy subjects (5.1 +/- 0.6 and 4.5 +/- 0.3 vs. 7.9 +/- 0.2 micrograms/L, P < 0.05), whereas urinary cross-linked N-telopeptide of type I collagen concentrations were similar in the three groups of subjects (72.8 +/- 2.2, 71.6 +/- 2.7, and 64.6 +/- 1.7 nmol bone collagen equivalent/mmol creatinine). BMD was significantly decreased in patients of groups 1 and 2, compared with controls, both at lumbar spine (0.84 +/- 0.06 and 0.87 +/- 0.04 vs. 1.01 +/- 0.02 g/cm2, P < 0.05) and femoral neck (0.78 +/- 0.06 and 0.80 +/- 0.04 vs. 0.93 +/- 0.02 g/cm2, P < 0.05). A significant inverse correlation was found between disease duration and BMD values, evaluated as T scores, both at lumbar spine (group 1: r = -0.952, P < 0.005; group 2: r = -0.921, P < 0.001) and at femoral neck (group 1: r = -0.914, P < 0.05; group 2: r = -0.683, P < 0.05). In conclusion, patients with central diabetes insipidus had a significant bone impairment, compared with healthy subjects. Replacement with endonasal desmopressin at standard doses was not able to prevent or reverse the bone impairment. These findings suggest that, in patients with central diabetes insipidus, bone status analysis is mandatory; and a bone-loss preventing treatment might be beneficial.

Topics: Administration, Intranasal; Adolescent; Adult; Bone Density; Bone Development; Bone Resorption; Case-Control Studies; Collagen; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Femur Neck; Humans; Hypoglycemic Agents; Lumbosacral Region; Male; Middle Aged; Osteocalcin; Peptide Fragments; Spine

In a retrospective study, the intra- and early postoperative data of 39 children with 46 operations for craniopharyngioma were analyzed. Diabetes insipidus (DI) occurred in 30 out of 32 cases without preoperative evidence of DI. We observed that all children who did not have a pituitary stalk preserved and 5 out of 7 patients with preserved pituitary stalk developed DI within 18 h of surgery. Short-term inappropriate secretion of antidiuretic hormone (SIADH) occurred in 2 children, but was quickly followed by DI. The time of onset of DI and SIADH did not correlate with sex, age, body weight, location of tumor, or duration or extent of surgery. Parenteral desmopressin was an effective treatment for intra- and postoperative DI. The duration of the clinical effect of desmopressin administration varied in different patients between 4 and 23 h. An approach to the immediate intra- and postoperative management of children with craniopharyngioma is presented.

Topics: Administration, Intranasal; Adolescent; Child; Child, Preschool; Combined Modality Therapy; Craniopharyngioma; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Fluid Therapy; Humans; Inappropriate ADH Syndrome; Infant; Infant, Newborn; Male; Perioperative Care; Pituitary Neoplasms; Postoperative Complications; Retrospective Studies; Water-Electrolyte Imbalance

In the kidney, facilitated urea transport in precise vascular and tubular structures is mainly involved in water conservation. Three urea transporters have been cloned: UT2-long expressed in terminal inner medullary collecting duct (IMCD), UT2-short expressed in thin descending limb, and UT11 in descending vasa recta. The effect of arginine vasopressin (AVP) administration on mRNA expression of these three transporters was examined in Brattleboro rats with diabetes insipidus. V2 effects were discriminated from combined V1 + V2 effects by comparing treatments with 1-deamino-8-D-AVP (dDAVP) (selective V2 agonism) and AVP (V1 and V2 agonism). Acute and chronic treatments were studied. Abundance of specific mRNA was assessed by quantitative Northern blot analysis of RNA extracted from two regions of inner stripe of outer medulla and from two regions of inner medulla (IM). The results show that mRNA of these urea transporters are differently regulated by AVP. (1) Long-term treatment with either AVP or dDAVP does not alter UT2-long mRNA in tip IM (terminal IMCD) except for a transient initial decrease. (2) Unlike AVP, dDAVP induces the appearance of significant expression of UT2-long mRNA in base IM (initial IMCD), indicating a major V2 effect. (3) UT2-short mRNA in deep inner stripe of outer medulla and base IM (thin descending limb of short and long loops, respectively) is progressively upregulated with duration of AVP or dDAVP treatment. (4) The much higher changes in UT2-long and UT2-short induced by dDAVP compared with AVP suggest that they are dependent mainly on V2 agonism, and likely attenuated by V1 agonism. (5) UT11 mRNA expression in tip IM is equally depressed by AVP and dDAVP, indicating that this vascular transporter is also influenced by AVP and/or urine-concentrating activity, via an indirect mechanism that remains to be determined.

Topics: Animals; Arginine Vasopressin; Carrier Proteins; Deamino Arginine Vasopressin; Diabetes Insipidus; Gene Expression; Kidney; Kidney Tubules; Male; Membrane Glycoproteins; Membrane Transport Proteins; Rats; Rats, Brattleboro; RNA, Messenger; Tissue Distribution; Urea; Urea Transporters; Vasopressins

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Female; Humans; Infant, Newborn; Meningitis, Bacterial; Renal Agents; Streptococcal Infections; Streptococcus agalactiae

We reported 4 cases of lymphocytic infundibuloneurohypophysitis. All four patients had diabetes insipidus as initial symptoms without anterior pituitary dysfunction. All patients showed pituitary stalk swelling and two patients showed enlargement of the pituitary gland. No patients were operated on for a histological diagnosis. No patients received corticosteroid treatment for this pathology. The mean follow-up period was 36 months. The diabetes insipidus continued in all cases, but radiological findings showed improvement in all cases. In one case, adrenal insufficiency occurred after 10 months, but had disappeared 6 months later. We think lymphocytic infundibuloneurohypophysitis can be diagnosed without histological examinations and can be treated conservatively without corticosteroid treatment. It seems to be a self-limiting disease. This disease can be distinguished from lymphocytic adenohypophysitis, but in some cases, both the anterior and posterior pituitary glands are invaded, and in this situation lymphocytic hypophysitis may be an appropriate name. Even if the initial symptom is diabetes insipidus, careful follow-up is needed for the duration of the disease.

Topics: Aged; Chronic Disease; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Inflammation; Lymphocytes; Magnetic Resonance Imaging; Male; Middle Aged; Pituitary Diseases; Pituitary Gland

Diabetes insipidus is uncommon in pregnancy. Despite physiological modifications in hydroelectrolytic balance during normal pregnancy, the capacity of the kidney to concentrate urine is preserved, partially due to lower vasopressin secretion.. A young woman developed diabetes insipidus during the third trimester of normal pregnancy. The disease regressed totally after delivery. However, magnetic resonance imaging revealed a persistent expansive intrasellar image with a high-intensity signal.. Onset of diabetes insipidus is usually rapidly progressive in pregnancy. Occurring generally during the third trimester in normal pregnancies, diabetes insipidus is generally well tolerated and responds to dDAVP, usually without pituitary abnormally, and regresses after delivery. Two types are distinguished: partially latent diabetes insipidus occurring during pregnancy and due to a central rather than nephrogenic origin; and excessive vasopressinase activity leading to diabetes insipidus usually associated with liver anomalies and high frequency of pre-eclampsia. During normal pregnancy, the size of the anterior pituitary increases and the normal high-intensity signal in the posterior pituitary seen on MRI usually regresses or disappears. In diabetes insipidus, the posterior pituitary hypersignal image generally disappears, reflecting reduced vasopressin storage. Few observations of diabetes insipidus occurring during pregnancy have been reported with morphological explorations. Most have described a "normal" aspect of the pituitary, specifically in the post partum period. In our patient, the weak vasopressin response to the end of water restriction at post partum when the diabetes insipidus symptoms had disappeared would suggest partial central diabetes insipidus revealed by pregnancy. Other pathologies involving this region could also be involved due to the unusual and persistent sellar image, with an expansive process showing a high intensity signal on MRI. An asymptomatic craniopharyngioma cyst was hypothesized and would be more compatible with the observed symptoms.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hypothalamo-Hypophyseal System; Kidney; Magnetic Resonance Imaging; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Third; Renal Agents

DDAVP (desmopressin, Minirin is now available in tablet form. We studied the switch from nasal to oral administration in patients taking DDAVP for diabetes insipidis. A retrospective analysis included 56 patients. Mean nasal dosage was found to be 20.4 micrograms desmopressin and mean oral dosage was 417 micrograms. This gave a dosage ratio of about 20, in agreement with current data on the drug's bioavailability. In addition, the daily dose was fractioned more often with oral administration than with nasal administration. This study prepares the way for a prospective study needed to better define the conditions for oral administration of DDAVP (Minirin).

Topics: Administration, Intranasal; Administration, Oral; Adult; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Administration Schedule; Humans; Renal Agents; Retrospective Studies; Surveys and Questionnaires

We encountered a pregnant woman with transient diabetes insipidus which developed during the third trimester. A hypertonic saline infusion study did not concentrate the osmolality of urine. Her laboratory data showed hypokalemia, hyperreninemia, an increased concentration of plasma aldosterone and an increased urinary excretion rate of prostaglandin E2, which resembled hyperprostaglandin E-syndrome. T1-weighted magnetic resonance imaging of the posterior pituitary gland revealed decreased intensity. Polyuria reached 4-6 L daily, and urine osmolality remained dilute despite a lapse of four days since treatment with intranasal 1-desamino-8-D-arginine vasopressin (dDAVP: 10-25 microg every 12 h). The patient was conservatively managed without medical treatment, then delivered in the 38th week of pregnancy without complication. The osmolality of the patient's urine was higher than that of the plasma when tested 3 days postpartum. The abnormality of magnetic resonance imaging of the posterior pituitary gland disappeared at 6 months after delivery. We consider that subclinical nephrogenic diabetes insipidus in our patient was exacerbated during pregnancy.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Magnetic Resonance Imaging; Pituitary Gland; Pregnancy; Pregnancy in Diabetics; Pregnancy Outcome; Pregnancy Trimester, Third; Renal Agents; Treatment Outcome

Fourteen of 58 (24%) children with Langerhans cell hisiocytosis (LCH) currently attending the Hospital for Sick Children (London) developed thirst and polyuria during the course of their disease. Three had single-system disease confined to bone, and 11 had multisystem disease. The median age at presentation of LCH was 2 years 0 months, and polyuria/polydipsia developed at a median age of 3 years 9 months (range 1 month before diagnosis of LCH to 4 years after diagnosis). Each child had a water deprivation test with measurement of urinary arginine vasopressin (AVP) to document diabetes insipidus. The doses of 1-desamino-8-D arginine vasopressin (DDAVP) required to control symptoms were compared at diagnosis and at a mean follow-up of 7 years 8 months. Local and systemic treatment was recorded. Ten of 14 children were shown to have "complete" diabetes insipidus, whilest the other four had "partial" diabetes insipidus. Seven children were treated with irradiation. with or without systemic chemotherapy, six with systemic chemotherapy only, and one with DDAVP replacement only. No child, including two with partial diabetes insipidus irradiated within 4 weeks of the onset of symptoms, lost symptoms of polyuria/polydypsia and none was able to discontinue DDAVP replacement. One child treated with Etoposide showed a temporary rise in urinary AVP level to within the normal range but still needed DDAVP to control her symptoms. The mean doses of DDAVP at onset of diabetes insipidus and at follow-up were 9.3 micrograms and 18 micrograms daily, respectively. We conclude that the most appropriate treatment for reversing diabetes insipidus complicating Langerhans cell histiocytosis is yet to be determined. Precise documentation of posterior pituitary dysfunction, including measurement of urinary AVP levels, is essential if the effects of new forms of treatment are to be assessed accurately.

Topics: Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Histiocytosis, Langerhans-Cell; Humans; Hypoglycemic Agents; Infant; Male

Diabetes insipidus, which presents with polyuria, polydipsia, and profound electrolyte abnormalities, occurs rarely in pregnancy. We report a patient with severe oligohydramnios that resolved after treatment of diabetes insipidus.. A 14-year-old girl was admitted at 33 weeks' gestation with cramping and vaginal spotting. A sonogram indicated oligohydramnios and an amniotic fluid index (AFI) of 2.6, with normal fetal kidneys and bladder. On hospital day 2, the AFI was 0.0. Recorded fluid was 8 L in and 13.6 L out. Serum sodium was 153 mEq/L. Diabetes insipidus was diagnosed and treated with intranasal desmopressin acetate. The oligohydramnios resolved rapidly, and the patient delivered a healthy 2700-g male infant at 38 weeks.. Although rare, diabetes insipidus may present initially in pregnancy and should be considered in patients with oligohydramnios. Simple diagnosis with determination of 24-hour urine volume and serum electrolytes can identify this potentially reversible cause of oligohydramnios and poor obstetric outcome.

Topics: Adolescent; Amniotic Fluid; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Female; Humans; Hypoglycemic Agents; Infant, Newborn; Male; Oligohydramnios; Pregnancy; Pregnancy Complications; Pregnancy in Adolescence; Sodium; Ultrasonography, Prenatal

The majority of cases of central diabetes insipidus are still pathogenetically unclear (idiopathic). Atherosclerotic cholesterol emboli might be partly responsible for some of these idiopathic cases. A 54-year-old woman with known aortic valve stenosis and a history of a transitory ischemic attack presented with sudden-onset polyuria and polydipsia of up to eight l/d, which had started acutely with headaches. She had been treated with lithium for 3 years because of cyclothymic depression. Plasma sodium was in the upper normal range (142-148 mmol/l). Hypertonic saline infusion during lithium therapy revealed a normal threshold of thirst and resetting of vasopressin secretion (osmotic threshold > 300 mosmol/l), whereas vasopressin reserve was normal. Lithium withdrawal led to an even greater delay of vasopressin release upon hypertonic saline infusion (> 310 mosmol/l). Pituitary function tests revealed a normal anterior pituitary function. MR imaging of the hypothalamo-hypophyseal region showed a normal hypothalamic region and a highly intensive neurohypophyseal signal in the T1-weighted image. The patient responded well to desmopressin. We suggest that in this rare case clinical symptoms as well as biochemical findings like impairment of AVP release might be related to a minor structural hypothalamic damage by a vascular lesion, caused, for example, by an atheromatous (cholesterol) embolism in the hypothalamic region responsible for integration of osmoreceptor function and AVP-secretion. The patient's atherosclerosis and aortic stenosis might be responsible for this event.

Topics: Aortic Valve Stenosis; Arginine Vasopressin; Arteriosclerosis; Deamino Arginine Vasopressin; Diabetes Insipidus; Drinking; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Polyuria; Saline Solution, Hypertonic

We present six cases of diabetes insipidus (DI) complicating pregnancy. In three cases, DI was manifested during pregnancy and required the administration of desmopressin acetate (1-desamino-8-D-arginine vasopressin, DDAVP). All these cases exhibited abnormal laboratory data such as an elevation of liver enzymes or a decrease in serum antithrombin III. The remaining three cases had suffered from DI before pregnancy which was well controlled on DDAVP. The clinical courses of these pregnancies were all uneventful subsequent to therapy. If DI is first recognized during pregnancy, attention should be paid to the possibility of abnormal liver function and eclampsia.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes, Gestational; Female; Humans; Hypoglycemic Agents; Liver; Pregnancy; Pregnancy in Diabetics

In the differential diagnosis of patients with polyuria-polydipsia one must distinguish usually between primary polydipsia (PP) and central diabetes insipidus (CDI). The first situation is a state of volume expansion and the second of volume contraction. We evaluate whether serum uric acid determination could help to differentiate between the two conditions.. We analyzed the score of 13 consecutive patients with CDI, 7 patients with PP, and 7 patients with nephrogenic diabetes insipidus (NDI). Serum uric acid concentration was available during normonatremia without treatment with 1-desamino-8-D-arginine vasopressin (dDAVP), during mild dehydration and during treatment with dDAVP. In 8 of these patients plasma renin activity (PRA), urate, urea and creatinine clearances were also available. These data were also obtained in the patients with NDI. In 1 patient with CDI, we studied the effect on urate clearance of dDAVP, which stimulates exclusively the V2 receptors, and of triglycyl-lysine-vasopressin (TGLV), a potent V1-receptor agonist.. Normonatremic polydypsic patients with CDI presented an increase in uric acid concentration (7.1 +/- 2.2 mg/dL), whereas in the PP group the value was decreased (3 +/- 0.75 mg/dL; P <0.001). All the normonatremic PP presented a serum uric acid concentration lower than 5 mg/dL, whereas all the normonatremic CDI patients, exept 1, presented a value higher than 5 mg/dL. In both groups blood urea concentration was decreased as a consequence of high renal clearances. The hyperuricemia of CDI was related to low uric acid clearances. Patients with hypernatremia and NDI presented a lower increase in serum uric acid concentration than those with similar levels of hypernatremia and CDI (NDI: 5.7 +/- 0.8 mg/dL and CDI: 7.9 +/- 2.3 mg/dL; P <0.05) and the NDI patients presented an urate clearance corrected for creatinine clearance which was significantly higher than in CDI (9% +/- 3% and 4% +/- 1.1%; P <0.01). When the patients with CDI were treated with dDAVP and normalyzed their PRA (0.9 +/- 0.4 ng/mL/h) we observed still mild hyperuricemia compared to controls (5.5 +/- 1.4 mg/dL and 4.3 +/- 0.9 mg/dL; P <0.01) and a low fractional excretion of filtered uric acid (6.5% +/- 1.7% compared to 8.2% +/- 2% in controls; P <0.05). Acute administration of dDAVP, stimulating the V2 receptors, in one patient with CDI, had no effect on urate clerance, while TGLV, which stimulates the V1 receptor, increased urate clearance.. The presence of an serum uric acid concentration higher than 5 mg/dL in polyuric polydipsic patients is highly suggestive of CDI. Even when these patients are treated with dDAVP many of them remain hyperuricemic, and this seems to be the consequence of a lack of V1 receptor stimulation.

Topics: Adult; Antihypertensive Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Insipidus, Nephrogenic; Diagnosis, Differential; Drinking; Female; Humans; Hypernatremia; Lypressin; Male; Medical Records; Renal Agents; Retrospective Studies; Sodium; Terlipressin; Uric Acid

A young white man with new-onset central diabetes insipidus was discovered to have a posterior pituitary mass on magnetic resonance imaging. No other radiological abnormalities were noted in the anterior pituitary, infundibulum or hypothalamus. No other endocrinopathies were present: laboratory investigations showed normal basal concentrations of anterior pituitary hormones, including prolactin. The patient was suspected to have sarcoidosis affecting the posterior pituitary, because of the discovery of pulmonary sarcoidosis during his diagnostic evaluation. His symptoms of polydipsia and polyuria responded promptly to intranasal administration of 1-desamino-8-D-arginine vasopressin (DDAVP). The patient demonstrated complete regression of the posterior pituitary mass after a course of corticosteroid therapy. However, his diabetes insipidus persisted and he continues to need DDAVP treatment, currently at 12 months of follow-up. The resolution of the neurohypophysial mass was compatible with the diagnosis of pituitary sarcoidosis and this precluded the need for a transsphenoidal biopsy or surgery.

Topics: Adrenal Cortex Hormones; Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Lung Diseases; Magnetic Resonance Imaging; Male; Pituitary Diseases; Pituitary Gland, Posterior; Radiography, Thoracic; Sarcoidosis

A 61-year-old man who had a 10-year history of anhidrosis was found to have idiopathic diabetes insipidus. He showed no spontaneous sweating or pilocarpine-induced sweat response. Skin pathology showed a normal eccrine gland. Microneurography detected no skin sympathetic nerve activity. Within a month of desmopressin treatment for diabetes insipidus, sweating and skin sympathetic nerve activity returned.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Electrophysiology; Humans; Hypoglycemic Agents; Hypohidrosis; Male; Middle Aged; Pilocarpine; Skin; Sweat Glands; Sweating; Sympathetic Nervous System

Vasovagal reflexes, such as hypotension and bradycardia, are induced by rapid hemorrhage and mimic neurocardiogenic reflexes in mammals. We examined the role of vasopressin in the neurocardiogenic responses to mild, rapid hemorrhage (1 mL/100 g for 30 seconds) and severe hemorrhage (1 mL/100 g body wt for 30 seconds repeated three times at 11-minute intervals) in homozygous Brattleboro and Long-Evans rats. Mild, rapid hemorrhage induced severe bradycardia and hypotension only in Long-Evans rats. Exogenous vasopressin (1.85 pmol/kg per minute for 1 hour) restored both the bradycardic and hypotensive responses in Brattleboro rats. DDAVP, a vasopressin V2-receptor agonist (0.19 pmol/kg per minute for 24 hours), did not affect the cardiovascular responses to hemorrhage in Brattleboro rats, although it maintained urine production within normal limits. However, OPC-31260 (21.6 mumol/kg IV), a vasopressin V2-receptor antagonist, attenuated both the hypotensive and bradycardic responses to hemorrhage in Long-Evans rats. A vasopressin V1-receptor antagonist attenuated bradycardia and delayed the recovery of arterial pressure after hemorrhage but did not affect the hypotension that occurred immediately after hemorrhage in Long-Evans rats. Methylatropine also attenuated both the bradycardic and hypotensive responses induced by hemorrhage, but propranolol had no effect on the cardiovascular responses to hemorrhage in Long-Evans rats. The recovery of arterial pressure after repeated hemorrhage was less adequate in Brattleboro rats than in Long-Evans rats. Our results suggest that the neurocardiogenic responses to hemorrhage, especially hypotension, may be related to vasodilation induced by a V2-receptor-mediated mechanism and by the vagal reflex, both of which are substantiated by the existence of vasopressin. The coexistence of V1- and V2-receptor mechanisms may be necessary for the hypotensive response to hemorrhage. We found that a V2-receptor antagonist attenuated the hypotension mediated by the so-called neurocardiogenic reflex.

Topics: Acute Disease; Animals; Antidiuretic Hormone Receptor Antagonists; Arginine Vasopressin; Autonomic Nerve Block; Benzazepines; Cardiovascular System; Deamino Arginine Vasopressin; Diabetes Insipidus; Heart; Hemorrhage; Male; Nervous System; Rats; Rats, Brattleboro; Rats, Inbred Strains; Receptors, Vasopressin; Recurrence; Vasopressins

As diabetes insipidus in brain-dead organ donors leads to hypovolaemia, hyponatraemia, and hypotension, desmopressin is recommended for treatment of diabetes insipidus. As its effect on early renal allograft function remains unclear, we conducted a study to evaluate the effect of desmopressin on renal-graft survival.. We report the results of a prospective study in 41 brain-dead organ donors (mean age 45 +/- 12 years) with diabetes insipidus, who were treated either with adequate fluid substitution and bolus application of desmopressin (desmopressin group; n = 22) or with volume substitution along (control group; n = 19). Donors as well as recipients of both groups were well matched with respect to age, sex, dopamine dosage, serum electrolytes, cold ischaemic time, HLA match, number of prior transplantations, and current cytotoxic antibodies. Early renal allograft function was evaluated in 71 recipients (mean age 48 +/- 4 years within 3 days after transplantation.. Overall, primary non-function was observed in 26 (36.6%) of 71 recipients. The rate of primary non-function was significantly higher in the desmopressin group compared to the control group (desmopressin group 48.6%; control group 23.5%; P = 0.28).. The use of desmopressin during organ procurement is associated with a higher rate of primary non-function of renal allografts.

Topics: Adolescent; Adult; Aged; Brain Death; Child; Creatinine; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Graft Survival; Humans; Kidney Transplantation; Male; Middle Aged; Prospective Studies; Renal Agents; Tissue and Organ Procurement; Transplantation, Homologous

In hyponatremia related to syndrome of inappropriate antidiuretic hormone (SIADH), hypouricemia is explained primarily by the high uric acid clearance rate that results from the decrease in tubular uric acid reabsorption. This modification of tubular handling of uric acid is considered to be induced by the increase in the "effective vascular volume". This study was designed to determine if V1-receptor stimulation participates in the development of a high uric acid clearance rate as in SIADH, in which the antidiuretic hormone acts on V1 and V2 receptors. Therefore, the urate clearance rate was measured in seven volunteers with 1-desamino-8-D-arginine vasopressin (dDAVP)-induced hyponatremia, with dDVAP stimulating exclusively the V2 receptors (Group I), and in six patients with SIADH (Group II) during both normo- and hyponatremia. As expected, in both groups, the serum uric acid concentration decreased during hyponatremia, but did so to a larger extent in the patients with SIADH (-53% versus -29%, P < 0.02). Despite similar levels of hyponatremia (126 +/- 5 mmol/L and 125 +/- 5.5 mmol/L), of hypoproteinemia (64 +/- 5 g/L and 63 +/- 5 g/L) and of salt excretion (FENa, 0.66 +/- 0.28% and 0.73 +/- 0.25%), the urate clearance (8.3 +/- 3.3 mL/min) and the fractional excretion of filtered uric acid (5.7 +/- 2%) in Group I were not significantly different during hyponatremia than during normonatremia (6.4 +/- 1.5 mL/min and 5.4 +/- 0.9%). On the other hand, in Group II, both parameters were increased (17.8 +/- 2.9 mL/min and 19.6 +/- 5.3%; P < 0.001) and both values were higher than in the dDAVP-induced hyponatremia (P < 0.01). Additionally, the administration of a potent V1-receptor agonist (triglycyl-lysine-vasopressin) in a patient with central diabetes insipidus with preexisting dDAVP-induced hyponatremia produced a rapid increase of urate clearance. Because dDAVP acts only on the V2 receptors, these data suggest that the higher urate clearance observed during hyponatremia related to SIADH is not only the consequence of an increased "effective vascular volume," but that V1-receptor stimulation also contributes to it, by a mechanism that remains to be determined.

Topics: Adult; Body Water; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hyponatremia; Inappropriate ADH Syndrome; Kidney Tubules, Proximal; Lypressin; Male; Metabolic Clearance Rate; Natriuresis; Receptors, Vasopressin; Sodium; Terlipressin; Uric Acid

The effect of pulse parameters (duty and frequency) in a constant direct current iontophoresis on the antidiuretic response (elevation in rat urinary osmotic pressure) of desmopressin acetate (DDAVP) was examined in diabetes insipidus rats. Although antidiuretic response was not affected by frequency, it was induced by a duty of more than 26% and prolonged with increasing duty. A positively relationship between dose and AUC, the area under the osmotic pressure-time curve, was confirmed by intravenous administration of DDAVP, and the AUC induced by the iontophoretic delivery increased with increasing duty. The voltage across rat skin required to maintain a constant current density was investigated. A higher voltage was initially applied rat skin in a higher duty. This was related the prolonged pharmacological response induced by iontophoresis.

Topics: Animals; Deamino Arginine Vasopressin; Diabetes Insipidus; Disease Models, Animal; Diuresis; Dose-Response Relationship, Drug; Electricity; Iontophoresis; Male; Rats; Rats, Wistar; Renal Agents; Skin Absorption

Recovery of the pituitary function from post-traumatic hypopituitarism is an exceptional event. We present the case of a 32 year-old man who was involved in a road traffic accident in which he suffered a severe head injury. Four days following the trauma the patient developed post-traumatic central diabetes insipidus and desmopressin was started. At discharge of the intensive care unit, the patient was referred to us for endocrine assessment. Three months after the head injury, the hormonal evaluation of the hypothalamic-pituitary axis by means of insulin stress test with the simultaneous administration of TRH and GnRH resulted in reduced responses of GH, cortisol, TSH, FSH, and LH with low baseline serum concentrations of free T4 and testosterone. Both serum basal and stimulated PRL concentrations were normal. Magnetic resonance imaging demonstrated deformity of the sella turcica with displacement of the pituitary gland by a post-traumatic retention cyst. A new evaluation of the pituitary function performed 6 months after the trauma showed spontaneous recovery of the gonadal, thyroid and adrenal function. However, GH response was reduced both to insulin-induced hypoglycemia, clonidine and GHRH tests. Presence of normal serum PRL levels, normal PRL response to TRH and reduced GH responses to pituitary and hypothalamic stimuli suggests both hypothalamic and pituitary damage. The present case shows an unusual case of partial spontaneous resolution of a post-traumatic hypopituitarism. Based on this clinical observation we recommend periodic evaluation of the pituitary function in these kind of patients.

Topics: Accidents, Traffic; Adult; Brain Injuries; Deamino Arginine Vasopressin; Diabetes Insipidus; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Human Growth Hormone; Humans; Hydrocortisone; Hypopituitarism; Hypothalamus; Insulin; Luteinizing Hormone; Magnetic Resonance Imaging; Male; Pituitary Gland; Prolactin; Thyrotropin; Thyrotropin-Releasing Hormone

1. The pharmacokinetics and pharmacodynamics of intranasal (IN) and oral 1-deamino-8-D-arginine vasopressin (DDAVP) were compared in 10 Chinese adults with central diabetes insipidus previously controlled on IN DDAVP. This was followed by comparison of the acute pharmacodynamics of commonly used oral preparations (containing 100, 200 and 400 micrograms per tablet) and a 1 year prospective evaluation of the long-term safety and efficacy of oral DDAVP. 2. Following 20 micrograms IN and 200 micrograms orally, respective plasma DDAVP concentrations peaked after 45.6 +/- 7.3 and 93.3 +/- 3.3 (mean +/- s.e.mean) min, reaching 24.1 +/- 4.7 and 15.1 +/- 3.2 pmol 1(-1) and respective terminal half-lives were 2.2 +/- 0.1 and 2.0 +/- 0.1 h. Based on the area under the concentration-time-curve, the bioequivalent IN/oral ratio was 1:16. 3. As judged by changes in urine flow rate and osmolality after IN or oral (100, 200 or 400 micrograms) DDAVP, antidiuretic activity increased rapidly during the second hour and peaked at 4 h. The antidiuresis duration and magnitude correlated with the oral dose (P < 0.001 and < 0.05 respectively), and was least following 100 micrograms (P < 0.01 vs 200 or 400 micrograms). Increasing the dose from 200 to 400 micrograms did not increase maximal antidiuretic activity significantly, but there was a trend towards a longer duration of action (P = 0.076). 4. During the 1-year prospective study with oral DDAVP 300-600 micrograms per day in two to three doses, stable and satisfactory antidiuresis (comparable with that on previous IN therapy) was maintained; tablets were well-tolerated and no side-effect warranted drug withdrawal. 5. These findings suggest that the 100 and 200 micrograms preparations of oral DDAVP are adequate for the long-term control of central diabetes insipidus in our population, and that the 400 micrograms preparation may have a role if the frequency of administration is to be reduced.

Topics: Administration, Intranasal; Administration, Oral; Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Female; Follow-Up Studies; Humans; Male; Osmolar Concentration; Prospective Studies

To assess clinical signs, biochemical findings, results of modified water deprivation and other diagnostic tests, response to treatment, and survival time in dogs with central diabetes insipidus (CDI).. Retrospective study.. 20 dogs with CDI.. Signalment, history, physical examination, results of diagnostic tests, response to treatment, and survival time were extracted from the medical record of each dog and supplemented with information obtained from owners via telephone.. Isosthenuria or hyposthenuria was a consistent finding. Seven dogs with complete CDI and 13 dogs with partial CDI were identified on the basis of results of a modified water deprivation test. Dogs treated with desmopressin acetate responded well to treatment. Seven dogs were alive 18 to 72 months (median, 36 months) after diagnosis, and 10 dogs died or were euthanatized 1 week to 2 years (median, 2 months) after diagnosis. Seven of 10 dogs that died developed neurologic signs after diagnosis of CDI. Computed tomography revealed a mass in the region of the pituitary gland in 5 of 7 dogs. Necropsy of 6 dogs, including 2 dogs on which computed tomography had been performed, revealed neoplasia in the pituitary gland.. Onset of neurologic signs after diagnosis of CDI in middle- to old-aged dogs indicates that CDI may not be a benign disease that is treated easily. Brain imaging is recommended after diagnosis of CDI in middle- to old-aged dogs. Also, because many dogs are isosthenuric on initial examination, CDI cannot be ruled out as a cause of polyuria and polydipsia on the basis of lack of hyposthenuria.

Topics: Animals; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Dog Diseases; Dogs; Female; Follow-Up Studies; Male; Renal Agents; Retrospective Studies; Specific Gravity; Treatment Outcome; Urine; Water Deprivation

We describe a case of diabetes insipidus (DI) due to a pituitary tumor in a 33-year-old pregnant woman who developed a sudden onset of polyuria (over 8 l/day) and polydipsia at 30 weeks of gestation. Her plasma concentration of vasopressin (AVP) was low compared with high serum osmolality (298 mOsm/kg), and her urine output was well controlled by treatment with desmopressin acetate (DDAVP). Cranial magnetic resonance imaging (MRI) demonstrated a 1.8 x 1.2-cm pituitary tumor, but she did not have any disturbance in the release of anterior pituitary hormones. The serum concentration of cystine aminopeptidase (CAP) was within the normal range for a woman at 34 weeks of gestation. After an uncomplicated delivery of a healthy girl, her polyuria gradually resolved. The size of the pituitary tumor gradually decreased in parallel to a reduction in her urine output, but a silent hemorrhage was detected in her pituitary gland 4 weeks after the delivery. Although pregnancy is sometimes associated with central DI, the occurrence of DI due to pituitary tumor under pregnancy is rare. The basal AVP recovered to within the normal range, but the low response of AVP secretion to high osmolality persisted. In this case, pregnancy may affect the manifestation of subclinical DI. This case may therefore enhance our understanding of the mechanisms of DI during pregnancy.

Topics: Adenoma; Adult; Body Weight; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hypoglycemic Agents; Magnetic Resonance Imaging; Osmolar Concentration; Pituitary Function Tests; Pituitary Gland, Anterior; Pituitary Neoplasms; Pregnancy; Pregnancy Complications; Pregnancy Complications, Neoplastic; Pregnancy Trimester, Third; Time Factors; Urine; Vasopressins

Both central diabetes insipidus (DI) and a high rate of excretion of sodium (Na) and chloride (Cl) contributed to the development of polyuria and dysnatremia in two patients during the acute postoperative period after neurosurgery. To minimize difficulties in diagnosis and projections for therapy, two available (but not often used) clinical tools were helpful. First, the osmole excretion rate early on revealed the co-existence of central DI and an osmotic diuresis. The osmoles excreted were largely Na salts; after antidiuretic hormone acted, this electrolyte diuresis caused the urine flow rate to be much higher than otherwise anticipated. Interestingly, part of this saline diuresis occurred when the extracellular fluid volume was contracted. The tool to explain the basis for the dysnatremias was a tonicity balance. Hypernatremia, which developed before treatment of central DI, was primarily a result of a positive balance for Na rather than a large negative balance for water. Moreover, hyponatremia that developed once antidiuretic hormone acted was primarily a result of a negative balance for Na; the urine volume was large and its Na concentration was hypertonic. To prevent a further decline in the plasma Na concentration, either the Na concentration in the urine should be decreased by provision of urea or a loop diuretic while replacing all unwanted water and electrolyte losses; alternatively, the fluid infused should have a similar Na concentration and volume as the urine (infuse hypertonic saline).

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Female; Humans; Hypernatremia; Hyponatremia; Male; Natriuresis; Osmosis; Postoperative Complications; Sodium; Vasopressins

A 13-year-old boy's acute onset of diabetes insipidus was the first manifestation of a pineal tumor. One year after the physical symptoms of diabetes insipidus occurred, neurological examinations, tumor markers, and computed tomography brain scan were all normal. Three years later, rapid development of neurological changes was observed with the prevailing symptoms of increased intracranial pressure. The changes were related to a pineal germ cell tumor identified by a high level of beta-human chorionic gonadotropin in plasma and neuroradiological investigations, including computed tomography and magnetic resonance imaging. The clinical course of this case is unusual and we advocate the following: (1) the follow-up of children with diabetes insipidus is important for determining whether or not it is an idiopathic type and (2) elevation of plasma beta-human chorionic gonadotropin and development of neurological signs in patients with so-called idiopathic diabetes insipidus should arouse clinical suspicion of an intracranial germ cell tumor. It should be noted that the brain tumor is significant as the underlying pathology of childhood diabetes insipidus.

Topics: Administration, Intranasal; Adolescent; Biomarkers, Tumor; Brain Neoplasms; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Deamino Arginine Vasopressin; Diabetes Insipidus; Germinoma; Humans; Male; Peptide Fragments; Pineal Gland

Urine-concentrating ability is regulated by vasopressin. Recently, the specific water-channel protein of the renal collecting duct, known as aquaporin-2, was cloned. However, it is not certain whether this molecule is responsive to vasopressin.. We measured the urinary excretion of aquaporin-2 and its response to vasopressin in 11 normal subjects and 9 patients with central or nephrogenic diabetes insipidus. The urine samples were collected during periods of dehydration and hydration and after the administration of vasopressin. Urine samples were analyzed for aquaporin-2 by the Western blot assay and immunogold labeling, and the amount of aquaporin-2 was determined by radioimmunoassay.. Aquaporin-2 was detectable in the urine in both soluble and membrane-bound forms. In the five normal subjects tested, the mean (+/- SE) urinary excretion of aquaporin-2 was 11.2 +/- 2.2 pmol per milligram of creatinine after a period of dehydration, and it decreased to 3.9 +/- 1.9 pmol per milligram of creatinine (P = 0.03) during the second hour after a period of hydration. In the six other normal subjects, an infusion of desmopressin (1-desamino-8-D-arginine vasopressin) increased the urinary excretion of aquaporin-2 from 0.8 +/- 0.3 to 11.2 +/- 1.6 pmol per milligram of creatinine (P < 0.001). The five patients with central diabetes insipidus also had increases in urinary excretion of aquaporin-2 in response to the administration of vasopressin, but the four patients with X-linked or non-X-linked nephrogenic diabetes insipidus did not.. Aquaporin-2 is detectable in the urine, and changes in the urinary excretion of this protein can be used as an index of the action of vasopressin on the kidney.

Topics: Adult; Aged; Aquaporin 2; Aquaporin 6; Aquaporins; Blotting, Western; Case-Control Studies; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Ion Channels; Kidney; Male; Middle Aged; Radioimmunoassay

Topics: Aquaporin 2; Aquaporin 6; Aquaporins; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Ion Channels; Kidney; Vasopressins

Topics: Adult; Blood Glucose; Brain Edema; Brain Neoplasms; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Mellitus, Type 1; Diabetic Coma; Diabetic Ketoacidosis; Diagnosis, Differential; Fatal Outcome; Female; Fluid Therapy; Headache; Humans; Hypernatremia; Insulin; Polyuria; Postoperative Complications; Radiography

To understand the secretion and synthesis of atrial natriuretic peptide we measured immunoreactive atrial natriuretic peptide from plasma, heart tissues and brain areas, and ANP mRNA was determined from heart auricles and ventricles of vasopressin-deficient Brattleboro rats (DI) and from desmopressin treated Brattleboro rats (DI+DDAVP). Long-Evans rats (LE) served as controls. DI+DDAVP rats were given for 3 days sc. injections of 0.5 micrograms 1-desamino-8-D-arginine vasopressin in 1 mL saline twice a day. The rats were housed in single metabolic cages and urinary output and water intake were measured daily. All the body and organ weight parameters were similar in the three groups when the rats were killed. No change was seen in the plasma ANP level between the groups. The right ventricle of DI+DDAVP rats had significantly (P < 0.05) higher concentration of ANP than LE rats (15.8 +/- 4.4 vs. 3.4 +/- 0.6 ng mg-1 tissue). The left ventricle of DI and DI+DDAVP had significantly (P < 0.05) lower amounts of ANP mRNA than LE rats (0.5 +/- 0.2 vs. 1.3 +/- 0.2 and 0.5 +/- 0.1 vs. 1.3 +/- 0.2 arbitrary units). In the hypothalamus, the ANP concentration was significantly (P < 0.05) lower both in DI and in DI+DDAVP rats than in LE rats (9.3 +/- 1.3 vs. 14.5 +/- 1.6 and 6.1 +/- 0.6 vs. 14.5 +/- 1.6 pg mg-1 tissue). To conclude, although the water intake and urinary output of DI rats were changed towards normal with desmopressin treatment, the heart ventricular and hypothalamic ANP did not parallel the change.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Atrial Natriuretic Factor; Body Weight; Brain; Deamino Arginine Vasopressin; Diabetes Insipidus; Drinking; Heart Atria; Heart Ventricles; Hypoglycemic Agents; Male; Myocardium; Organ Size; Rats; Rats, Brattleboro; RNA, Messenger; Urination; Vasopressins; Water-Electrolyte Balance

A 46-year-old man who had a history of hypogonadism, bilateral hydronephrosis and huge residual urine volume during the past ten years was admitted complaining of fever and flank pain. Polyuria which was more than 4 liters per day and inability of urine concentration suggested diabetes insipidus. Magnetic resonance imaging (MRI) demonstrated a tumor which was compatible with craniopharyngioma. Tumor resection and administration of desmopressin improved polyuria and urinary tract dilatation with marked reduction of residual urine volume from 400 ml to 20 ml.

Topics: Craniopharyngioma; Deamino Arginine Vasopressin; Diabetes Insipidus; Dilatation, Pathologic; Humans; Hydronephrosis; Male; Middle Aged; Pituitary Neoplasms; Renal Agents; Urinary Tract

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hypothalamus; Magnetic Resonance Imaging; Osmolar Concentration; Urine; Water Deprivation

Almost all cases of congenital nephrogenic diabetes insipidus (NDI) are transmitted in an X-linked recessive manner by an asymptomatic carrier female to her affected son. Severe symptomatic NDI has not previously been reported in a female with X-linked recessive NDI. Each of the three members of this family has an abnormal V2 receptor gene, which results in truncation of the V2 receptor beginning at arginine-337. This prematurely terminates the receptor at the carboxy-terminal tail and very likely disrupts receptor function. The son has an abnormal V2 receptor gene on his X-chromosome, whereas the mother and daughter have one normal and one abnormal gene for the V2 receptor. The infusion of desmopressin into the mother and son reveals a total lack of antidiuretic response, whereas the daughter increases urinary osmolality normally. The plasma factor VIII concentration after the infusion of desmopressin in the son does not rise, whereas the mother and daughter have half of the normal factor VIII response, similar to asymptomatic female carriers of NDI. These responses to desmopressin in daughter and son are those of a typical carrier female and male affected with NDI. In contrast, the mother acts as an NDI patient when the urine concentration is measured, but acts as a carrier in terms of the factor VIII response to desmopressin. We postulate that the renal tubular cells of the mother demonstrate extreme lyonization of X-chromosome inactivation, whereas in the tissue that subserves the hematological response to desmopressin, X-chromosome inactivation followed a more typically random distribution.

Topics: Adult; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Drug Resistance; Factor VIII; Female; Genes, Recessive; Genetic Linkage; Humans; Kidney Concentrating Ability; Male; Osmolar Concentration; Receptors, Vasopressin; Vasopressins; X Chromosome

The effects of concentration, amperage and duration on the antidiuretic response induced by iontophoretic delivery of desmopressin acetate (DDAVP) were examined using a diabetes insipidus model in rats. A higher current density brought about a larger and longer antidiuretic response. Prolonged iontophoretic duration caused an overdose. Repeated short iontophoretic treatments with lower current density maintained a constant response with a short lag time and a rapid disappearance of pharmacological response immediately after cessation of the final treatment. This type of iontophoresis substantially reduced the inter-subject variability of response as compared to the response using an intranasal route of administration.

Topics: Administration, Cutaneous; Administration, Intranasal; Animals; Deamino Arginine Vasopressin; Diabetes Insipidus; Disease Models, Animal; Diuresis; Dose-Response Relationship, Drug; Drug Delivery Systems; Drug Overdose; Iontophoresis; Male; Rats; Rats, Wistar; Skin Absorption

The 6-year follow-up of a patient affected by Wolfram's syndrome, a rare disease characterized by diabetes insipidus (DI), diabetes mellitus (DM), optic atrophy (OA), neurosensory deafness (D), atony of the urinary tract and other abnormalities (DIDMOAD or Wolfram's syndrome), is described. Our patient has diabetes insipidus, diabetes mellitus, abnormal audiograms, without subjective evidence of hearing loss, and dilatation of the urinary tract. Diagnosis was suspected at the age of 8 years. Diabetes mellitus was the first manifestation and treatment with insulin was necessary. Desmopressin therapy decreased dramatically the daily urinary output. In view of the significant morbidity and mortality from renal failure associated with recurrent urinary infections, we have drawn special attention to the urological manifestations of the syndrome. During the follow-up, the patients underwent some investigations, such as renal ultrasound and echotomography and cystourethroscopy. Outstanding results of these studies are severe bilateral hydronephrosis with dilatated ureters and loss of renal tissue. The particular finding is the presence of posterior urethral valves with obstructed bladder. The anatomical outlet obstruction are variable and may be disastrous. There may be failure to thrive, sepsis, anemia be disanal failure. In such instances corrective surgery could improve bladder and ureteral functions.

Topics: Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Complications; Diabetes Insipidus; Diabetes Mellitus; Drinking; Follow-Up Studies; Humans; Insulin; Male; Polyuria; Urography; Urologic Diseases; Wolfram Syndrome

With the use of two central health registries in Sweden, the Hospital Discharge Registry and the Medical Birth Registry, we identified 100 infants born of women who had been hospitalized for diabetes insipidus. By checking the medical records of these women, 29 infants were identified whose mothers had diabetes insipidus prior to the pregnancy and had been treated through the pregnancy with desmopressin. These infants had a normal birth weight and gestational length; there was only one congenital malformation identified (a ventricular septum defect with a patent ductus arteriosus and simian lines). This child died at the age of 14 years in a hypophyseal disease. This is the largest material published on desmopressin during pregnancy. The results suggest that maternal diabetes insipidus and treatment with desmopressin during the whole pregnancy does not constitute a major risk for the infant.

Topics: Birth Weight; Crown-Rump Length; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Gestational Age; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications; Retrospective Studies; Risk Factors

We report a case of AML with diabetes insipidus (DI). A 68-year-old female was admitted to our hospital because of fever and leukocytosis. The WBC was 197,000/microliter with 98% blasts positive for myeloperoxidase, CD33, CD34 and HLA-DR. While, on admission, urine volume was more than 6 liters daily. Blood vasopressin level was 0.3 microgram/ml. The patient was diagnosed as having AML with DI. By chemotherapy consisting of BHAC, DNR, 6-MP and PSL and intrathecal administration of AraC, MTX and PSL, and nasal drip of DDAVP, complete remission was attained and the urine volume was reduced to normal. Finally DDAVP became unnecessary. Although the exact cause of DI cannot be ascertained, rapid increase of leukemic blasts and leukostasis in small vessels might be associated with hypothalamus-pituitary system damage. Reportedly, DI is a rare complication of leukemia and administration of DDAVP could be halted in only two patients with leukemia and DI.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Leukemia, Myeloid, Acute; Mercaptopurine; Prednisolone; Renal Agents

We conducted a retrospective analysis of the cases of 122 children operated on for various brain tumors, to determine the incidence and natural history of postoperative diabetes insipidus (DI), and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Abnormalities of water homeostasis were observed in 15 patients (12%). DI, with or without SIADH, was observed in 10 patients (8%), while SIADH alone was seen in five (4%). DI was permanent in five subjects (50%), whereas SIADH resolved completely in all affected individuals. Parenteral desmopressin (dDAVP) was an effective mode of therapy in the postoperative period. The effect did not correlate with a dosage strictly based on body weight.

Topics: Adolescent; Age Distribution; Brain Neoplasms; Child; Child, Preschool; Craniotomy; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Inappropriate ADH Syndrome; Infant; Male; Postoperative Complications; Sex Distribution; Treatment Outcome; Water

We present two patients with known sarcoidosis who developed neurosarcoidosis manifested by paranoid psychosis and clinical diabetes insipidus with hypernatremia. Both had gadolinium enhanced magnetic resonance imaging which demonstrated leptomeningeal and hypothalamic enhancement. Both had elevated protein and a lymphocytosis in their cerebrospinal fluid, which improved after corticosteroid therapy. The patients improved clinically with this therapy as well. We suggest that new onset psychosis in a sarcoid patient, particularly with symptoms of hypothalamic/pituitary involvement, should be evaluated for neurosarcoidosis with an MRI and CSF examination. If the results are consistent with neurosarcoidosis, the patient should be treated promptly with corticosteroids.

Topics: Adult; Benzothiadiazines; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuretics; Female; Humans; Hypernatremia; Magnetic Resonance Imaging; Male; Nervous System Diseases; Paranoid Disorders; Sarcoidosis; Sodium Chloride Symporter Inhibitors

Concentration of urine in mammals is regulated by the antidiuretic hormone vasopressin. Binding of vasopressin to its V2 receptor leads to the insertion of water channels in apical membranes of principal cells in collecting ducts. In nephrogenic diabetes insipidus (NDI), the kidney fails to concentrate urine in response to vasopressin. A male patient with an autosomal recessive form of NDI was found to be a compound heterozygote for two mutations in the gene encoding aquaporin-2, a water channel. Functional expression studies in Xenopus oocytes revealed that each mutation resulted in nonfunctional water channel proteins. Thus, aquaporin-2 is essential for vasopressin-dependent concentration of urine.

Topics: Amino Acid Sequence; Animals; Aquaporin 2; Aquaporin 6; Aquaporins; Base Sequence; Cloning, Molecular; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Genes, Recessive; Heterozygote; Humans; Kidney; Kidney Concentrating Ability; Male; Membrane Proteins; Molecular Sequence Data; Oocytes; Pedigree; Point Mutation; Protein Structure, Secondary; RNA, Complementary; Water; Xenopus laevis

Topics: Adult; Carbamazepine; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant, Newborn; Male; Pregnancy; Pregnancy Complications; Pregnancy, Multiple; Twins; Vasopressins

This report is on six pregnancies of a woman with idiopathic diabetes insipidus detected after previous stillbirth, during the second pregnancy. On treatment with the only then available injectable substitute, an eutrophic child developed. Since the end of the second pregnancy, the patient has been treated with DDAVP. During the other five pregnancies dystrophic children were delivered due to placental insufficiencies. In the last pregnancy, after cessation of foetal growth a new growth phase could be initiated by improvement of placenta flow by haemodilution.

Topics: Adult; Cardiotocography; Cesarean Section; Deamino Arginine Vasopressin; Diabetes Insipidus; Dose-Response Relationship, Drug; Female; Fetal Death; Fetal Growth Retardation; Humans; Infant, Newborn; Male; Pregnancy; Pregnancy Complications; Ultrasonography, Prenatal

The Brattleboro rat with hypothalamic diabetes insipidus (BDI) has an abnormal aversion to drinking quinine-adulterated water compared with normal rats of the parent Long Evans (LE) strain. This BDI animal tolerates marked hypovolemia and decreased body weight in preference to drinking the quinine-adulterated fluid, indicative of a reduced motivation to drink. Acute or chronic treatment of BDI rats with desamino-8D arginine vasopressin (DDAVP) restored to normal their drinking response to quinine solution. Partial restoration of fluid turnover in BDI rats with hydrochlorothiazide, which has an antidiuretic effect in diabetes insipidus (when vasopressin is absent), failed to abolish the abnormal drinking response to quinine-adulterated solution in 8 out of 12 animals. In contrast, induction of diabetes mellitus in LE rats, which resulted in a marked polydipsia and polyuria even though vasopressin was still present, did not impair the drinking response to quinine solutions. These results suggest that the abnormal drinking response to quinine-adulterated fluid in BDI rats is reversed by treatment with the vasopressin V2-receptor agonist DDAVP but is unlikely to be a consequence of the restoration of fluid turnover to normal levels by a renal action. A possible central action involving vasopressin and the motivation to drink is discussed.

Topics: Animals; Avoidance Learning; Deamino Arginine Vasopressin; Diabetes Insipidus; Drinking; Habituation, Psychophysiologic; Hydrochlorothiazide; Male; Motivation; Premedication; Quinine; Rats; Rats, Brattleboro; Streptozocin; Taste; Vasopressins

A case of familial central diabetes insipidus and dilatation of the urinary tract is reported. Administration of desmopressin for 1 year improved urinary tract dilatation with a concomitant reduction in urine volume. Urinary cyclic adenosine monophosphate and prostaglandin E2 excretion increased after treatment.

Topics: 6-Ketoprostaglandin F1 alpha; Adult; Cyclic AMP; Deamino Arginine Vasopressin; Diabetes Insipidus; Dinoprost; Dinoprostone; Humans; Hydronephrosis; Male; Thromboxane B2; Urine

To elucidate the role of arginine vasopressin (AVP) in the development of stress-induced gastric ulcer, the mucosal lesions after restraint and water immersion were examined in Brattleboro strain rats with hereditary hypothalamic diabetes insipidus (DI) and in Long-Evans rats (LE) used as controls. Restrained animals were immersed in water for 2 h, and the size of lesion was expressed as percentage of the lesion area to the total glandular mucosal area, which were defined as ulcer index (UI). In DI rats, UI was significantly higher than in control LE rats, despite the attenuated responses of plasma adrenocorticotropic hormone (ACTH) to stress. Although subcutaneous injection of selective antidiuretic analogue 1-desamino-8-D-AVP did not affect UI, intracerebroventricular (icv) administration of AVP reduced UI in DI rats, and icv administration of V1 antagonist [d(CH2)5Tyr(Me)]AVP elevated UI in LE rats. These results indicate that endogenous AVP plays a role in preventing the formation of gastric ulcers induced by stress via a central V1 receptor. Furthermore, we suggest that elevation of ACTH in plasma is not essential in the development of stress-induced gastric ulcer in rats.

Topics: Adrenocorticotropic Hormone; Animals; Arginine Vasopressin; Cerebral Ventricles; Deamino Arginine Vasopressin; Diabetes Insipidus; Epinephrine; Gastric Mucosa; Immersion; Injections, Intraventricular; Injections, Subcutaneous; Male; Norepinephrine; Rats; Rats, Brattleboro; Restraint, Physical; Species Specificity; Stomach Ulcer; Stress, Psychological

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Brain; Cerebellar Neoplasms; Combined Modality Therapy; Cyclophosphamide; Deamino Arginine Vasopressin; Dexamethasone; Diabetes Insipidus; Doxorubicin; Humans; Hydrocortisone; Lymphoma; Magnetic Resonance Imaging; Male; Thyroxine; Vasopressins; Ventriculoperitoneal Shunt; Vincristine

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infusion Pumps

A 60-year-old woman was admitted to our hospital for surgical treatment of the left inguinal hernia. She had suffered from diabetes insipidus for ten years, and hormonal study revealed low plasma level of vasopressin. She has been taking nasally desmopressin acetate 5 micrograms twice a day and urinary output has been well controlled around 1200-1400 ml.day-1. CT-scan showed empty sella without any pituitary tumors. There were no evidences of increased intracranial pressure and neurological deficit. Following nasal instillation of desmopressin acetate 5 micrograms one hour before anesthesia, spinal anesthesia was performed with tetracaine 10 mg. Cephalad sensory block assessed by pinprick spread to T6 within 10 minutes. Systolic blood pressure gradually decreased from 120 to 90 mmHg, although no vasoconstrictors were needed. Arterial blood pressure was stable during the surgery. The operation lasted 80 minutes with 650 ml of fluid replacement, blood loss of 50 g and urinary output of 25 ml. She had no postspinal headache nor neurological deficit after surgery. Empty sella syndrome associated with diabetes insipidus is rare. Low spinal anesthesia can be performed safely whenever there is no evidence of increased intracranial pressure, although care should be taken for perioperative fluid and circulatory management.

Topics: Administration, Intranasal; Anesthesia, Spinal; Blood Pressure; Deamino Arginine Vasopressin; Diabetes Insipidus; Empty Sella Syndrome; Female; Hernia, Inguinal; Humans; Intraoperative Care; Middle Aged; Monitoring, Intraoperative

The aim of the present study was to investigate the hormonal control of water-balance in children with diabetes insipidus and to assess safety and efficacy of long-term treatment with oral dDAVP. Plasma atrial natriuretic peptide, plasma renin activity, aldosterone, plasma and urinary cyclic 3'5'-guanosine monophosphate and urinary prostaglandin E2 were measured in eight patients (aged 3-21 y) with central diabetes insipidus. At baseline, 12 h after the last dDAVP dose, patients had hypotonic polyuria but normal plasma sodium concentrations and plasma osmolality relative to a control group. The mean plasma atrial natriuretic peptide concentration in patients (26.2 +/- 2.6 pg/ml) tended to be lower than in controls (36.5 +/- 8.2 pg/ml, mean +/- SEM), although the difference was not significant. Plasma cyclic 3'5' guanosine monophosphate was higher in controls (6.0 +/- 0.6 pmol/ml, mean +/- SEM) than in patients (3.8 +/- 0.3 pmol/ml). Aldosterone, plasma renin activity, urinary cyclic guanosine monophosphate and urinary prostaglandin E2 were similar in the two groups. During 3 h following dDAVP administration, atrial natriuretic peptide levels did not change in patients but decreased significantly in controls to 23.0 +/- 4.0 pg/ml. No adverse reactions, or circulating antibodies against dDAVP, were observed after 3.5 years of oral dDAVP treatment. The average oral dDAVP dosage was similar after 1 and 3.5 years of treatment (906 +/- 406 micrograms/24 h, mean +/- SD). Water-balance is not detectably different from normal in correctly treated diabetes insipidus patients in terms of plasma atrial natriuretic peptide, plasma renin activity and aldosterone levels. Long-term oral dDAVP treatment is safe and efficacious.

Topics: Administration, Oral; Adolescent; Adult; Aldosterone; Atrial Natriuretic Factor; Child; Child, Preschool; Cyclic GMP; Deamino Arginine Vasopressin; Diabetes Insipidus; Dinoprostone; Female; Follow-Up Studies; Humans; Male; Renin; Water-Electrolyte Balance

Topics: Administration, Oral; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans

A case of transient diabetes insipidus in pregnancy occurring in a 26 year-old woman is reported, and possible mechanisms leading to this disorder are considered. Delivery of a healthy boy was uneventful after induction of labor with prostin, and the condition remitted spontaneously shortly after delivery, following a short period of exogenous desmopressin administration. A water deprivation test confirmed undetectable serum ADH values, presumably due to temporary inappropriate ADH secretion or excessive vasopressinase activity.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Pregnancy; Pregnancy Complications; Vasopressins

Topics: Brain Death; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Intensive Care Units; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Tissue Donors

A report is made on the manifestation of diabetes insipidus (neuropituitary syndrome), observed six days after a Caesarean section (29-years old I. Gravida). The progress of pregnancy and delivery as well as the successful treatment with Desmopressin (Minirin) post partum are described. The aetiology is still obscure.

Topics: Adult; Cesarean Section; Chorioamnionitis; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant, Newborn; Male; Pregnancy; Puerperal Disorders; Water-Electrolyte Balance

1. We have studied the response of six patients with cranial diabetes insipidus and six age-matched control subjects to dietary sodium restriction during constant administration of the synthetic vasopressin analogue desamino-[8-D-arginine]vasopressin. 2. Urine flow increased on the first low salt day in the normal control subjects but not in the patients with cranial diabetes insipidus. Body weight fell 1.35 kg in the control subjects but was constant in the patients with cranial diabetes insipidus. 3. Urinary sodium excretion fell at the same rate in both groups. Diurnal variation of urinary sodium excretion and creatinine clearance was present in the control subjects but not in the patients with cranial diabetes insipidus. 4. Changes in plasma sodium concentration and osmolality were similar. Plasma protein concentration increased more in the control subjects (from 69.1 +/- 1.5 to 73 +/- 1.2 versus from 71.7 +/- 1 to 73.2 +/- 1.1 milligrams). The responses of plasma atrial natriuretic peptide, plasma renin activity and salivary aldosterone concentration were similar between the two groups. Salivary aldosterone concentration levels were consistently higher in the patients with cranial diabetes insipidus. 5. We confirm that the low salt diuresis is triggered by release from the antidiuretic activity of arginine vasopressin. In the patients with cranial diabetes insipidus extracellular fluid osmoregulation appeared to be achieved by the movement of water out of and sodium into the extracellular fluid. 6. Absent posterior pituitary function and hypothalamic disturbances did not alter renal sodium conservation.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Blood Pressure; Craniopharyngioma; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Heart Rate; Humans; Male; Middle Aged; Pituitary Neoplasms; Sodium; Sodium, Dietary

In patients with advanced breast cancer the incidence of diabetes insipidus is between 0.1% and 0.9%. Satisfactory symptomatic relief can be obtained with Desmopressin-acetate. In the presence of this symptom complex magnetic resonance imaging (MRI) can aid in the detection of metastases to the posterior pituitary. By the use of magnetic resonance imaging, the incidence for and implementation of local radiotherapy can be firmly grounded.

Topics: Adult; Antineoplastic Agents; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Combined Modality Therapy; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Lymph Node Excision; Lymphatic Irradiation; Lymphatic Metastasis; Magnetic Resonance Imaging; Mastectomy; Patient Care Planning; Postoperative Care; Radiotherapy Dosage

We describe a patient who, at the onset of acute myelomonocytic leukemia, presented with marked polyuria, polydipsia and laboratory findings consistent with diabetes insipidus (DI). He was treated with vasopressin (DDAVP) with a good response and concurrently induced with daunorubicin and conventional doses of cytosine arabinoside. CR was achieved. The vasopressin requirement decreased progressively, but the patient remained DDAVP-dependent after consolidation treatment. He underwent allogeneic BMT, conditioned with busulfan and cyclophosphamide. By day 15 after BMT vasopressin was no longer required and at a follow-up of 9 months the patient has no evidence of DI. In the absence of specific findings, we think it possible that he had leukemic microinfiltration of the hypothalamic-pituitary area. The drugs used for conditioning may have eradicated CNS disease.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Purging; Bone Marrow Transplantation; Busulfan; Cytarabine; Daunorubicin; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Incidence; Leukemia, Myelomonocytic, Acute; Male; Remission Induction

Topics: Child, Preschool; Cholangiography; Cholangitis, Sclerosing; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Follow-Up Studies; Histiocytosis, Langerhans-Cell; Humans; Liver; Liver Cirrhosis, Biliary; Liver Transplantation; Prednisone; S100 Proteins; Skin; Vinblastine; Xanthogranuloma, Juvenile; Xanthomatosis

Topics: Adolescent; Age Factors; Brain Neoplasms; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetic Nephropathies; Diabetic Neuropathies; Female; Humans; Infant; Japan; Male; Reference Standards; Sex Factors

The rate of aqueous humor flow was studied in 17 human subjects with neurogenic diabetes insipidus. Flow was measured by fluorophotometry on two consecutive afternoons. The first day, subjects used desmopressin to control their diuresis; on the second day, subjects did not use desmopressin and had uncontrolled diuresis. On both days, one eye was treated with the beta-adrenergic antagonist, timolol. With desmopressin, the rate of aqueous humor flow in the untreated eye was 2.53 +/- 0.79 microliters/min (mean +/- standard deviation) and in the timolol-treated eye was 1.69 +/- 0.40 microliters/min. Without desmopressin, the rate of aqueous humor flow in the untreated eye was 2.34 +/- 0.69 microliters/min and in the timolol-treated eye was 1.53 +/- 0.43 microliters/min. Thus, the use of desmopressin was associated with a slightly higher rate of aqueous humor flow in both the normal and the beta-adrenergically inhibited eye (P = .05), and the suppression of aqueous humor flow associated with beta-adrenergic inhibition occurred with and without antidiuretic hormone (P < .001). The observed differences in aqueous humor flow on the two days could have been caused by a direct effect on the eye or to indirect effects, such as the change in plasma osmolality, which changed from 291 +/- 6 mOsm on the desmopressin day to 299 +/- 8 mOsm on the desmopressin-abstention day (P < .001).

Topics: Administration, Intranasal; Adult; Aged; Aqueous Humor; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Female; Humans; Male; Middle Aged; Osmolar Concentration; Timolol

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Infant, Newborn; Male; Vasopressins

Topics: Adult; Biopsy; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Glucocorticoids; Humans; Lymph Nodes; Methylprednisolone; Nervous System Diseases; Sarcoidosis

A rare case of a postmenopausal (60-year-old) female with lymphocytic adenohypophysitis manifesting as a sudden onset of diabetes insipidus is reported. Magnetic resonance imaging with gadolinium-diethylene-triaminepentaacetic acid enhancement showed a spherical lesion, approximately 1 cm in diameter, in the sella turcica and a thickened, deviated pituitary stalk. The abnormal tissue was totally removed. Histological examination showed marked infiltration of lymphocytes and plasma cells. Postoperatively, the pituitary stalk became normal. Preoperative differentiation of lymphocytic adenohypophysitis from pituitary adenoma is extremely difficult, and biopsy is essential.

Topics: Adenoma; Autoimmune Diseases; Biopsy; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Female; Humans; Lymphocytes; Magnetic Resonance Imaging; Menopause; Middle Aged; Pituitary Diseases; Pituitary Gland, Anterior; Pituitary Neoplasms; Plasma Cells

The effect of 1-deamino-8-D-arginine vasopressin (DDAVP) on mean arterial pressure, pulse rate (PR), plasma renin activity (PRA), plasma factor VIIIc and von Willebrand factor were studied in a case of persistent lithium-induced nephrogenic diabetes insipidus (LINDI). 20% decrease in MAP, 22% increase in PR, 100% in PRA, and release of coagulation factors (2- to 3-fold) were noticed after infusion of 0.3 micrograms/kg DDAVP. Urinary prostaglandin (PG) E2 were enhanced. The treatment of this LINDI by PG synthesis inhibitor (PSI) combined with a low osmotic diet (LOD) led to a 51% fall in urine volume, 57% in free water clearance and 75% in sodium clearance. Urinary osmolality rose by 42% but remained low, probably in part because of the LOD. Urinary PGE2 was about one fifth of the initial high value. The results argue for (1) an end-organ resistance to DDAVP confined to the kidneys in LINDI and (2) an effectiveness of indomethacin combined with an LOD.

Topics: Adult; Blood Coagulation; Blood Pressure; Deamino Arginine Vasopressin; Diabetes Insipidus; Dinoprostone; Factor VIII; Female; Hemodynamics; Humans; Lithium; Pulse; Renin; von Willebrand Factor; Water Deprivation

Intranasal desmopressin represents the treatment of choice in Central Diabetes Insipidus. Nevertheless, this route of administration bears some practical disadvantage, linked to either difficult delivering technique, or the status of nasal mucose. The antidiuretic effectiveness of oral desmopressin has been recently demonstrated, both in experimental animals and in man. In our study we compared oral vs. intranasal desmopressin efficacy in 13 patients affected by Central Diabetes Insipidus. The results show that the peroral administration of Desmopressin at a mean dose of 500-600 micrograms/die determines an antidiuretic effect comparable to that of intranasal route, without affecting body weight, arterial pressure and chemical analysis. Side effects, generally limited to the first week of treatment, were described (nausea, vomiting, headache, dizziness [corrected], bitter taste, epygastralgia, asthenia, epystassis), inducing 4/13 patients to withdrawal the trial.

Topics: Administration, Intranasal; Administration, Oral; Adult; Blood Pressure; Body Weight; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Drug Administration Schedule; Female; Humans; Male; Osmolar Concentration; Specific Gravity

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Pregnancy; Pregnancy in Diabetics; Pregnancy, Multiple; Twins

The posterior pituitary lobe and stalk were studied by magnetic resonance imaging in 20 children with diabetes insipidus of different origins: primary familial autosomal dominant (n = 2) or idiopathic (n = 2), and secondary to craniopharyngioma (n = 6, resected in 5), to Langerhans cell histiocytosis (n = 5), to excessive water intake (dipsogenic; n = 3), to renal vasopressin insensitivity (n = 1), and to osmoreceptor dysfunction (n = 1). Of the four children with primary diabetes insipidus, the posterior bright signal was recognizable in two with the familial autosomal dominant form and one with the idiopathic form; in the latter, the pituitary stalk was thin, while it was normal in the first two patients; no posterior hyperintense signal with enlarged and gadolinium-enhanced pituitary stalk was observed in the fourth. The posterior hyperintense signal was absent without evidence of ectopic posterior pituitary tissue regeneration in five children with surgically removed craniopharyngioma and was doubtful in the child with unresected craniopharyngioma; the stalk was unrecognizable in all patients. In the five children with Langherans cell histiocytosis, the posterior bright signal was absent, while the stalk was normal in two and unexpectedly enlarged in three (uniformly in two and mainly at the level of median eminence and hypothalamus in one). All five patients with dipsogenic or nephrogenic diabetes insipidus or osmoreceptor dysfunction had normal images of posterior pituitary lobe and stalk. Normal posterior pituitary bright signal and stalk were found in all 25 healthy control children. Plasma vasopressin was undetectable in all patients except in nephrogenic one, in the child with osmoreceptor dysfunction, and in two of three dipsogenic children, the third mimicking partial neurogenic diabetes insipidus.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Adolescent; Adult; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant; Magnetic Resonance Imaging; Male; Pituitary Gland, Posterior; Vasopressins; Water Deprivation

Twelve patients, aged 16-66 years, affected by cranial diabetes insipidus either idiopathic or secondary (head injuries, histiocytosis X, metastatic tumors, pituitary or hypothalamic surgery) were studied. Diagnosis was made on the basis of both dehydration test and sensitivity to exogenous vasopressin. The relationship between plasma and urine osmolality at the end of the dehydration test was evaluated (and its usefulness for diagnostic purpose confirmed). According to this test two different conditions, namely partial and complete, of cranial diabetes insipidus were defined. All the patients underwent the following diagnostic procedures: skull x-ray, evaluation of visual fields, encephalic CT-scan. Idiopathic central diabetes insipidus incidence was found to be 33.3% of all cases, with a sharp prevalence for male sex; the median age of onset was 12.5 years. In our experience the frequency of idiopathic condition was similar to that reported in most recent literature confirming a decreasing incidence, most likely due to the use of more sophisticated diagnostic procedures.

Topics: Adolescent; Adult; Aged; Brain; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Osmolar Concentration; Tomography, X-Ray Computed; Water Deprivation

Topics: Adult; Cesarean Section; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Pregnancy; Pregnancy in Diabetics; Pregnancy Trimester, First

Topics: Administration, Intranasal; Adolescent; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Pituitary Gland; Tomography, X-Ray Computed

Two pregnant women developed overt polyuria (up to 11 l/day) and polydipsia during their second and third trimesters of pregnancy. In one patient hydronephrosis was present. Both patients suffered from mild gestational diabetes mellitus. Plasma sodium was 145 and 162 mmol/l. Polyuria and urinary hypo-osmolality responded well to desmopressin acetate. After delivery, polyuria and polydipsia disappeared in one patient and significantly improved in the other. Infusion of hypertonic saline one and two weeks respectively after delivery led to plasma hyper-osmolality (294 mosmol/kg and 305 mosmol/kg) without detectable stimulation of arginine vasopressin (AVP). Anterior pituitary function was normal. No stimulation of AVP occurred following insulin-induced hypoglycemia. AVP plasma disappearance after i.v. pulse injection of 1 microgram AVP as well as AVP plasma concentration after continuous infusion of 10 ng AVP/min was studied two weeks after delivery in one patient. The results suggested markedly elevated degradation of AVP compared to control subjects, probably due to an increased vasopressin activity. Eight months after delivery, hypertonic saline infusion in one patient led to a plasma-osmolality of 312 mosmol/kg without stimulation of AVP. In the second patient, AVP was not detectable (less than 0.2 pg/ml) six months after delivery when plasma osmolality was 290 mosmol/kg. Our studies demonstrate that a subclinical compensated diabetes insipidus was preexistent in both patients. Exacerbation occurred due to an increased AVP-clearance and presumably due to the hemodynamic and hormonal alterations during pregnancy, including a mild gestational diabetes mellitus.

Topics: Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes, Gestational; Female; Humans; Polyuria; Pregnancy; Pregnancy Complications; Sodium

Topics: Administration, Intranasal; Adult; Craniocerebral Trauma; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Male; Patient Care Planning

A 42-year-old woman was admitted to our hospital because of polydipsia and polyuria. On admission, the daily urine volume was about 6 to 8 L/day, and the plasma arginine vasopressin (AVP) level was undetectable. To determine an involvement of atrial natriuretic peptide (ANP) in maintaining plasma volume homeostasis in the patient with diabetes insipidus (DI), changes of plasma ANP levels were measured during the daytime and after 2.5% hypertonic saline followed by intravenous administration of Pitressin. The plasma ANP level was maintained within a normal range during the day. An intravenous infusion of 2.5% hypertonic saline increased plasma ANP levels, while it failed to increase urine osmolality. The addition of an intravenous bolus of Pitressin (10 U) increased urine osmolality with a decrease of urine volume. Plasma ANP levels showed only a transient decrease at 15 min after Pitressin injection. A daily supplement of 1-desamino-8-D-arginine vasopressin (DDAVP) slightly decreased plasma ANP levels. The present study suggests that an increase in plasma AVP level may not have a direct stimulatory action on ANP secretion in patients with DI.

Topics: Arginine Vasopressin; Atrial Natriuretic Factor; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Homeostasis; Humans; Middle Aged; Plasma Volume

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Genes; Genetic Testing; Humans; Kidney Diseases; Male; Renin

Transient polyuria and polydipsia during pregnancy are rare, and their cause is not entirely clear. Possible explanations include the exacerbation of preexisting abnormalities in the secretion or action of vasopressin and abnormally large increases in plasma vasopressinase activity.. We studied two women in whom overt polyuria and polydipsia developed during the third trimester of pregnancy and disappeared after delivery. The secretion and action of vasopressin were studied both when the women had polyuria and polydipsia and later, when their water intake and urine volume were normal.. One patient had partial nephrogenic diabetes insipidus. She had little increase in urine osmolality in response to water deprivation, hypertonic-saline infusion, and vasopressin injection and no response to desmopressin acetate (1-deamino-8-D-arginine vasopressin) during the immediate postpartum period. Her basal and stimulated plasma vasopressin concentrations were high (16.5 to 203.4 pmol per liter) before and during hypertonic-saline infusion 30 months post partum. The other patient had partial neurogenic diabetes insipidus. She had subnormal basal plasma vasopressin concentrations, a subnormal increase in the plasma vasopressin level and a subnormal decrease in urine flow in response to the administration of vasopressin, and a normal response to desmopressin. After pregnancy, when her urine volume was normal, she had no increase in plasma vasopressin in response to hypertonic-saline infusion, but she had a normal rise in the plasma vasopressin level and a normal renal response to vasopressin administration.. Pregnancy may unmask subclinical forms of both nephrogenic and neurogenic diabetes insipidus. This exacerbation may result from both increased vasopressinase activity and diminished renal responsiveness to vasopressin.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hypertonic Solutions; Osmolar Concentration; Polyuria; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Third; Thirst; Vasopressins

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Therapy, Combination; Female; Humans; Indomethacin; Kidney Diseases; Middle Aged

Two brothers, patient 1 with fever and vomiting, and patient 2 with failure to gain weight were studied. After 4 hr of water deprivation test, the urinary osmolality of the patient 1 was only 105 mOsm/liter and his body weight showed a 4.6% reduction. In response to desamino-8-D arginine vasopressin intranasal administration, no significant elevation of urinary osmolality of patient 1 occurred. After low dose vasopressin tests, the maximal urinary osmolality of their father was in the normal range, but that of their mother was below the normal range. Moreover, the patients showed no significant increase of urinary osmolality after the same tests. The brothers were diagnosed as nephrogenic diabetes insipidus (NDI) and their mother was diagnosed as a carrier. An early diagnosis of NDI is important, since adequate managements such as low-solute diet with restricted protein and salt intake or such as water intake at frequent intervals can prevent the hyperosmolality which would develop the delayed mental and physical developments. The usefulness of the combination of indomethacin with thiazide diuretics is described.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Kidney Diseases; Male; Osmolar Concentration; Pedigree; Urine; Water Deprivation

Fibrinolytic responses to infusion of 1-desamino-8-D-arginine-vasopressin (DDAVP) were assessed in 6 males with congenital nephrogenic diabetes insipidus (NDI), 6 carriers of the NDI gene and 6 normal control subjects. Tissue-type plasminogen activator (t-PA) activity and antigen increased significantly in normal subjects, while plasminogen activator inhibitor (PAI) activity decreased. None of these changes were observed in patients with NDI. In 2 female carriers, normal fibrinolytic responses were seen, while in the other carriers responses were delayed. These findings are consistent with the concept of a general V2-receptor defect in congenital NDI. DDAVP tests are of limited use in NDI carrier detection.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Fibrinolysis; Humans; Kidney Diseases; Male; Plasminogen Inactivators; Tissue Plasminogen Activator

Individuals receiving lithium carbonate commonly have nephrogenic diabetes insipidus. There is no effective and practical treatment for this condition. We have found that large doses of desmopressin (DDAVP) may provide effective therapy without adverse effects. A recent report showed that indomethacin improved nephrogenic diabetes insipidus that had persisted after the lithium therapy was discontinued. We have provided additional evidence that indomethacin may be effective, even when treatment with lithium is continued. We also have shown that indomethacin together with desmopressin can markedly decrease polyuria, though indomethacin must be used with care because it may impair renal function.

Topics: Adult; Antiviral Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Evaluation; Drug Synergism; Drug Therapy, Combination; Female; Humans; Indomethacin; Injections, Subcutaneous; Kidney Diseases; Lithium; Lithium Carbonate; Osmolar Concentration

Three patients with congenital, nephrogenic diabetes insipidus (NDI) from two unrelated families were tested for haemostatic and fibrinolytic responses to DDAVP infusion and venous occlusion. None of the three patients showed a response of factor VIII:C, vWF:Ag or t-PA to DDAVP, a V2-agonist. However, the baseline levels of these factors in the patients' plasma were normal and during venous occlusion a rise in t-PA antigen and t-PA activity was observed in all patients. One patient showed a definite response of the t-PA antigen level to exercise. It is concluded that (extrarenal) V2-receptor-mediated responses are absent in these patients, but that baseline homeostasis and the response to venous occlusion and physical exertion are intact. Presumably, these depend on other mechanisms. This observation denies a central role for vasopressin receptors in the on-demand regulation of clotting and clot dissolving properties of the blood.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Fibrinolysis; Homeostasis; Humans; Kidney Diseases; Male; Plasminogen Inactivators; Receptors, Angiotensin; Receptors, Vasopressin; Tissue Plasminogen Activator

To examine a possible role for atrial natriuretic peptide (ANP) in water and sodium metabolism disturbances associated with abnormal vasopressin (AVP) secretion, we measured plasma ANP concentrations in 15 patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and in 17 patients with central diabetes insipidus (DI). The mean plasma ANP concentration (30.2 +/- 10.4 pmol/L) in SIADH patients who had hyponatremia, plasma hypoosmolality, hyperosmolar urinary compared to plasma sodium levels, and increased plasma AVP levels relative to plasma osmolality was significantly higher than that in normal subjects (12.6 +/- 4.9 pmol/L), although there was a considerable individual variation in plasma ANP ranging from normal to clearly elevated levels (15.1-47.0 pmol/L). When hyponatremia was corrected by water restriction or demeclocycline administration, plasma ANP levels decreased significantly and fell into the normal range (12.5 +/- 4.3 pmol/L). DI patients who complained of polyuria and polydipsia and had hypoosmolar urine, normal or elevated plasma sodium concentrations, and decreased plasma AVP levels relative to plasma osmolality, on the other hand, had a significantly lower mean plasma ANP level (7.6 +/- 2.9 pmol/L) than normal subjects. There was, again, a considerable overlap between plasma ANP levels in individual DI patients (4.2-13.9 pmol/L) and those in normal subjects. Treatment with 1-desamino-8-D-arginine vasopressin resulted in a significant increase in the mean plasma ANP level (18.6 +/- 8.0 pmol/L). There were no significant correlations between plasma ANP and AVP levels in either group of patients. The results indicate that ANP secretion is modulated by changes in plasma volume consequent to abnormal AVP secretion, which may have a pathophysiological significance in maintaining volume homeostasis.

Topics: Adolescent; Adult; Aged; Atrial Natriuretic Factor; Blood Volume; Deamino Arginine Vasopressin; Demeclocycline; Diabetes Insipidus; Female; Humans; Inappropriate ADH Syndrome; Male; Middle Aged; Polyuria; Sodium; Vasopressins; Water-Electrolyte Balance

The concentration of atrial natriuretic peptides (ANF) was measured radioimmunologically in 18 selected microdissected brain areas of rats with inherited diabetes insipidus (Brattleboro rats) and their control rats (Long-Evans rats). In 7 brain areas known to be involved in the regulation of fluid homeostasis or blood pressure (subfornical organ, organum vasculosum lamina terminalis, periventricular preoptic nucleus, perifornical nucleus, nucleus of the solitary tract, tegmentum pontis, arcuate nucleus) ANF concentration was significantly changed. After restoration of antidiuresis with the V2 receptor agonist 1-desamino-8-D-arginine vasopressin (DDAVP) ANF levels of Brattleboro rats adapted at least partly to those of the control rats in all brain areas except the subfornical organ. Furthermore, ANF was then significantly changed in the supraoptic and paraventricular nuclei of DDAVP-treated diabetes insipidus rats. These data show that the central ANF system is sensitive for changes in electrolyte and fluid homeostasis.

Topics: Animals; Arcuate Nucleus of Hypothalamus; Atrial Natriuretic Factor; Brain; Deamino Arginine Vasopressin; Diabetes Insipidus; Hippocampus; Hypothalamus; Medulla Oblongata; Pons; Preoptic Area; Rats; Rats, Brattleboro; Subfornical Organ; Tegmentum Mesencephali; Water-Electrolyte Balance

Replacement therapy in cases of hypopituitarism in the adult has improved dramatically in the last decade. After initial detailed investigation of the extent of the hormone deficiency, the replacement therapy is tailored to the particular needs of the individual. Over-replacement with glucocorticoids must be avoided. Replacement of gonadal steroids is simpler than the induction of fertility. Gonadotrophin-releasing hormone has simplified fertility induction in cases of hypothalamic origin of the disease. Altered body composition and poor quality of life reversible with GH therapy have emphasised the importance of GH in the adult.

Topics: Adrenocorticotropic Hormone; Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Estrogens; Female; Gonadotropin-Releasing Hormone; Gonadotropins; Humans; Hypogonadism; Hypopituitarism; Infertility; Male; Progesterone; Testosterone; Thyrotropin

A case is presented of a pregnancy complicated by a suprasellar mass diagnosed at 27 weeks' gestation. This patient developed diabetes insipidus, which was successfully treated with 1-desamino-8-D-arginine vasopressin. Thyrotropin-releasing hormone and ACTH stimulation tests were also abnormal, requiring the institution of thyroid and cortisol replacement therapy. The patient was delivered at 34 weeks' gestation secondary to worsening visual field testing. A craniotomy was performed in the postpartum period with removal of a craniopharyngioma. With successful medical treatment and careful observation, surgical intervention may be postponed until postpartum or until a gestational age with lower neonatal morbidity and mortality is reached.

Topics: Adult; Combined Modality Therapy; Craniopharyngioma; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hydrocortisone; Pituitary Neoplasms; Pregnancy; Pregnancy Complications, Neoplastic; Thyroxine

Authors describe the simultaneous occurrence of ascites due to liver cirrhosis and diabetes insipidus in a patient with consistently normal urine volume. The diagnosis of diabetes insipidus has been proved by the water deprivation test combined with the administration of dDAVP as well as by serial determinations of plasma arginine vasopressin levels before and during infusion of hypertonic sodium chloride solution. Authors discuss the differential-diagnostic difficulties of the case and consider the mechanisms playing a role in the abolishment of diabetic polyuria by hepatic disease.

Topics: Aged; Arginine Vasopressin; Ascites; Body Water; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuretics; Humans; Injections, Intravenous; Kidney; Liver Cirrhosis; Male; Sodium Chloride

The role of endogenous vasopressin in cardiovascular homeostasis was examined using vasopressin-deficient rats (Brattleboro) (n = 194) and their parent strain, Long-Evans rats (n = 181). Mean arterial pressure (blood pressure) and heart rate were measured every 4 seconds with or without infusion of drug solution for 21 hours, and mean values and their standard deviations (lability) were calculated. Blood pressure in Brattleboro rats (116 +/- 1.1 mm Hg, mean +/- SEM) was significantly higher than that in Long-Evans rats (96 +/- 0.7 mm Hg, p less than 0.001), whereas heart rates (381 +/- 3.3 and 375 +/- 2.9 beats/min, respectively) were similar. The lability of blood pressure and heart rate in Brattleboro rats (9.2 +/- 0.1 mm Hg and 42.3 +/- 0.7 beats/min) was also greater than that in Long-Evans rats (6.7 +/- 0.1 mm Hg, p less than 0.001 and 38.4 +/- 0.8 beats/min, p less than 0.01, respectively). In Brattleboro rats, intravenous vasopressin (0.1 ng/kg/min or 0.6 ng/kg/min) did not affect blood pressure, although it did reduce heart rate and decreased lability of blood pressure and heart rate. Intracerebroventricular (central) infusion of vasopressin (2 pg/kg/min) in Brattleboro rats induced initial hypertension and tachycardia followed by long-lasting hypotension and bradycardia, whereas in Long-Evans rats it induced only hypertension and tachycardia. In both strains, central vasopressin dramatically decreased the lability of blood pressure and heart rate. Neither intravenous (0.2 ng/kg/min) nor central desmopressin (2 pg/kg/min or 0.2 ng/kg/min), a V2 renal receptor agonist, changed any of these parameters in Brattleboro rats, although both diminished urinary volume. Neither intravenous (50 ng/kg/min) nor central (3.3 pg/kg/min) d(CH2)5-Tyr(Me)-arginine vasopressin, a vasopressin V1 receptor antagonist, modulated any of these parameters in Long-Evans rats. These results suggest that endogenous as well as exogenous vasopressin acts centrally as a cardiovascular inhibitor and stabilizer through a receptor mechanism other than V1 or V2 receptor mechanisms.

Topics: Animals; Arginine Vasopressin; Blood Pressure; Cardiovascular Physiological Phenomena; Cardiovascular System; Deamino Arginine Vasopressin; Diabetes Insipidus; Heart Rate; Injections, Intravenous; Rats; Vasopressins

Topics: Arginine Vasopressin; Brain Death; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Kidney Transplantation; Retrospective Studies; Tissue Banks; Tissue Donors; Transplantation, Homologous

Topics: Celiac Disease; Congenital Hypothyroidism; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hyponatremia; Hypothyroidism; Infant; Male; Seizures

Two patients with post-traumatic diabetes insipidus (DI) are reported. One had suffered a fatal injury and the other a mild contusion without amnesia before DI developed. These two instances exemplify the wide spectrum of post-traumatic DI and, hence, the importance of ruling out DI even afer a mild closed-head injury.

Topics: Adult; Central Nervous System; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Female; Humans; Male; Middle Aged; Vasopressins; Wounds and Injuries

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Postoperative Complications

We recently showed that the administration of the antidiuretic V2 specific agonist, 1-desamino[8-D-arginine]vasopressin (dDAVP), to seven male patients with congenital nephrogenic diabetes insipidus (CNDI) did not cause a decrease in blood pressure nor an increase in plasma renin activity or factor VIIIc or von Willebrand factor release. In normal subjects, plasma renin activity, coagulation factors and plasma cyclic AMP are stimulated not only by dDAVP but also by the administration of epinephrine. In the present study, we measured tissue plasminogen activator (activity and antigenicity), von Willebrand factor multimers, plasma and urinary cyclic AMP concentrations following dDAVP or epinephrine administration. We infused epinephrine into three male patients with CNDI. Factor VIIIc and tissue plasminogen activator augmented by 75 to 100% and von Willebrand Factor multimers were increased; plasma renin activity and plasma cyclic AMP concentration increased by 200%. None of these values changed when the same subjects as well as eleven other male patients with CNDI received dDAVP. Furthermore, dDAVP administration increased plasma cyclic AMP concentrations in normal subjects, but not in 14 male patients with CNDI. These results demonstrate the specificity of the extrarenal V2 receptor defect expressed in our patients. The lack of a plasma cyclic AMP response to the administration of dDAVP would suggest an altered pre-cyclic AMP stimulation mechanism.

Topics: Adult; Blood Coagulation Factors; Cyclic AMP; Deamino Arginine Vasopressin; Diabetes Insipidus; Epinephrine; Humans; Male; Nephrons; Receptors, Angiotensin; Receptors, Vasopressin

The effects of the absence of various hormones (antidiuretic hormone, thyroid hormone, parathyroid hormone, and calcitonin) on proximal and distal structures were studied in diabetes insipidus (DI) Brattleboro rats. The cross-sectional area of the first segment of proximal convoluted tubules (S1) was significantly reduced in thyroparathyroidectomized (TPTX) DI rats compared with Long-Evans rats (the strain of origin of DI rats) and untreated DI rats. Administration of triiodothyronine (T3, 10 micrograms/day for 7 days) to TPTX-DI rats restored the proximal tubule structure. In the distal convoluted tubule (DCT) the cross-sectional area of the epithelium and the number of nuclei per cross-sectional area were significantly greater in untreated ADH-deficient DI rats than in the control Long-Evans rats. Daily administration of 1-desamino-8-D-arginine vasopressin (dDAVP, 500 ng/day for 3 wk) significantly reduced the size and the number of DCT cells in DI rats. Cortical micropuncture data indicated that the Na+ concentration in the fluid delivered to the DCT and the absolute amount of Na+ reabsorbed along the DCT were higher in DI than in dDAVP-treated DI rats. It is concluded that functional changes in the PCT, subsequent to chronic TPTX, are accompanied by marked alteration of the cell anatomy of this nephron segment, and that the processes that modify the Na load delivered to the DCT and the Na transport in the DCT are accompanied by structural modifications of this segment.

Topics: Animals; Deamino Arginine Vasopressin; Diabetes Insipidus; Kidney Tubules; Kidney Tubules, Distal; Kidney Tubules, Proximal; Nephrons; Parathyroid Glands; Peptides; Rats; Rats, Brattleboro; Rats, Inbred Strains; Thyroid Hormones; Thyroidectomy; Vasopressins

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Remission, Spontaneous; Time Factors

Multifocal eosinophilic granuloma is part of the spectrum of histiocytosis X, in which the unifying feature is the proliferation and infiltration of histiocytes. Central nervous system (CNS) involvement has a predilection for the hypothalamic nuclei, and these infiltrates appear as high signal foci on T2-weighted magnetic resonance (MR) images that completely resolve after effective chemotherapy. Intradiploic skull lesions are well delineated with MRI, and the relation to underlying brain may be confidently assessed. MRI is the procedure of choice for staging multifocal eosinophilic granuloma in the skull and CNS, as well as for monitoring response to therapy.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bone Diseases; Child, Preschool; Combined Modality Therapy; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Therapy, Combination; Eosinophilic Granuloma; Female; Humans; Hypothalamic Diseases; Magnetic Resonance Imaging; Prednisone; Skull; Ventromedial Hypothalamic Nucleus

Three cases of leukaemia complicated by pituitary diabetes insipidus are presented. In one patient diabetes insipidus developed five months before acute myelomonocytic leukaemia became apparent. The two other patients suffered from acute myelomonocytic leukaemia and from a blastic transformation of chronic myeloid leukaemia. In one case a transient cure of diabetes insipidus was obtained after intrathecal chemotherapy and irradiation of the skull.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Injections, Spinal; Leukemia, Myeloid; Male; Methotrexate; Middle Aged

PGE2 synthesis was measured along the nephron of Brattleboro (DI) rats, lacking ADH, and control LE rats, using an enzyme immunoassay. Experiments were performed in vitro, in the absence of exogenous arachidonic acid, using microdissected tubular segments. The effect of a chronic treatment of dDAVP was tested on three ADH sensitive tubular segments, medullary thick ascending limb (MTAL), medullary collecting tubule (OMCD) and papillary collecting duct (IMCD). No difference in PGE2 synthesis was present between LE and DI in glomerulus and tubular segments up to OMCD. In both strains, values were low in the proximal tubule and the loop of Henle, and gradually increased along the collecting tubule. In IMCD, PGE2 synthesis was much higher in DI (12.8 +/- 2.0 pg per 30 min per mm tubular length) than in LE (3.8 +/- 0.5, LE vs. DI p less than 0.001). In MTAL and OMCD, dDAVP treatment did not affect PGE2 synthesis. In IMCD, dDAVP reduced PGE2 synthesis to values (5.3 +/- 0.8 pg per 30 min per mm tubular length), which were not significantly different from those of LE. Neither oxytocin, which has been shown to be elevated in DI rats, nor furosemide, that reduced papillary osmolarity to values comparable to those of DI rats, were able to increase PGE2 synthesis in IMCD of LE rats. The mechanism of the increase in PGE2 synthesis in IMCD of DI rats, and of the inhibitory effect of dDAVP is yet unknown; it may participate to compensate for the lack of ADH in the Brattleboro rat.

Topics: Animals; Deamino Arginine Vasopressin; Diabetes Insipidus; Dinoprostone; Diuresis; Female; Furosemide; Kidney Medulla; Kidney Tubules; Kidney Tubules, Collecting; Loop of Henle; Nephrons; Osmolar Concentration; Oxytocin; Rats; Rats, Brattleboro; Urine; Vasopressins

Diabetes insipidus during pregnancy is an uncommon medical problem. We present a woman who developed transient central diabetes insipidus during two successive pregnancies. A water deprivation study with plasma arginine vasopressin concentrations confirmed the diagnosis and established the efficacy of 1-desamino-8-d-arginine-vasopressin (dDAVP). The patient was then successfully and safely treated through the second pregnancy with dDAVP.

Topics: Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Osmolar Concentration; Pregnancy; Pregnancy Complications; Recurrence; Water Deprivation; Water-Electrolyte Balance

Antidiuretic hormone is known to stimulate the renal synthesis of prostaglandins. These autacoids, in turn, modulate the pressure natriuresis phenomenon. Accordingly, the present study was done to test the hypothesis that, in the absence of antidiuretic hormone and antidiuretic hormone-dependent prostaglandin synthesis, the pressure natriuresis response is blunted. Experiments were performed on Brattleboro diabetes insipidus rats (n = 7) and Long Evans control rats (n = 14). A change in perfusion pressure in the Long Evans rats from 89.3 +/- 1.0 to 108.7 +/- 1.1 mm Hg (p less than 0.05) was associated with significant increases in the fractional excretion of sodium (1.1 +/- 0.2 to 2.3 +/- 0.3%) and the urinary prostaglandin excretion (32.6 +/- 6.8 to 56.6 +/- 10.0 pg/min). In contrast, a similar change in perfusion pressure in the diabetes insipidus rat from 88.6 +/- 1.4 to 106.2 +/- 1.5 mm Hg (p less than 0.05) resulted in no significant increases in either sodium or prostaglandin excretions. Treatment of a third group of diabetes insipidus rats (n = 9) with 1-desamino-8-D-arginine vasopressin (1 microgram/day) restored the natriuretic response to increases in renal perfusion pressure. Treated diabetes insipidus and Long Evans control rats had comparable natriuretic responses to increases in renal perfusion pressure. Untreated diabetes insipidus rats, on the other hand, had blunted responses. In summary, the pressure natriuresis response in diabetes insipidus rats is blunted compared with Long Evans control rats. We conclude that antidiuretic hormone is necessary for the complete expression of the pressure natriuresis response.

Topics: Animals; Deamino Arginine Vasopressin; Diabetes Insipidus; Kidney; Male; Natriuresis; Perfusion; Prostaglandins; Rats; Rats, Brattleboro; Rats, Inbred Strains; Rats, Mutant Strains; Urodynamics; Vasopressins

Ten families with nephrogenic diabetes insipidus (NDI) have been analysed for restriction fragment length polymorphisms (RFLPs). A search for linkage was performed using various chromosome-specific single-copy DNA probes of known regional assignment to the human X chromosome. Close linkage was found between the disease locus and the markers DXS52, DXS15, DXS134 and the F8 gene. This result assigns the NDI gene to the subtelomeric region of the long arm of the X chromosome. The regional localization of the gene by the identification of closely linked markers should have repercussions for genetic counselling and prevention in NDI families.

Topics: Alleles; Chromosome Mapping; Deamino Arginine Vasopressin; Diabetes Insipidus; DNA Restriction Enzymes; Female; Gene Frequency; Genetic Linkage; Genotype; Humans; Kidney; Male; Pedigree; X Chromosome

The antidiuretic hormone arginine vasopressin interacts with two types of receptors: V1, which mediates the effects of vasopressin on vascular smooth muscle, and V2, which mediates the antidiuretic effects on renal tubules. Resistance of the renal tubules to arginine vasopressin and to the antidiuretic V2-specific agonist 1-desamino[8-D-arginine] vasopressin (dDAVP) occurs in congenital nephrogenic diabetes insipidus, a rare X-linked disease, although the V1-receptor responses remain intact. The extrarenal actions of dDAVP in normal persons are a decrease in blood pressure, an increase in plasma renin activity, and stimulation of the release of factor VIIIc and von Willebrand factor. We measured the response of mean arterial pressure, pulse rate, plasma renin activity, factor VIIIc, and von Willebrand factor to an infusion of dDAVP (0.3 microgram per kilogram of body weight) in seven male patients with congenital nephrogenic diabetes insipidus, six obligatory carriers of the gene for nephrogenic diabetes insipidus, five patients with central diabetes insipidus, and four normal subjects. In the normal subjects and the patients with central diabetes insipidus, dDAVP decreased mean arterial pressure (by 10 to 15 percent) and increased pulse rate (by 20 to 25 percent), renin activity (by 65 percent), and the release of coagulation factors (twofold to threefold) (all changes were significant, P less than 0.01). None of these changes were observed in the patients with congenital nephrogenic diabetes insipidus, and minimal responses were observed in the obligatory carriers. These results confirm the existence of extrarenal vasopressin V2-like receptors, which may be defective in patients with congenital nephrogenic diabetes insipidus.

Topics: Arginine Vasopressin; Blood Coagulation; Blood Pressure; Deamino Arginine Vasopressin; Diabetes Insipidus; Factor VIII; Hemodynamics; Humans; Kidney Diseases; Kidney Tubules; Male; Pulse; Receptors, Angiotensin; Receptors, Vasopressin; Renin; von Willebrand Factor

Desmopressin (DDAVP) is used intramuscularly in the treatment of post operative diabetes insipidus as soon as the condition is diagnosed to ensure continuous replacement of antidiuretic hormone secretion during the first 5 days of therapy. Two successive studies, each involving 15 patients, were conducted. The first study was designed to test the effectiveness and detect the possible side effects of intramuscular DDAVP, while the purpose of the second study was to evaluate the clinical application of the drug. With seven 2 mcg doses of DDAVP, administered 12-hourly by intramuscular injection to patients weighing more than 30 kg, continuous antidiuresis during 96 hours was achieved. This method is simple and effective, but it should not be prolonged beyond that period of time. Moreover, to prevent plasma hypo-osmolality, fluid intake must be strictly controlled and kept at the same level as or below diuresis.

Topics: Adolescent; Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Evaluation; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Neurosurgery; Prospective Studies

V1 and V2 vasopressin receptor functions were studied in 2 patients with congenital nephrogenic diabetes insipidus. V1 receptor-mediated functions (increase in urinary prostaglandin E2 excretion and plasma cortisol levels) and Gs (guanine nucleotide-binding stimulatory protein) activity of erythrocyte membranes were normal in both patients. After infusion of 0.4 micrograms/kg dDAVP, a 57-yr-old male patient had no increase in plasma factor VIII coagulant, ristocetin cofactor, or fibrinolytic activity or change in von Willebrand factor multimers. In addition, he had no vasodilatory response to dDAVP, a response that occurs in normal subjects and patients with central diabetes insipidus. In contrast, a 25-yr-old female patient had normal hemostatic and vasodilatory responses to the infusion of dDAVP. These observations indicate that the cellular abnormalities in patients with congenital nephrogenic diabetes insipidus may be either at the V2 receptor or in the postreceptor (and Gs activity) cascade of events that mediate vasopressin-induced antidiuresis. Therefore, heterogeneity exists in the biochemical cause(s) of congenital nephrogenic diabetes insipidus in man.

Topics: Adult; Biomechanical Phenomena; Blood Coagulation; Deamino Arginine Vasopressin; Diabetes Insipidus; Factor VIII; Female; Hemodynamics; Humans; Kidney Diseases; Male; Middle Aged; Skin Temperature; von Willebrand Factor

The effects of 1-deamino-8D-arginine vasopressin (DDAVP) on plasma factor VIII and von Willebrand factor (vWF) levels were studied in four patients with nephrogenic diabetes insipidus (NDI) from two unrelated families. While the urine osmolality remained low, the plasma levels of factor VIII and vWF rose 2- to 3-fold after infusion of 0.3 micrograms/kg DDAVP, compared to preinfusion levels. The degree of increase was similar in both NDI patients and normal subjects. We conclude that in NDI patients the end-organ resistance to DDAVP is confined to the kidneys and does not involve the sites from which factor VIII and vWF are released.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Evaluation; Factor VIII; Female; Humans; Infusions, Intravenous; Kidney Diseases; Male; von Willebrand Factor

Topics: Adolescent; Brain Neoplasms; Child; Child, Preschool; Craniopharyngioma; Craniotomy; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Female; Humans; Hypernatremia; Male; Osmolar Concentration

A 22 year-old woman with diabetes insipidus on chronic therapy with desmopressin acetate (DDAVP) developed recurrent venous thromboembolism and transient thrombocytopenia temporally related to the administration of DDAVP. Large increases in plasma von Willebrand factor (vWF), vWF-activity, and relative increases in the concentrations of the larger multimeric forms of vWF-antigen were observed, as well as a plasma factor which sensitized normal platelets to undergo spontaneous aggregation in vitro. Additional studies showed that the patient's plasma retained the platelet aggregation inducing activity after selective removal of vWF by immunoabsorption. The nature of the platelet activating factor and the relationship of this factor and the excessively increased and transiently abnormal vWF to the recurrent venous thromboembolism in this patient remain uncertain. Although the findings do not implicate definitively DDAVP in the elevation of vWF in this patient, it is suggested that its use be considered with caution in patients with diabetes mellitus and increased levels of vWF.

Topics: Adult; Antithrombin III; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Fibrinogen; Humans; Platelet Aggregation; Staphylococcus aureus; Thrombocytopenia; Thromboembolism; von Willebrand Factor

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Humans

Previous studies from this laboratory have demonstrated that vasopressin stimulates K, Mg, Ca, Cl, and Na reabsorption by the thick ascending limb of Henle's loop (TALH) of the rat kidney. Micropuncture of superficial nephrons and clearance experiments were performed to determine whether desensitization of the TALH to vasopressin may be demonstrated in vivo and whether such desensitization is specific for the effects of vasopressin (i.e., homologous) or also alters the response to the other hormones acting on the same pool of adenylate cyclase in this nephron segment. Brattleboro rats, with hereditary hypothalamic diabetes insipidus (DI), were given i.m. injections of 1-desamino-8-D-arginine-vasopressin (des-1-amino-[DArg8]VP (herein designated dDAVP); 2 micrograms/day) for 3 days. The effects of maximal physiological doses of arginine-8-vasopressin ([Arg8]VP (herein designated AVP); 20 pg/min per 100 g of body weight) were studied 2 days after the cessation of treatment, when the animals had returned to DI. The K, Mg, Ca, and, to a lesser extent, Cl and Na concentrations in the fluid leaving the TALH of superficial nephrons were higher in dDAVP-treated than in untreated rats given similar amounts of AVP during the experiments. A 50-60% desensitization of the TALH to AVP was still apparent 2 days after stopping the dDAVP injections. Desensitization is homologous, as judged from normal responses to physiological doses of glucagon and calcitonin, two hormones acting on the same cyclase pool as AVP in the rat TALH. The AVP-dependent increase of urine osmolality, however, indicated that its effects on the permeability to water of the collecting duct were scarcely affected in dDAVP-treated rats. It is concluded that (i) AVP induces homologous desensitization in the rat TALH and (ii) the TALH can be markedly desensitized to AVP when the collecting duct response to this hormone is poorly affected or even fully maintained.

Topics: Adenylyl Cyclases; Animals; Arginine Vasopressin; Calcitonin; Cations; Chlorides; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Tolerance; Glomerular Filtration Rate; Glucagon; Kidney Tubules; Loop of Henle; Male; Osmolar Concentration; Rats; Rats, Brattleboro; Urine

Previous studies have shown a disappearance of interstitial cells from the renal medulla of rats with hereditary diabetes insipidus (Brattleboro) when the animals were treated with vasopressin in high doses. The present study was undertaken to elucidate the mechanisms behind this cell loss. The disappearance of interstitial cells from the renal medulla of Brattleboro rats was quantitatively determined by electron microscopic stereology after various types of treatment. A considerable decrease in the volume density of interstitial cells was induced by the administration of either 8-arginine vasopressin or 1-desamino-8-D-arginine vasopressin. This lesion of the interstitial cells was not prevented by the simultaneous administration of oxytocin. Even a 48-hour period of water deprivation also resulted in a slight decrease in the volume density of interstitial cells. The results indicate that the observed loss of renal medullary interstitial cells is not a direct effect of the hormone on the cells but probably secondary to the marked increase in the renal medullary solute (urea) concentration. The fact that animals with hardly any renomedullary interstitial cells concentrated their urine to a virtually normal level shows that these cells cannot play an important role in the concentrating mechanism. The interstitial cells recovered rapidly when the vasopressin treatment was discontinued, but it could not be determined whether this was due to local proliferation or to the immigration of cells from extrarenal tissue.

Topics: Analysis of Variance; Animals; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Kidney Medulla; Male; Microscopy, Electron; Osmolar Concentration; Oxytocin; Rats; Rats, Brattleboro; Rats, Inbred Strains; Urine; Vasopressins

A 37-year-old woman who had developed diabetes insipidus after an abortion, requiring nasal substitution treatment with desmopressin (Minirin), began to suffer from fatigue, nocturnal sweating, cough and dyspnoea on exertion. Exogenous-allergic alveolitis was demonstrated by chest x-ray, lung function tests, blood gas analysis, broncho-alveolar lavage and transbronchial lung biopsy. After changing the treatment to an intramuscularly administered preparation and starting steroid therapy the clinical, radiological and lung function findings rapidly improved.

Topics: Administration, Intranasal; Adrenal Cortex Hormones; Adult; Alveolitis, Extrinsic Allergic; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Injections, Intramuscular

A 20-year-old woman with a transient diabetes insipidus as a complication to meningococcal meningitis is presented. This condition has only been described once before. Culture of blood and spinal fluid yielded Neisseria meningitidis group B, sensitive to penicillin. The diabetes insipidus arose on day 4 after admission and continued to day 15. Treatment comprised benzylpenicillin, DIC therapy, assisted ventilation, and vasopressin.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Meningitis, Meningococcal

Topics: Adult; Aminopeptidases; Cystinyl Aminopeptidase; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Pregnancy; Pregnancy Complications

Atrial natriuretic peptide (ANP) was measured by radioimmunoassay in atrial and plasma extracts from normal Long-Evans (LE) rats and Brattleboro-strain diabetes insipidus (DI) rats. LE rats, dehydrated for 72 hours, had an increased plasma osmolality and plasma vasopressin. They also demonstrated a higher atrial immunoreactive ANP (IR-ANP) content than hydrated animals (72 hr dehydration: 178.2 +/- 30.4 micrograms/g wet weight atria, mean +/- SE, control: 60.4 +/- 8.2; P less than 0.001). Plasma IR-ANP in dehydrated LE rats tended to be lower than hydrated LE but this was not statistically significant [72 hr dehydration: 61.9 +/- 5.9 pg/ml, control: 82.4 +/- 8.2]. IR-ANP concentration in atrial extracts from DI rats, without detectable plasma vasopressin levels but with increased plasma osmolality, was not different from that in hydrated LE rats (DI: 100.6 +/- 13.2 micrograms/g). There was also no significant difference between plasma IR-ANP in DI and hydrated LE rats (DI: 100.2 +/- 11.9 pg/ml). The atrial IR-ANP concentration in DI rats was decreased by infusion with either arginine-vasopressin (AVP) or 1-deamino-8-arginine vasopressin (DDAVP), and plasma IR-ANP was increased significantly by both infusions (AVP: 171.3 +/- 18.1 pg/ml, DDAVP: 179.5 +/- 24.6). Thus, changes in atrial and plasma IR-ANP concentration appeared to be associated with changes in water balance but not with plasma AVP levels, indicating that the changes in volume may be a more important factor controlling ANP release in vivo than vasopressin itself.

Topics: Animals; Arginine Vasopressin; Atrial Natriuretic Factor; Blood; Deamino Arginine Vasopressin; Dehydration; Diabetes Insipidus; Heart Atria; Male; Osmolar Concentration; Rats; Rats, Brattleboro; Renin

Topics: Adolescent; Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Factor VIII; Humans; Hypothalamo-Hypophyseal System; Infusions, Intravenous; Pituitary-Adrenal System; Tissue Plasminogen Activator; von Willebrand Factor

The clinical and neuroradiological findings in a case of semilobar holoprosencephaly associated to hypernatremia behaving like diabetes insipidus are described. The differential diagnosis with a neurogenic hypernatremia is discussed. The advantages of ultrasounds in the diagnosis of this malformation are pointed out. So are the characteristics which differentiate it from other neurological malformations and the importance of a dorsal sac to delimitate the more serous clinical forms.

Topics: Abnormalities, Multiple; Brain; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hypernatremia; Infant; Sodium; Tomography, X-Ray Computed; Ultrasonography

A case of a pregnant woman with diabetes insipidus is reported. The course of the pregnancy was uneventful except for a slightly increased need for vasopressin during the last trimester. Neurophysin levels increased at a rate similar to that seen in the normal pregnant state. The combination of normal neurophysin physiology and undisturbed spontaneous labor demonstrating normal oxytocin secretion suggests that there is a singular deficiency of antidiuretic hormone in essential diabetes insipidus.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Female; Humans; Neurophysins; Pregnancy; Pregnancy Complications; Vasopressins

Topics: Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Infant; Male; Osmolar Concentration

We describe three patients who have polydipsia and polyuria due to an abnormality in the osmoregulation of thirst. The clinical manifestations of the syndrome are similar to those of neurogenic diabetes insipidus. Thus, under basal conditions the patients have thirst, normal to high normal levels of plasma osmolality, and low levels of plasma vasopressin. Moreover, antidiuretic therapy greatly reduces thirst and polydipsia as well as polyuria. The only clinically distinguishing feature of the response is that thirst and water intake decrease less rapidly than water excretion. As a consequence, the patients with this syndrome develop variable degrees of dilutional hyponatremia and hypoosmolemia during treatment. The plasma vasopressin response to osmotic stimulation is relatively normal. In most of the patients, the osmotic threshold for vasopressin release is at the upper limit of normal, but this finding only explains their modest elevation in basal plasma osmolality. Thirst and water intake also change as a function of plasma osmolality. However, the threshold or "set" of the thirst osmostat appears to be abnormally low. The degree of downward resetting varies from patient to patient, but is always sufficient to stimulate thirst and water intake at levels of plasma osmolality below the normal range. This abnormality can account not only for the thirst and polyuria under basal conditions but also for the overhydration that occurs during antidiuretic therapy. The pathogenesis of the osmoregulatory abnormality is unknown but may be due to disruption of one or more of the afferent pathways that regulate the "set" of the thirst and vasopressin osmostats.

Topics: Adult; Body Weight; Deamino Arginine Vasopressin; Diabetes Insipidus; Drinking; Female; Humans; Male; Syndrome; Thirst; Urine; Vasopressins; Water-Electrolyte Balance

A male, aged 16, with chronic hypernatremia, adipsia, polyphagia, and poikilothermia was studied regarding regulation and secretion of arginine vasopressin. During recumbency at night, low plasma arginine vasopressin levels and increased volumes of dilute urine were found; whereas plasma arginine vasopressin levels and urine osmolalities rose and urine volumes decreased during ambulation in the daytime. Neither a 25% reduction of mean arterial pressure nor hypertonic saline infusion increased plasma arginine vasopressin or urine osmolalities. Treatment with 1-desamino-D-arginine-vasopressin at 6 p.m. and a scheduled fluid intake according to actual body weight eradicated hypernatremia and hyperosmolality. These data demonstrate a complete loss of arginine vasopressin secretion to osmotic stimulation, a partial defect of arginine vasopressin secretion to non-osmotic stimulation, an abolished response to stimulation of high-pressure-baroreceptors, but an intact responsiveness to stimulation of low-pressure-baroreceptors.

Topics: Adolescent; Arginine Vasopressin; Body Temperature Regulation; Deamino Arginine Vasopressin; Diabetes Insipidus; Feeding and Eating Disorders; Humans; Hypernatremia; Hyperphagia; Male; Obesity; Thirst

Sheehan's syndrome and diabetes insipidus were diagnosed in a 31-year-old woman seven months after postpartum bleeding with a short duration of hypotension. The diagnosis of diabetes insipidus was established by the inability to concentrate urine during water deprivation and the marked increase in urinary osmolality after administration of 1-Desamino-8-D-arginine-vasopressin (DDAVP). Obstetricians should be aware of diabetes insipidus as a postpartum complication.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hypopituitarism; Postpartum Hemorrhage; Pregnancy; Puerperal Disorders; Water Deprivation

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Infant, Newborn; Male; Meningitis; Streptococcal Infections; Streptococcus agalactiae

We have presented a case of pregnancy complicated by diabetes insipidus. Treatment with desmopressin acetate (DDAVP) appropriately managed the DI, and was not associated with a worsening of the condition as pregnancy progressed.

Topics: Adolescent; Cesarean Section; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant, Newborn; Postoperative Complications; Pregnancy; Pregnancy Complications; Pulmonary Edema

The effects of 1-desamino-8-D-arginine vasopressin (dDAVP) on superficial and juxtamedullary nephrons were investigated by micropuncture in diabetes insipidus (DI) Brattleboro rats chronically treated with the peptide. The rats, acutely deprived of endogenous calcitonin, parathyroid hormone (PTH), and glucagon [hormone-deprived (HD) rats], were examined either 4 days after cessation of dDAVP treatment (HDT, control diuretic rats) or when the treatment was continued until the micropuncture experiment, during which dDAVP was also given intravenously (HDT + dDAVP, experimental nondiuretic rats). In the presence of dDAVP, the reabsorption of Cl, Na, Mg, and Ca by the superficial loop of Henle was significantly increased, as previously observed in HD-untreated rats during acute infusion of dDAVP. The effects on the superficial distal tubule were also similar. The effects on K, however, were different both in the loop and in the distal tubule. At the bend of the juxtamedullary nephrons, the treatment alone (HDT rats) increased fractional delivery (FD%) of Na and Cl, whereas FD% of Mg, Ca, K, and P was unaltered. In HDT + dDAVP rats, FD% of H2O, Cl, Na, and Ca was significantly lower than in HDT rats, and FD% of K, Mg, and P did not differ significantly. In conclusion, in the presence of dDAVP, the FD% of H2O, Na, and Cl at the bend of the long-loop nephrons decreases, in accordance with our previous hypothesis that water removal along the rat descending limb increases outward NaCl diffusion along this segment.

Topics: Animals; Calcium; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Kidney Cortex; Loop of Henle; Magnesium; Male; Nephrons; Rats; Rats, Brattleboro; Sodium Chloride

The antidiuretic effect and pharmacokinetics of 10 to 20 micrograms of intranasal (IN) and 200 to 400 micrograms of oral (po) 1-deamino-8-D-arginine vasopressin (DDAVP) were studied in 10 paediatric diabetes insipidus patients. A significant increase in urine osmolality was obtained with all doses, maximum within 2 h and still present at 8 h. At 12 h after administration, the ratio urine osmolality/plasma osmolality was above 1 only after 20 micrograms intranasally and 400 micrograms perorally. The free water clearance decreased rapidly with all doses and was similar in magnitude and duration for both the intranasal and peroral routes of administration and remained negative for more than 8 h. The maximum plasma concentrations of DDAVP, measured with a specific and sensitive RIA method, was dose-dependent and there was not significant difference in time until maximum concentration was obtained or in plasma half-life between the two routes of administration. The ratio established, 1:20, by calculating the area under the curve showed a bio-equivalence between 10 micrograms IN and 200 micrograms po and between 20 micrograms IN and 400 micrograms po of DDAVP. This work further emphasized the effectiveness of the oral route and the rapidity of absorption. By continuous monitoring of DDAVP plasma values we have demonstrated that peak values were reached within one hour after administration. This study demonstrates that the doses needed to treat diabetes insipidus patients by the oral route will be approximately 20 times greater than by the nasal route.

Topics: Administration, Intranasal; Administration, Oral; Adolescent; Adult; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Dose-Response Relationship, Drug; Female; Humans; Male; Osmolar Concentration; Urine

We describe a case of diabetes insipidus after head injury in which thirst persisted despite treatment with DDAVP and normal plasma osmolality. Symptoms were only completely relieved when plasma osmolality was below 270 mosmol/kg. We believe that this might have been due to hypothalamic injury causing resetting of the thirst osmostat. To our knowledge, this type of primary polydipsia has not been described before in association with diabetes insipidus following head injury.

Topics: Adult; Craniocerebral Trauma; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Male; Osmolar Concentration; Thirst

Topics: Adult; Cyclophosphamide; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Therapy, Combination; Female; Granulomatosis with Polyangiitis; Humans; Prednisolone

A neonate with cranial diabetes insipidus was successfully treated with oral desmopressin. The patient had a midline cleft lip and palate and we obtained a more consistent response using the oral route than using the usual nasal route.

Topics: Administration, Oral; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant, Newborn

A 3-month-old child with bilateral cleft lip and palate and holoprosencephaly was hospitalized after he developed diabetes insipidus presumably due to hypothalamic dysfunction. He was initially treated with subcutaneous vasopressin injection but was switched to therapy with desmopressin acetate (DDAVP) before discharge. Because of his abnormal nasopharyngeal anatomy, we decided to administer the desmopressin acetate sublingually, and this was effective. A single daily dose of 2 micrograms (0.4 microgram/kg) resulted in a prompt antidiuresis, and the effect gradually lessened over a 24-hour period. Serum electrolyte values were restored to normal and have remained normal after three months of treatment. After additional study, the sublingual route might be considered for the administration of small-polypeptide therapeutic agents when other routes are impractical.

Topics: Abnormalities, Multiple; Adult; Brain; Cleft Lip; Cleft Palate; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Administration Routes; Female; Humans; Infant, Newborn; Male; Pregnancy

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant, Newborn; Labor, Obstetric; Male; Oxytocin; Pregnancy; Pregnancy Complications

The effect of oral administration of desmopressin (DDAVP) solution was investigated in six patients with cranial diabetes insipidus of varying aetiology. All patients experienced a prompt and prolonged antidiuresis. Nine patients have been managed with oral DDAVP tablets for up to 5 months and all preferred this route of administration to intranasal application using a rhinyle. Oral DDAVP gives excellent and convenient control in cranial diabetes insipidus.

Topics: Administration, Oral; Adolescent; Adult; Aged; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Middle Aged; Urination

The dose-response relationships and pharmacokinetics of orally administered 1-desamino-8-D-AVP (DDAVP) were investigated. In water-loaded normal subjects marked reductions in urine flow rate and increases in urinary osmolality occurred. The responses were maximal 2 h after ingestion of 50, 100, and 200 micrograms, and lasted at least 6 h. Plasma DDAVP levels increased in a dose-dependent fashion and its disappearance from the plasma followed an exponential time course, with a half-life 86 to 142 min. In water-loaded adults with central diabetes insipidus (CDI), 200 micrograms oral DDAVP caused marked antidiuresis and mean urinary osmolality increased from 107 mosm/kg to 554 mosm/kg after 3 h. In these patients the effect also lasted at least 6 h. Children with CDI were less sensitive than normal subjects to the 50-microgram dosage and required 100 micrograms orally to achieve a duration of action similar to that resulting from 200 micrograms in adults. Oral DDAVP may be useful for treating some patients with CDI.

Topics: Administration, Intranasal; Administration, Oral; Adolescent; Adult; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Dose-Response Relationship, Drug; Female; Humans; Kinetics; Male; Middle Aged; Osmolar Concentration

Three women with neurohypophyseal diabetes insipidus, treated for prolonged periods, including pregnancy, with L-deamino-8-d-arginine vasopressin, gave birth in our hospital. Two of the infants had severe congenital heart disease, one of which was associated with trisomy 21. The third baby, born prematurely, presented with mild intrauterine growth retardation; at the age of 21 months, the boy had severe failure to thrive, hypotonia, and motor retardation. These three cases raise doubts as to the safety of diabetes insipidus or its treatment in pregnancy.

Topics: Abnormalities, Drug-Induced; Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects

A case of transient vasopressin-resistant diabetes insipidus is reported, which developed during the seventh month of pregnancy and remitted postpartum. The patient was resistant to large doses of deamino-D-arginine vasopressin as well as to aqueous pitressin. She was treated with hydrochlorothiazide. Evidence that prostaglandins may play a role in this syndrome is discussed.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Resistance; Female; Humans; Hydrochlorothiazide; Osmolar Concentration; Pregnancy; Pregnancy Complications; Time Factors; Vasopressins

A young patient developed hypothalamic diabetes insipidus due to histiocytosis in infancy and was satisfactorily treated with Pitressin. As a teenager she no longer had thirst or polyuria after treatment was stopped. These symptoms only returned during her two pregnancies. When non-pregnant her urine output was 1.7-2.0 1/24 h, basal plasma osmolality 288-290 mOsm/kg, and during pregnancy 24 h urine volume was 4.5-5.21, plasma osmolality 278-280 mOsm/kg. Studies on osmoregulation of thirst and AVP release, and on renal sensitivity to the V2 agonist desmopressin and endogenous vasopressin were performed in pregnant and non-pregnant states. She had no circulating antibodies to AVP, and the effect of pregnancy-associated vasopressinase was eliminated. Results showed lowered basal plasma osmolality and osmolar thirst threshold in pregnancy but no failure of the renal concentrating mechanism. Plasma AVP concentrations after osmotic stimulation were lower in pregnancy. We propose that she developed thirst and polyuria during pregnancy because of lowering of her osmolar thirst threshold to plasma osmolalities which caused her to drink sufficient quantities of fluid to further reduce AVP secretion. We cannot exclude, however, the possibility that there was increased clearance of circulating AVP.

Topics: Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hypothalamic Diseases; Osmolar Concentration; Polyuria; Pregnancy; Pregnancy Complications; Recurrence; Thirst

A case of transient vasopressin-resistant diabetes insipidus is reported which developed during the seventh gestational month. Polyuria reached 4-6 L daily and urine osmolality remained dilute despite 21 hours of water deprivation followed by 5 U intramuscularly of aqueous pitressin, as well as four days of treatment with intranasal DDAVP (0.1-0.5 mL every 12 hours). Urinary excretion of prostaglandin E2, 1384 ng/24 hours, was fourfold that in nongravid subjects and a plasma arginine vasopressin level of 12 pg/mL was recorded. Indomethacin had no effect on urine osmolality but decreased urine volume markedly. Hydrochlorothiazide, also, decreased urine volumes, and this drug was used to manage the patient until delivery. The syndrome remitted in the puerperium, the patient concentrating her urine to 938 mOsm/kg when tested several months postpartum.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Resistance; Female; Humans; Hydrochlorothiazide; Osmolar Concentration; Pregnancy; Pregnancy Complications; Syndrome

We studied the effects of chronic replacement with arginine vasopressin (AVP) or 1-desamino-D-arginine vasopressin (DDAVP), as well as acute replacement with AVP or DDAVP, on the responsiveness of oxytocin (OT) neurons as indexed by plasma oxytocin-associated neurophysin concentration [( OT-RNP]) during acute salt loading in conscious, chronically catheterized homozygous Brattleboro (DI) rats. Salt loading was carried out on days 5 and 12 of AVP (3,000 ng/day) or DDAVP (50 ng/day) treatment or 60 min after intraperitoneal injection of 1 microgram AVP or 25 ng DDAVP. All vasopressin treatments did not significantly alter the basal [OT-RNP]. In response to infusion of 18% saline, there were corresponding significant increases in plasma osmolality (Posmol) and [OT-RNP] in all animals. The increases in [OT-RNP] in vasopressin-treated DI rats were markedly reduced compared with those observed earlier for untreated DI animals despite similar rises in Posmol. The slopes of the relationship between delta [OT-RNP] and delta Posmol were 9.0 and 9.8 fmol X ml-1 X mosmol-1 X kg for chronically AVP-treated DI rats, 8.9, and 8.8 fmol X ml-1 X mosmol-1 X kg for chronically DDAVP-treated DI animals, 10.7 fmol X ml-1 X mosmol-1 X kg for acutely AVP-treated DI rats, and 8.3 fmol X ml-1 X mosmol-1 X kg for acutely DDAVP-treated animals compared with that of 34.9 fmol X ml-1 X mosmol-1 X kg for untreated DI rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Blood; Deamino Arginine Vasopressin; Diabetes Insipidus; Male; Neurons; Neurophysins; Osmolar Concentration; Oxytocin; Pituitary Gland, Posterior; Rats; Rats, Brattleboro; Saline Solution, Hypertonic; Sodium Chloride; Vasopressins

The possibility that sympathetic nervous system activity may be altered in Brattleboro rats with diabetes insipidus (DI) was studied using the norepinephrine (NE) turnover technique. Female DI and Long-Evans rats were used. NE turnover in peripheral organs was calculated by measuring the decline in tissue [NE] after inhibition of tyrosine hydroxylase with alpha-methyltyrosine. NE turnover was increased significantly in the kidney of DI rats but was not significantly altered in other peripheral organs examined (heart, duodenum, skeletal muscle). Both NE and epinephrine concentrations in the adrenal gland were significantly higher in the DI rats. Treatment of DI rats for 7 days with vasopressin tannate (Pitressin, 100 mU/100 g) or 1-deamino-[8-D-arginine] vasopressin (DDAVP, 250 ng X kg-1 X day-1) reversed the changes in renal NE turnover and also decreased the turnover in other tissues. The results of these studies suggest that, compared with Long-Evans rats, DI rats have a selective increase in NE turnover in the kidney and the potential to release more catecholamines from the adrenal glands. The apparently nonspecific effect of antidiuretic therapy on NE turnover in DI rats is probably mediated by the epithelial receptor for vasopressin, because both Pitressin and DDAVP produced similar results.

Topics: Adrenal Glands; Animals; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Duodenum; Female; Heart Ventricles; Kidney; Muscles; Norepinephrine; Rats; Rats, Brattleboro; Rats, Mutant Strains; Vasopressins; Water-Electrolyte Balance

Seven paediatric patients with central diabetes insipidus were studied in an open dose ranging study in hospital followed by a six month study on an outpatient basis to assess the efficacy and safety of peroral administration of DDAVP (desmopressin) tablets. In the dose ranging study a dose dependent antidiuretic response was observed. The response to 12.5-50 mcg was, however, less effective in correcting baseline polyuria than were doses of 100 mcg and above. Patients were discharged from hospital on a preliminary dosage regimen ranging from 100 to 400 mcg three times daily. After an initial adjustment in dosage in three patients at one week follow up, all patients were stabilised on treatment with tablets and reported an adequate water turnover at six months. As with the intranasal route of administration dosage requirements varied from patient to patient, and a dose range rather than standard doses were required. A significant correlation, however, was found for the relation between previous intranasal and present oral daily dosage. No adverse reactions were reported. No clinically significant changes were noted in blood chemistry and urinalysis. All patients expressed a preference for the oral over existing intranasal treatment. Treatment with tablets offers a beneficial alternative to the intranasal route, particularly in patients with chronic rhinitis or impaired vision.

Topics: Administration, Intranasal; Administration, Oral; Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Male; Osmolar Concentration

To study the effect of 1-deamino-8D-arginine vasopressin (DDAVP) on the factor VIII response in nephrogenic diabetes insipidus (NDI), 0.30 microgram/kg DDAVP was given to 2 unrelated NDI patients, 3 obligate carriers, and 20 controls. Factor VIII coagulant activity (FVIIIC) and factor VIII related antigen (FVIIIR:Ag) responses were absent in both NDI patients and were decreased by approximately 50% in the carriers by comparison with controls. These results show that the vasopressin receptor defect in NDI is not confined to the kidney but is equally expressed in other tissues including the vascular endothelium and hepatic sinusoids, the respective sites of FVIIIR:Ag and FVIIIC production. A decreased factor VIII response may help in identifying carriers in families at risk.

Topics: Adolescent; Adult; Antigens; Arginine Vasopressin; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Factor VIII; Female; Heterozygote; Humans; Male; Middle Aged; von Willebrand Factor

Urinary adenosine 3',5'-monophosphate (cAMP) excretion before and after administration of aqueous vasopressin (pitressin) and 1-deamino-8-D-arginine vasopressin (DDAVP) was measured in congenital nephrogenic and in vasopressin sensitive diabetes insipidus (VS-DI). Excretion of cAMP into the urine increased markedly in response to pitressin (676%) and to DDAVP (252%) in VS-DI. Nephrogenic diabetes insipidus (N-DI) could be divided into two categories (type 1 and type 2) in respect to urinary cAMP responsiveness. In type 1, cAMP excretion showed no definite change after stimulation with pitressin (102%) or DDAVP (127%). On the other hand, urinary excretion of cAMP was significantly elevated in response to DDAVP in familial cases of N-DI type 2 (1269%) without producing any concentrating effect on the urine. Two different defects are considered to be involved in the pathogenesis of N-DI.

Topics: Adolescent; Adult; Child; Child, Preschool; Cyclic AMP; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Male; Osmolar Concentration; Urination; Vasopressins

Vasopressin stimulates renal prostaglandin (PGE2) production at several loci and in turn PGE2 modulates the antidiuresis. We have found the time courses of increased urinary PGE2 in subjects with central diabetes insipidus (DI) parallel the antidiuretic responses to AVP and dDAVP. The antidiuretic response to 4 micrograms dDAVP in these subjects was far greater than the response to 5 U (12.5 micrograms) AVP, but the PGE2 response to the dDAVP was only marginally greater than that which followed the AVP. Therefore, dDAVP disproportionately stimulates antidiuresis in relation to PGE2 production, whereas the reverse holds for AVP. In subjects with nephrogenic DI 12.5 micrograms AVP caused no antidiuresis but stimulated PGE2 excretion as well as in subjects with central DI. There was an intermediate relationship between antidiuresis and PGE2 excretion in subjects with central DI given AVP and subjects with nephrogenic DI injected with dDAVP. In summary, 1) the normal PGE2 response to AVP in subjects with nephrogenic DI is consistent with other evidence that non-antidiuretic actions of vasopressin are not impaired in these subjects. 2) The limited capability of dDAVP to stimulate PGE2 may be a factor in the augmented antidiuretic response to dDAVP in subjects with central DI. 3) Antidiuretic and PGE2 responses to vasopressin can be dissociated, thus allowing further consideration of mechanisms by which each may be independently controlled and interrelated.

Topics: Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Dinoprostone; Diuresis; Female; Humans; Kidney; Male; Osmolar Concentration; Prostaglandins E; Time Factors

Topics: Brain Diseases; Carbamazepine; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Female; Humans; Male

A 24 year old man developed partial central diabetes insipidus with impaired thirst and an elevated osmotic threshold to the release of arginine vasopressin (AVP). Plasma AVP was present in inappropriately small concentrations despite severe hyperosmolality. In addition, marked hypertension accompanied this disorder and all abnormalities, including the hypertension, responded to 1-desamino-8-D-arginine vasopressin therapy. Several lines of evidence suggest this disorder may be a disturbance of hypothalamic function.

Topics: Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Glucose; Humans; Hypernatremia; Hypertension; Infusions, Parenteral; Male; Radioimmunoassay; Sodium Chloride; Thirst; Water

Topics: Arginine Vasopressin; Cadaver; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Kidney Transplantation; Postoperative Complications

Up to 1984, 69 cases of diabetes insipidus associated with pregnancy had been reported on. In only four such cases did preeclampsia develop. We treated a patient for the fifth such case.

Topics: Adult; Cesarean Section; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant, Newborn; Magnesium Sulfate; Male; Pre-Eclampsia; Pregnancy; Pregnancy in Diabetics

Topics: Abnormalities, Multiple; Brain; Chromosome Aberrations; Chromosome Deletion; Chromosome Disorders; Chromosomes, Human, 16-18; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant; Infant, Newborn; Intellectual Disability

The effects of water deprivation and the injection of deamino [8-D-arginine] vasopressin (dDAVP) on the metabolic activity of the hypothalamo-neurohypophysial neurones of mice with inherited nephrogenic diabetes insipidus (DI +/+ Severe) have been investigated by quantitative autoradiography using the [14C]2-deoxyglucose (2-DG) technique. The relative metabolic activities (rma) of the paraventricular nuclei (PVN) and pars nervosa (PN) in severely diabetic mice were not significantly different from the rma of the PVN and PN in Non-severe or Normal mice, but the rma of the pars distalis (PD) was greater in the Severe mice than in the other two strains. Water deprivation (4-5 h) significantly increased the rma of the PVN and PN in Severe mice compared with those in Non-severe mice that had been similarly deprived of water. The increased rma of the PVN and PN produced by water deprivation in Severe mice was not reduced to normal by injection of dDAVP. The injection of dDAVP alone had no effect on the rma of the PVN or PN, but dDAVP injection alone, water deprivation alone, or both treatments combined decreased the rma of the PD in Severe mice. Neither the supraoptic nuclei (SON) nor any of the other 19 brain areas studied were affected, in terms of rma, by either water deprivation, injection of dDAVP, or both.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Arginine Vasopressin; Autoradiography; Brain; Deamino Arginine Vasopressin; Deoxy Sugars; Deoxyglucose; Diabetes Insipidus; Diabetic Nephropathies; Female; Hypothalamo-Hypophyseal System; Injections, Intraperitoneal; Male; Mice; Mice, Mutant Strains; Species Specificity; Water Deprivation

In the present study nine diabetes insipidus patients were treated with desmopressin (DDAVP) tablets. All patients had a significant reduction of their polyuria after a peroral dose of 50 micrograms DDAVP. During a 6-day trial, a peroral treatment with two or three daily peroral doses of DDAVP controlled their polyuria. A dose-response study in five of the patients indicated that peroral DDAVP doses as small as 10 micrograms have effects on renal concentrating ability. A log-linear relationship was found between DDAVP doses and maximal urine osmolalities and duration of antidiuresis. Measurements of plasma DDAVP concentrations after peroral DDAVP revealed a linear relationship between amounts of DDAVP absorbed and dose, but with great interindividual differences. The results indicate that graded renal response occur at plasma concentrations of DDAVP between 1 and 5 pg/ml. The results of this study and the assessment by the patients of the treatment indicate that peroral therapy with DDAVP may be an attractive alternative to traditional intranasal administration of the drug.

Topics: Administration, Oral; Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Male; Middle Aged; Polyuria

Topics: Administration, Intranasal; Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Resistance; Humans; Male

A morphometric study was undertaken to quantitate the morphologic changes induced by ADH availability in the rat kidney. Homozygous Brattleboro rats with hereditary diabetes insipidus (DI) (no ADH) were compared to heterozygous Brattleboro control rats (HZ) and to DI rats after 5 to 6 weeks of continuous ADH infusion by implantable Alzet osmotic minipumps (TDI). ADH resulted in a 37% increase in mass of kidney per unit body wt. All kidney zones and all nephron segments were not increased uniformly. The inner stripe was enlarged more than other renal zones. It represented 15.5 +/- 0.7% of the total kidney height along the cortico-papillary axis in DI and 22.2 +/- 1.5% in TDI (P less than 0.025). The volume of the inner stripe in DI and TDI amounted to 10.9 +/- 0.9 and 18.0 +/- 1.0% of the total kidney volume, respectively (P less than 0.001). Selective increases in tubular diameter and cell height, due mostly to an hypertrophy of pre-existing cells, were observed in the earliest part of the thick ascending limbs (TAL) in the inner stripe, resulting in a twofold increase in epithelial volume per unit tubular length (P less than 0.001). Volume density of mitochondria and surface density of basolateral membranes were unchanged but, due to the increase in cell volume and inner stripe thickness, the amount of mitochondria and the surface area of basolateral membrane in the TAL were more than tripled in the inner stripe of treated rats. These changes provide a much greater salt transport capacity in the TAL of treated rats. They probably represent an adaptation of the early TAL to an enhanced sodium chloride transport in response to a direct ADH stimulation and/or to an increased salt delivery to this segment in the concentrating kidney.

Topics: Animals; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Heterozygote; Kidney Concentrating Ability; Kidney Medulla; Loop of Henle; Male; Rats; Rats, Brattleboro; Vasopressins

Five families were studied in which cranial diabetes insipidus occurred. In the pedigrees presented, the disease clearly followed an autosomal dominant mode of inheritance. Linkage analysis was performed in one large family by calculating lod scores for linkage between loci for cranial diabetes insipidus and 18 polymorphic markers and chromosome heteromorphisms. No significant genetic linkage was found and only one of the polymorphic markers gave a positive hint of linkage. A water deprivation test was performed in nine patients from three of the families and in healthy control subjects. The plasma concentration of arginine vasopressin was very low or undetectable in the patients, and unlike the control subjects did not increase significantly during water deprivation. Arginine vasopressin and serum osmolality (Sosm) were significantly positively correlated in the controls, but not in the patients. The results indicated that an arginine vasopressin-level lower than 2 pg/ml strongly suggests a diagnosis of cranial diabetes insipidus if at the same time Sosm is higher than 295 mosmol/kg. Studies with different intranasal dosages of 1-deamino-D-arginine-vasopressin (DDAVP) given once or twice a day showed that 20 micrograms effectively reduced urinary output and that administration once a day could be sufficient.

Topics: Adolescent; Adult; Aged; Arginine Vasopressin; Brain Diseases; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Mellitus; Female; Genetic Linkage; Humans; Lod Score; Male; Middle Aged; Osmolar Concentration; Pedigree

Topics: Administration, Intranasal; Adult; Carbamazepine; Chlorpropamide; Chronic Disease; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Drug Evaluation; Humans; Pituitary Hormones, Posterior; Vasopressins

Topics: Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Eruptions; Female; Humans; Urticaria; Vasopressins

Topics: Adenylyl Cyclases; Adult; Aged; Cyclic AMP; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant; Male; Vasopressins; Water Deprivation

Twenty patients with postpartum hypopituitarism underwent a dehydration test followed by the administration of synthetic arginine-vasopressin (DDAVP; desmopressin). Panhypopituitarism was confirmed by hormonal assays in the basal state and after stimulation with combined luteinising hormone releasing hormone-thyrotrophin releasing hormone-insulin. All the patients were given replacement therapy with hydrocortisone and thyroid hormones. Results were compared with those in 12 normal women. Urinary concentrating ability was diminished in the patients as compared with the controls (maximum urine osmolality 688 (SEM 23) mmol (mosmol)/kg in the patients v 967 (SEM 29) mmol/kg in the controls). Also the change in urine osmolality after administration of desmopressin was greater in the patients (+9.55 (SEM 1.98)% in the patients v 2.49 (SEM 0.96)% in the controls). Partial diabetes insipidus is apparently common in Sheehan's syndrome. This association should be borne in mind when managing these patients, especially those in acute failure.

Topics: Adult; Deamino Arginine Vasopressin; Dehydration; Diabetes Insipidus; Diuresis; Female; Humans; Hypopituitarism; Kidney Concentrating Ability; Osmolar Concentration; Pregnancy; Urodynamics

The effects of (1-desamino-8-D-arginine) vasopressin (dDAVP) on water and electrolyte transport in the distal tubule were investigated by micropuncture. Since, in addition to antidiuretic hormone, parathyroid hormone, calcitonin and glucagon stimulate the adenylate-cyclase system in this nephron segment, experiments were performed on hormone-deprived rats, i.e. homozygous DI Brattleboro rats with reduced levels of endogenous parathyroid hormone, calcitonin and glucagon. Along the distal tubule, dDAVP enhanced water, Cl, Na and Ca reabsorption and sharply increased net K secretion. Phosphate transport was left unchanged and Mg reabsorption was not significantly altered by dDAVP between the early and late distal tubule. Antidiuretic hormone also slightly increased water filtration rate in the superficial nephron, which rose in proportion to whole kidney glomerular filtration rate. It is concluded that, in rats: antidiuretic hormone stimulates water, NaCl and Ca absorption and enhances K secretion along the distal tubule and the tubular effects of dDAVP on electrolyte transport in the loop and distal tubule are responsible for decreasing Mg and Ca urinary excretion.

Topics: Absorption; Animals; Arginine Vasopressin; Calcitonin; Deamino Arginine Vasopressin; Diabetes Insipidus; Electrolytes; Kidney Tubules; Kidney Tubules, Distal; Male; Parathyroid Hormone; Rats; Rats, Brattleboro

A ten year old boy with hereditary pituitary diabetes insipidus presented with massive bilateral hydronephrosis, hydroureters and an extremely large bladder. Radiological investigations excluded a mechanical obstruction or vesicoureteral reflux. Treatment with the adiuretin analog DDAVP resulted in regression of the urinary tract changes after 5 months and an almost complete disappearance after 3 1/2 years. The urinary tract dilatation probably results from the large urine flows which exceed the capacity of the urinary tract causing a functional obstruction and residual urine.

Topics: Arginine Vasopressin; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hydronephrosis; Male

We studied two women with severe hypotonic polyuria whose symptoms dated from infancy. We eliminated the possibility of central diabetes insipidus (DI) and primary polydipsia, and established the presence of nephrogenic DI on the basis of: 1) the interrelationships between plasma osmolality, urine osmolality, and urinary AVP; and 2) impaired antidiuretic responses to AVP and 1 deamino-8-D-arginine vasopressin. Though 25-50 times as resistant to 1 deamino-8-D-arginine vasopressin nasal spray as patients with central DI, these patients could be treated effectively with large doses of the nasal spray. One patient has been so treated for more than a year with dramatic improvement in her polydipsia, polyuria, and sense of well-being.

Topics: Administration, Intranasal; Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Resistance; Female; Humans; Kidney Concentrating Ability; Kidney Diseases; Polyuria; Thirst

A large Canadian kindred of Irish extraction extending from Quebec to British Columbia with autosomal dominant diabetes insipidus responsive to exogenous antidiuretic hormone (ADH) is described. Out of 121 individuals 34 have been identified as affected in seven generations. The disorder is characterized by variability in age at onset and in severity, and by apparently spontaneous abatement in old age. The affected subjects do not appear to manifest hypertension or its sequelae. In three individuals tested the plasma ADH level was very low in spite of adequate osmotic stimulation. However, the level rose in two of them when they were given furosemide, which suggests an osmoreceptor defect and a normal ADH response to volume change.

Topics: Adult; Arginine Vasopressin; Chlorpropamide; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Male; Middle Aged; Osmolar Concentration; Pedigree; Vasopressins

We report a case of neurogenic diabetes insipidus in a premature infant. It was treated with desmopressin, which appears to be the drug of choice for the treatment of this disease in early infancy.

Topics: Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Diseases in Twins; Female; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Male

The effects of a synthetic vasopressin analogue, DDAVP (1-deamino-8-d- arginine-vasopressin) were studied in 5 adults and 2 children with acute central diabetes insipidus secondary to neurosurgery. 5 mcg DDAVP was administered intranasally twice a day to the two children, whereas the adults received the drug i.m. (1 mcg twice a day, 3 patients; 1 mcg once a day, 1 patient; 4 mcg twice a day, 1 patient). All subjects displayed an early, prolonged response (12-24 hr). There were no side-effects. The effectiveness of DDAVP, its prolonged action, and virtual freedom from side-effects when given intranasally or parenterally make it the drug of choice in the treatment of acute neurosurgical diabetes insipidus.

Topics: Adolescent; Adult; Arginine Vasopressin; Cerebrospinal Fluid Shunts; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hypothalamo-Hypophyseal System; Male; Middle Aged; Osmolar Concentration; Specific Gravity; Urine

We have previously shown that certain aspects of internephron heterogeneity are reduced or absent in Brattleboro rats with hereditary diabetes insipidus (DI) lacking ADH and can be restored by long-term ADH administration started before complete kidney maturation. In the present study, the effects of long- and short-term availability of ADH in adulthood were studied in Brattleboro DI rats. Single nephron glomerular filtration rate (SNGFR), glomerular volume (GV), and proximal tubular length (PTL) were measured in superficial and juxtamedullary nephrons using the ferrocyanide and microdissection techniques. ADH administration for 6 wk in adult DI rats (group A) restored normal nephron heterogeneity of SNGFR, GV, and PTL by increasing the filtration and size of deep nephrons. Acute changes in ADH availability induced either by 1-h ADH infusion in DI rats (group C) or by ADH discontinuation for 2 days in treated DI rats (group D) did not significantly change the anatomical parameters and only moderately affected SNGFR compared with the preexisting states (groups B and A, respectively). These results suggest that the influence of ADH on internephron heterogeneity is initiated by an increase in deep nephron SNGFR. Based on recent findings concerning the effects of ADH on the medullary (M) part of the thick ascending limbs (TAL), we suggest that the increase in deep nephron SNGFR after ADH may be due to a change in the tubuloglomerular feedback signal at the macula densa resulting from ADH-induced stimulation of the solute reabsorption in the MTAL. Superficial nephrons would be less sensitive to this change due to their long cortical TAL, which removes the macula densa further from the MTAL and provides additional sites for solute reabsorption.

Topics: Animals; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Glomerular Filtration Rate; Homozygote; Kidney; Kidney Tubules, Proximal; Male; Nephrons; Osmolar Concentration; Rats; Rats, Brattleboro; Urine

Topics: Adult; Alveolitis, Extrinsic Allergic; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Hypersensitivity; Humans; Male; Pituitary Gland, Posterior; Tissue Extracts

We analyzed the effects of vasopressin in learning and memory of healthy individuals and patients with diabetes insipidus. The results of our investigations allow the conclusion that vasopressin effects a memory stimulation by influence of neurocentral mechanisms.

Topics: Adult; Arginine Vasopressin; Attention; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Lypressin; Memory; Memory, Short-Term; Mental Recall; Paired-Associate Learning; Retention, Psychology; Vasopressins

While 1-desamino-8-D-arginine-vasopressin is not suitable for the functional diagnostics of the anterior pituitary gland, it has as in the therapy of the central diabetes insipidus a firm place also in its diagnostics. A hypothalamic neurohypophyseal system was demonstrated. Apart from a secure diagnostic evidence the test shows further advantages in comparison to the hitherto performed methods: an essentially smaller load for patient and personnel, a shorter duration and a simplified performance. First findings in patients with central diabetes insipidus, in a female patient with renal diabetes insipidus and patient without disturbance of the water balance are discussed. A control of our findings in other institutions is desirable.

Topics: Administration, Intranasal; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Injections, Intravenous; Kidney Concentrating Ability; Pituitary Function Tests; Water-Electrolyte Balance

Topics: Adolescent; Arginine Vasopressin; Chlorpropamide; Craniopharyngioma; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Therapy, Combination; Humans; Male; Pituitary Neoplasms; Thirst

Direct measurement of plasma AVP and indirect assessment of antidiuretic activity during standard dehydration tests were made in 21 polyuric and polydipsic patients to establish the efficacy of each method in determining the cause of polyuria. Patients with acquired nephrogenic diabetes insipidus (e.g. diabetes mellitus, renal failure, hypercalcaemia) were excluded from the study. Cranial diabetes insipidus was diagnosed by plasma AVP responses to osmotic stimulation during infusion of hypertonic 5% saline which were subnormal in 13 patients, 4 of whom had undetectable plasma AVP and 3 who had reduced but osmoregulated AVP release. Standard water deprivation tests confirmed cranial diabetes insipidus in all but 2 patients who were diagnosed as partial nephrogenic diabetes insipidus. The remaining 8 patients had normal, osmoregulated AVP secretion; the cause of their polyuria was determined by their renal response to desmopressin. Two patients had nephrogenic diabetes insipidus and 6 had primary polydipsia. The majority of polyuric patients could be accurately diagnosed by carefully performed dehydration tests. We suggest that direct measurements of plasma AVP during osmotic stimulation are only necessary to distinguish mild forms of cranial from nephrogenic diabetes, or to define precisely the characteristics of AVP secretion.

Topics: Adolescent; Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Dehydration; Diabetes Insipidus; Diagnosis, Differential; Female; Humans; Male; Osmolar Concentration; Polyuria; Saline Solution, Hypertonic

The effects of 1-desamino-8-D-arginine vasopressin (dDAVP) on renal excretion and tubular transport of water and electrolytes were investigated in homozygous DI Brattleboro rats. To ascertain these effects on the loop of Henle, circulating glucagon, parathyroid hormone, and thyrocalcitonin were reduced before the experiments, as these hormones are believed to stimulate the same cells of the thick ascending limb as ADH. dDAVP did not alter either glomerular or proximal tubular functions. In the loop, it consistently raised reabsorption of Mg, Ca, K, and, to a lesser extent, Na and Cl, but phosphate transport was not affected. dDAVP lowered the urinary excretion rates for Mg, Ca, K, Cl, and total solutes. For Mg, this reduction was independent of the drop in the urinary flow rate following dDAVP administration but was significantly correlated to this drop in the case of Ca, K, Cl, and total solutes. Na and P excretions were not altered by dDAVP. It is concluded that, in vivo, administration of ADH 1) stimulates reabsorption of Na, Cl, Mg, Ca, and K by the thick ascending limb, 2) consistently enhances Mg reabsorption by the whole kidney by enhancing reabsorption in the loop of Henle, and 3) at maximal antidiuresis, raises Ca, K, Cl, and total solute reabsorption, probably because of the drop in tubular flow rates in the distal parts of the nephron consequent to the hormone administration.

Topics: Animals; Arginine Vasopressin; Biological Transport; Calcium; Deamino Arginine Vasopressin; Diabetes Insipidus; Electrolytes; Glomerular Filtration Rate; Kidney Tubules; Magnesium; Male; Phosphates; Potassium; Rats; Sodium

Two new cases of Wolfram's syndrome associated with progressive urinary tract dilatation are reported. The possibility of anatomic outlet obstruction or neurogenic bladder was eliminated radiologically and urodynamically. Dilatation of the urinary tract was considered to be a consequence of high diuresis associated with diabetes insipidus. A very important improvement in bilateral urinary tract distension was achieved with bladder drainage while dDAVP therapy dramatically decreased the daily urinary output. A review of diabetes insipidus and its urological implications is presented.

Topics: Adolescent; Blindness; Child; Deamino Arginine Vasopressin; Diabetes Complications; Diabetes Insipidus; Dilatation, Pathologic; Female; Humans; Male; Optic Atrophy; Syndrome; Urodynamics; Urologic Diseases

Topics: Adult; Arginine Vasopressin; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Dose-Response Relationship, Drug; Humans; Inappropriate ADH Syndrome; Male; Water Intoxication

Topics: Animals; Arginine Vasopressin; Blood Pressure; Deamino Arginine Vasopressin; Diabetes Insipidus; Heart Rate; Male; Phenylephrine; Pressoreceptors; Pulse; Rats; Rats, Brattleboro; Reflex; Species Specificity

Topics: Arginine Vasopressin; Chlorobutanol; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Hypersensitivity; Female; Humans; Middle Aged; Pruritus; Solutions

Topics: Angiotensin II; Animals; Body Weight; Cardiomegaly; Constriction; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Drinking; Hematocrit; Hypertension, Renal; Rats; Rats, Brattleboro; Rats, Mutant Strains; Renal Artery; Renin

Topics: Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Administration Schedule; Drug Eruptions; Female; Humans; Middle Aged

Topics: Adenylyl Cyclases; Animals; Arginine Vasopressin; Chlorpropamide; Cyclic AMP; Deamino Arginine Vasopressin; Diabetes Insipidus; Dinoprostone; Diuresis; Drug Interactions; Enzyme Activation; Kidney Medulla; Prostaglandins E; Rats; Rats, Brattleboro; Rats, Mutant Strains

Topics: Adrenalectomy; Adrenocorticotropic Hormone; Animals; Circadian Rhythm; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Fluorescent Antibody Technique; Histocytochemistry; Male; Pituitary Gland; Radioimmunoassay; Rats; Rats, Brattleboro; Rats, Mutant Strains; Vasopressins

Topics: Animals; Arginine Vasopressin; Aspirin; Deamino Arginine Vasopressin; Diabetes Insipidus; Dinoprost; Dinoprostone; Enzyme Induction; In Vitro Techniques; Kidney Medulla; Male; Microsomes; Prostaglandin-Endoperoxide Synthases; Prostaglandins E; Prostaglandins F; Rats; Time Factors

Topics: Administration, Intranasal; Adult; Arginine Vasopressin; Asthma; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Hypersensitivity; Humans; Male; Pulmonary Fibrosis; Vasopressins

Topics: Animals; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Kinetics; Metabolic Clearance Rate; Osmolar Concentration; Rats; Rats, Brattleboro; Rats, Mutant Strains; Thyroid Gland; Thyrotropin; Thyrotropin-Releasing Hormone; Thyroxine

Topics: Animals; Corticosterone; Deamino Arginine Vasopressin; Diabetes Insipidus; In Vitro Techniques; Pituitary Gland, Anterior; Prolactin; Rats; Rats, Brattleboro; Rats, Mutant Strains; Thyrotropin; Thyrotropin-Releasing Hormone

The relationship of renal prostaglandins to antidiuretic hormone action and water diuresis was examined in 13 normal subjects and 2 subjects with diabetes insipidus. Following overnight water deprivation, a oral water load caused a prompt and sustained rise in the rate of urinary PGE2 excretion from 7.7 +/- 1.2 to 81.6 +/- 26.4 ng/hr (P less than 0.0001) in 7 normal subjects. Because the simultaneous increase in urinary excretion of urea was only 17% of the rise in urinary PGE2, passive wash-out of renal PGE2 probably accounts for only a small fraction of the increment in PGE2 excretion. Administration of the antidiuretic hormone analogue DDAVP to 6 normal subjects during sustained water diuresis resulted in a decrease in PGE2 excretion and urine flow rate comparable to that of dehydrated subjects. Thus, PGE2 excretion varied directly with urine flow rate over a wide range of states of hydration in all 13 normal subjects. One patient with central diabetes insipidus and one with nephrogenic diabetes insipidus demonstrated a similar positive correlation of PGE2 excretion rate and urinary flow rate in states of hydration, dehydration, and after administration of DDAVP. In the patient with nephrogenic diabetes insipidus, this relationship of PGE2 excretion rate to urine flow rate was unaffedted by DDAVP over a broad range of urine flow rates. Inhibition of prostaglandin synthesis with indomethacin in 6 normal subjects resulted in a significant decline in free water clearance (7.7 +/- 1.0 to 4.7 +/- 0.9 ml/min. P less than 0.001) and an increase in the minimal UOsm (61 +/- 4 to 93 +/- 19 mOsm/kg. P less than 0.01) achieved during water diuresis without a change in creatinine or osmolar clearances. Furthermore, the tightly linked relationship of PGE2 excretion rate to urine flow rate was reduced in 5 of 6 subjects during indomethacin treatment. We conclude that urinary PGE2 excretion varies directly with urine flow rate and is not directly dependent on ADH activity or state of hydration in man. The rise in PGE2 excretion during water diuresis may enhance the excretion of free water since indomethacin treatment blunted free water clearance while suppressing the rise in PGE2 excretion.

Topics: Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Dehydration; Diabetes Insipidus; Dinoprostone; Diuresis; Female; Humans; Indomethacin; Kidney; Male; Middle Aged; Prostaglandins E; Urination

The biological half-lives and organ distribution of tritiated 8-lysine-vasopressin and 1-deamino-8-D-arginine-vasopressin were determined in R-Amsterdam rats and in homozygous and heterozygous Brattleboro rats with hereditary central diabetes insipidus. It was found that the biological half-lives of [3H]LVP and [3H]dDAVP in the Brattleboro rats did not differ significantly from that found in the control R-Amsterdam rats. The half-life of [3H]dDAVP proved longer than that of [3H]LVP in all three groups of animals. In the case of [3H]LVP the highest radioactivities were observed in the neurohypophyses, adenohypophyses, and kidneys of both the R-Amsterdam and Brattleboro rats. The accumulation of tritiated material was higher in the small intestine of the Brattleboro rats than in that of the R-Amsterdam animals. In all three groups of rats, [3H]dDAVP was accumulated to the greatest extent in the kidney and the small intestine. The kidney and small intestine contained less radioactivity in homozygous Brattleboro rats than in the controls. There was only a slight radioactivity accumulation in the adenohypophysis and neurohypophysis. From the results it was concluded that the decrease in the rate of enzymatic decomposition may play a role in the increased duration of antidiuretic action of dDAVP. The results have led to the conclusion that the accelerated elimination of vasopressin and its pathologic organ accumulation are probably not involved in the water metabolism disturbance of Brattleboro rats with hereditary diabetes insipidus.

Topics: Animals; Arginine Vasopressin; Chromatography, High Pressure Liquid; Deamino Arginine Vasopressin; Diabetes Insipidus; Half-Life; Intestine, Small; Kidney; Lypressin; Male; Pituitary Gland, Anterior; Pituitary Gland, Posterior; Rats; Rats, Brattleboro; Rats, Mutant Strains; Tissue Distribution; Tritium

Topics: 1-Sarcosine-8-Isoleucine Angiotensin II; Angiotensin II; Animals; Deamino Arginine Vasopressin; Diabetes Insipidus; Male; Oxytocin; Rats; Rats, Brattleboro; Rats, Inbred Strains; Rats, Mutant Strains; Vasopressins

Topics: Animals; Arginine Vasopressin; Blood Pressure; Deamino Arginine Vasopressin; Desoxycorticosterone; Diabetes Insipidus; Diet; Hypertension; Nephrectomy; Osmolar Concentration; Rats; Rats, Brattleboro; Rats, Mutant Strains; Sodium Chloride

Topics: Animals; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Epithelium; Heterozygote; Homozygote; Kidney Concentrating Ability; Kidney Tubules; Loop of Henle; Rats; Rats, Brattleboro; Rats, Mutant Strains

Topics: Animals; Arginine Vasopressin; Body Water; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Drinking; Hypothalamus; Osmolar Concentration; Pituitary Gland, Posterior; Rats; Rats, Brattleboro; Rats, Mutant Strains; Thirst; Vasopressins; Water-Electrolyte Imbalance

Topics: Adenylyl Cyclase Inhibitors; Animals; Arginine Vasopressin; Chemical Phenomena; Chemistry; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Dose-Response Relationship, Drug; Oxytocin; Rats; Structure-Activity Relationship; Vasopressins

Topics: Animals; Deamino Arginine Vasopressin; Diabetes Insipidus; Glycosaminoglycans; Heterozygote; Histocytochemistry; Homozygote; Hyaluronoglucosaminidase; Hydrocortisone; Kidney Medulla; Osmolar Concentration; Rats; Rats, Brattleboro; Rats, Mutant Strains

Topics: Animals; Carboxy-Lyases; Deamino Arginine Vasopressin; Dehydration; Diabetes Insipidus; Hepatectomy; Kidney; Ornithine Decarboxylase; Polyamines; Rats; Rats, Brattleboro; Rats, Mutant Strains; Testosterone; Vasopressins

Topics: Analgesia; Animals; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Immune Sera; Lypressin; Nociceptors; Rats; Rats, Brattleboro; Rats, Mutant Strains; Vasopressins

The intranasal DDAVP (1-deamino-8-D-arginine vasopressin) test is a safe and feasible method for the study of renal concentrating ability in children. This study describes a simplification of the test. Sixty randomly selected children were tested for urine osmolality at different hours after intranasal administration of DDAVP. No fluid restriction was prescribed. Optimal concentrating ability was attained after 3 and 5 hours. Without impairing the validity of the DDAVP test, it can be performed in a simpler way than previously recommended.

Topics: Administration, Intranasal; Adolescent; Arginine Vasopressin; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Infant; Kidney Concentrating Ability; Osmolar Concentration; Time Factors

Topics: Arginine Vasopressin; Body Water; Chlorpropamide; Deamino Arginine Vasopressin; Diabetes Complications; Diabetes Insipidus; Humans; Inappropriate ADH Syndrome; Male; Middle Aged; Polyuria; Time Factors; Vasopressins

Intracerebroventricularly (i.c.v.) administered angiotensin II (ANG II) at a dose of 100 ng caused a large increase in plasma oxytocin levels in Long Evans (LE) rats and in rats heterozygous for hypothalamic diabetes insipidus (HZ). In rats homozygous for diabetes insipidus (DI) even 100 fold higher doses of ANG II i.c.v. exerted only marginal effects on oxytocin release. The impaired responsiveness in DI rats was fully restored by prolonged treatment with a vasopressin (AVP) analogue. These data show that the decreased sensitivity of ANG II receptors in DI rats is due to the AVP defect and its metabolic consequences and can be reversed by AVP substitution.

Topics: Angiotensin II; Animals; Deamino Arginine Vasopressin; Diabetes Insipidus; Hypothalamic Diseases; Injections, Intraventricular; Oxytocin; Rats; Rats, Brattleboro; Stimulation, Chemical

In hypothalamic diabetes insipidus, water balance is achieved primarily through the thirst mechanism. The administration of an antidiuretic agent in the drinking water should restore the antidiuretic response to volume and osmoregulatory drive. To test this hypothesis, homozygous Brattleboro strain rats were given arginine vasopressin (AVP) or 1-desamino-8-D-arginine vasopressin (dDAVP) in the drinking water in concentrations of 10-10,000 micrograms/l (AVP) and 5-10,000 micrograms/l (dDAVP). Oral AVP was found to be ineffective. Oral dDAVP resulted in 1) a progressive increase in dDAVP dose, from 2.3 to 2,559 micrograms.day-1.kg-1; 2) a dose-dependent increase in urine osmolality from 306 to 1,796 mosmol/kg; and 3) a dose-dependent decrease in urinary solute excretion. At each dDAVP dose level, stable physiological states were achieved within 24 h. Similar antidiuretic states were achieved when dDAVP was administered in increasing doses or when therapy was initiated at a high dose. These findings demonstrate that inclusion of an appropriate antidiuretic agent in the drinking water can restore the renal response to volume-osmoregulatory drive.

Topics: Administration, Oral; Animals; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Dose-Response Relationship, Drug; Male; Rats; Rats, Brattleboro

Topics: Adenoma; Adolescent; Adult; Arginine Vasopressin; Craniopharyngioma; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Male; Middle Aged; Pituitary Neoplasms; Postoperative Period

Central diabetes insipidus (DI) patients showed impairments in short- and long-term memory functions, but not in attention and concentration, as compared to healthy individuals. A single i.m. injection or sub-chronic intranasal administration of either lysine-vasopressin (LVP) or 1-deamino-8-D-arginine-vasopressin (DDAVP) normalized the disturbed memory functions in DI patients. These peptides also improved memory functions in healthy individuals.

Topics: Administration, Intranasal; Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Injections, Intramuscular; Lypressin; Male; Memory; Middle Aged

The response to 1-deamino-8-D-arginine vasopressin (DDAVP), an intranasally administered analogue of vasopressin, was investigated in children and adults with central diabetes insipidus. To assess the action of DDAVP on the distal nephron, cyclic adenosine monophosphate (cAMP) excretion was assayed in urine collected 4 hr before and during four subsequent 4-hr periods after intranasal administration of 5 micrograms DDAVP. Maximal effects on urine volume and concentration were observed between 4 and 12 hr, coinciding with an elevated cAMP excretion in seven subjects. The pretreatment 4-hr cAMP excretion (micrograms/gm creatinine) correlated inversely with age (p less than 0.02) and surface area (p less than 0.001). Subsequent cAMP excretion after DDAVP increased inconsistently with no relationship to duration of antidiuresis, indicating that urinary cAMP is a poor index of antidiuretic hormone action on the distal nephron. We also confirmed that DDAVP intranasally induces antidiuresis in patients with diabetes insipidus over approximately 12 hr.

Topics: Adolescent; Adult; Arginine Vasopressin; Child; Child, Preschool; Cyclic AMP; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Infant

1. In six healthy volunteer subjects polydipsic water loading significantly increased urine volume from 1203 +/- 242 (SEM) to 5072 +/- 320 ml/24 h (P less than 0.001) with a significant decrease in urinary osmolality. This increase in urine volume by more than fourfold was associated with a slight increase in urinary excretion of prostaglandin E2 from 466 +/- 66 to 1017 +/- 174 pmol/24 h (P = 0.05). 2. In five patients with central diabetes insipidus mean urine volume of 10 838 +/- 107 ml/24 h was reduced to 1205 +/- 204 ml/24 h (P less than 0.001) by treatment with 1-desamino-8-arginine vasopressin (desamino-[Arg8]vasopressin; 15 microgram/day) with a significant rise in urinary osmolality. Desamino-[Arg8]vasopressin treatment was associated with a significant increase of suppressed urinary excretion of prostaglandin E2 (PGE2) in four of these patients from 246 +/- 66 to 2643 +/- 677 pmol/24 h (P less than 0.01). 3. Concomitant treatment with indomethacin in addition to desamino-[Arg8]vasopressin significantly suppressed urinary excretion of PGE2 and significantly increased urinary osmolality as compared with treatment with desamino-[Arg8]vasopressin alone. 4. Desamino-[Arg8]vasopressin significantly increased urinary excretion of adenosine 3':5'-cyclic monophosphate (cyclic AMP). However, there was no further change in urinary excretion of cyclic AMP during concomitant indomethacin treatment. 5. The results suggest that urine flow itself is not an important determinant of urinary PGE2 excretion. In patients with central diabetes insipidus the urinary concentrating response to desamino-[Arg8]vasopressin is enhanced during inhibition of prostaglandin synthesis without changes in urinary excretion of cyclic AMP.

Topics: Adult; Aldosterone; Cyclic AMP; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Indomethacin; Kallikreins; Kidney; Male; Middle Aged; Prostaglandins; Prostaglandins E; Renin; Water-Electrolyte Balance

Specific binding of (125I) arg8-vasopressin to mononuclear phagocytes of the circulating blood was studied in 3 patients (one male, two females) with hereditary hypothalamic diabetes insipidus before, during and after therapy with 1-desamino-8-D-arginine vasopressin and compared with values of 15 normal donors (7 males, 8 females). Before therapy specific radioligand binding activity was considerably increased (0.3 +/- 0.08 fmoles/2.2 X 10(5) cells/ml) versus controls (0.23 +/- 0.04 fmoles/2.2 X 10(5) cells/ml). Increased binding was due to increase in receptor concentration per cell. In contrast, during treatment and after withdrawal of therapy the receptor binding activity was 0.1 +/- 0.05 fmoles/2.2 X 10(5) cells/ml. The dissociation constant (KD) for hormone binding before therapy (25 +/- 0.2 pM) was roughly identical with that of normal donors (24 +/- 0.8 pM), indicating insignificant changes in receptor affinity. During treatment and 48 h after withdrawal of therapy, however, the KD value was 11 +/- 0.45 pM, which amy be accounted for by an elevation in the binding affinity. We conclude that untreated patients with hereditary hypothalamic diabetes insipidus have increased tissue sensitivity to vasopressin, but have decreased binding capacity during and even two days after discontinuation of therapy, possibly as the result of 1-desamino-8-D arginine vasopressin-induced desensitization phenomena.

Topics: Adolescent; Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hypothalamic Diseases; Macrophages; Male; Monocytes; Pedigree; Receptors, Cell Surface; Receptors, Vasopressin

Topics: Child; Craniopharyngioma; Deamino Arginine Vasopressin; Diabetes Insipidus; Headache; Humans; Male; Pituitary Neoplasms; Postoperative Complications; Vision Disorders

It has been postulated that renal prostaglandins (PGs) function as negative feedback inhibitors of the action of antidiuretic hormone (ADH), implying a correlation between levels of ADH and the rate of renal PG synthesis. These studies have evaluated the relationship between renal PG synthesis and hormone levels in rats with hereditary diabetes insipidus, a species devoid of circulating ADH. Since vasoconstrictor agents can stimulate renal PG synthesis by mechanisms unrelated to antidiuretic activity, deamino-8-D-arginine vasopressin (dDAVP) was utilized for replacement therapy instead of arginine vasopressin, which has considerable pressor activity. dDAVP was administered by S.C. implanted osmotic minipumps to obtain steady states of dDAVP at different dose levels. As indices of renal PG synthesis, urinary excretion of PGE2 and PGF2 alpha were measured by gas chromatography-mass spectrometry. PGE2 excretion, although increased by dDAVP treatment, was not correlated with dose of dDAVP. However, PGF2 alpha excretion was highly correlated with dose of dDAVP (r = 0.97, P less than .01). The sum (PGE2 + PGF2 alpha), which may more accurately reflect total medullary PG synthesis, was also significantly correlated with dose of dDAVP (r = 0.98, P less than .001). It is concluded that dDAVP stimulates renal PG synthesis in a dose-related fashion. This occurs at doses which bring urine osmolality into the normal physiological range. Furthermore, it is shown that stimulation of renal PG synthesis by arginine vasopressin is not due primarily to its pressor action. These experiments also provide evidence that urinary PGE2 and PGF2 alpha excretion can vary independently.

Topics: Animals; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Dose-Response Relationship, Drug; Female; Kidney; Prostaglandins E; Prostaglandins F; Rats

In a 10-year-old girl admitted to hospital for polyuria and polydipsia, the central nervous system origin of the symptoms was demonstrated by low antidiuretic hormone levels (inferior to 1 pg/ml) and reduction of diuresis after administration of 1-deamino-8D-arginine-vasopressin (DDAVP). A study of the girl's family history showed that the disease was hereditary and autosomal dominant. Intranasal instillations of DDAVP twice daily constitute the best known treatment of the condition.

Topics: Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Female; Humans; Infant; Pedigree; Vasopressins

The effects of 1-deamino-8-D-arginine vasopressin (DDAVP), 1-deamino-4-valin-8-D-arginine vasopressin (DVDAVP) and 8-arginine vasopressin (AVP) on water metabolism have been examined in 18 patients suffering from central diabetes insipidus. The hormone derivatives were sublingually administered. It was established that DDAVP and DVDAVP significantly reduced diuresis and increased urine osmolarity. DVDAVP was found to be more effective than DDAVP. AVP administered in equal doses had no significant effect on water metabolism. The duration of the action of sublingually administered DDAVP was 12 hrs; after dosing DVDAVP the effect lasted even 6 hrs. During one week of DDAVP administration, the accumulation of the drug was indicated by the gradual decrease of diuresis and the increase of the urine osmolarity. The sublingual administration of both DDAVP and DVDAVP tablets (3 X 30 micrograms/day) had an adequate therapeutic effect.

Topics: Adult; Aged; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Male; Middle Aged; Mouth Floor; Tablets; Valine; Vasopressins

A 23 year old woman with diabetes insipidus who had previously been treated with pitressin, pituitary snuff and chlorpropamide, was treated with DDAVP during pregnancy. DDAVP concentrations immunoassayed as vasopressin were determined in maternal serum and breast milk. Oxytocin antibodies were also determined in maternal serum.

Topics: Adult; Antibodies; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant, Newborn; Milk, Human; Oxytocin; Pregnancy; Pregnancy in Diabetics

Topics: Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Complications; Diabetes Insipidus; Diabetes Mellitus; Humans; Inappropriate ADH Syndrome; Male; Middle Aged

Nine children aged 7 2/12 to 17 9/12 years with central diabetes insipidus were subjected to water deprivation and water loading during treatment with 1-deamino-8-D-arginine vasopressin (DDVAP). Urine output remained unchanged despite the large differences in water intake. Serum osmolarity was not significantly affected by water deprivation. However, there was a marked decrease in serum osmolarity during water loading. This not accompanied by any symptoms of haemodilution. Thus patients apparently tolerate large variations in fluid intake during therapy with DDVAP.

Topics: Adolescent; Arginine Vasopressin; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Water; Water Deprivation

The effect of DDAVP (1-deamino-8-D-arginine vasopressin), a synthetic analogue of vasopressin, was studied in twelve patients with acute postoperative cranial diabetes insipidus (D.I.). The most severe D.I. occurred in four cases following total removal of tumor (3 pituitary microadenoma, 1 dermoid cyst). The urinary volume over 1000 ml per hour in these four cases could not be controlled by DDAVP but could be controlled by drip infusion of aqueous pitressin (AP) and pitressin tannate in oil (PTO). DDAVP was effective when the urinary volume was decreased in under 500 ml per hour. The mild D.I. occurred in four cases after partial removal of tumor (3 craniopharyngioma, 1 pituitary microadenoma). These four cases could be controlled by drinking water only during one or two postoperative weeks. DDAVP was administered in doses of 10 to 30 microgram two times daily after 2 or 3 postoperative weeks and the urinary production was normalized. The four patients developed D.I. after removal of functioning pituitary microadenoma operated by transsphenoidal route. These four cases were treated with drip infusion of AP and PTO during one or two weeks after the operation and were effectively treated with 5 to 15 microgram of DDAVP intranasally every 8 to 12 hours one or two weeks after the operation. Nine cases in 12 cases with postoperative D.I. became chronic D.I. The maintenance dose of DDAVP gradually lessened in accordance with decreasing urinary volume except the two cases of craniopharyngioma. No side effect was experienced for 19 months of treatment.

Topics: Adenoma; Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Male; Middle Aged; Pituitary Neoplasms; Postoperative Complications

Topics: Administration, Intranasal; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant; Infant, Newborn; Male; Osmolar Concentration

Topics: Arginine Vasopressin; Body Water; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hypernatremia; Hypoglycemia; Hyponatremia; Inappropriate ADH Syndrome; Pharmacology; Radioimmunoassay; Vasopressins; Water-Electrolyte Imbalance

The diagnoses provided by a standard indirect test of vasopressin function were compared with those obtained by radioimmunoassay of plasma vasopressin in 24 patients with nonglucosuric polyuria. All seven cases of severe neurogenic diabetes insipidus diagnosed by the indirect tests were confirmed by the vasopressin assay. However, two of six patients with partial neurogenic diabetes insipidus by indirect criteria had normal vasopressin secretion by the direct assay; one was found to have primary polydipsia, and the other nephrogenic diabetes insipidus. Moreover, three of 10 patients diagnosed as having primary polydipsia by the indirect test had clear evidence of partial vasopressin deficiency by the direct assay. The inability of the indirect test to distinguish accurately between partial neurogenic diabetes insipidus and primary polydipsia may be explained by increased sensitivity to low concentrations of vasopressin in the former disorder and a reduction of maximal concentrating ability in both. We conclude that the incorporation of a vasopressin assay improves accuracy in the differential diagnosis of polyuria.

Topics: Adolescent; Adult; Arginine Vasopressin; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; False Negative Reactions; Female; Humans; Male; Middle Aged; Osmolar Concentration; Polyuria; Radioimmunoassay; Saline Solution, Hypertonic; Vasopressins; Water Deprivation

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Female; Humans; Osmolar Concentration; Polyuria; Radioimmunoassay; Saline Solution, Hypertonic; Vasopressins; Water Deprivation

Topics: Adolescent; Adult; Arginine Vasopressin; Blood; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Female; Humans; Kidney Concentrating Ability; Male; Osmolar Concentration; Polyuria; Water Deprivation

The effect of chlorpropamide was determined in Brattleboro diabetes insipidus (DI) rats that were injected with 1-deamino-8-D-arginine vasopressin (dDAVP). Chlorpropamide augmented the antidiuretic responses to 0.78 and 1.56 ng dDAVP but not to larger doses. In an effort to explain this observation we investigated the effect of chlorpropamide on renal medullary adenylate cyclase activation by dDAVP and on phosphodiesterase activity. We found that the injection of chlorpropamide increased adenylate cyclase activation by dDAVP added in vitro to renal medullary cell membrane preparations from Brattleboro DI rats but had no effect on phosphodiesterase activity. When kidneys from Brattleboro DI rats, treated and not treated with chlorpropamide, were perfused in vitro, we found that 10(-4) M dDAVP increased the concentration of cAMP in comparison to untreated and chlorpropamide-treated groups, and that chlorpropamide plus dDAVP resulted in a greater concentration of renal cAMP than was found with dDAVP alone. We believe that treatment with chlorpropamide increases dDAVP-stimulated renal medullary adenylate cyclase activity without altering phosphodiesterase activity and that this leads to increased renal cAMP concentrations. This, in turn, causes an augmented antidiuresis in response to dDAVP.

Topics: Adenylyl Cyclases; Animals; Arginine Vasopressin; Chlorpropamide; Cyclic AMP; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Dose-Response Relationship, Drug; Kidney Medulla; Rats

Topics: Adolescent; Adult; Aldosterone; Arginine Vasopressin; Cyclic AMP; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Kidney; Middle Aged; Osmolar Concentration; Prostaglandins E; Prostaglandins F; Renin; Urine

Topics: Animals; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Kidney; Kidney Cortex; Kidney Medulla; Osmolar Concentration; Potassium; Rats; Sodium; Sodium-Potassium-Exchanging ATPase; Urea

Topics: Child, Preschool; Cyclic AMP; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Indomethacin; Infant; Kidney; Male; Prostaglandins E

In an attempt to clarify the mechanism responsible for the prolonged effect of DDAVP (1-desamino-8-D-arginine vasopressin), plasma levels of DDAVP and nephrogenous cyclic AMP were determined in patients with diabetes insipidus after a single intranasal administration of 10 micrograms of DDAVP. Plasma DDAVP levels were uniformly elevated within 30 min, and showed a peak ranging from 5.6 to 25.0 pg/ml between 30 and 120 min. The subsequent time-course of plasma DDAVP differed however, from patient to patient, and was irregular in most of them. In all of the patients whose plasma DDAVP dropped below 1.0 pg/ml, antidiuresis was still observed. Although the mean basal level of nephrogenous cyclic AMP in patients with diabetes insipidus was not significantly different from that in control subjects, the administration of DDAVP resulted in a 2-fold increase. A negative correlation between nephrogenous cyclic AMP and free water clearance was obtained. These results suggest that the long-acting nature of DDAVP may be attributed, in addition to its gradual absorption from nasal mucosa and slow metabolic clearance, to a higher or persistent biological activity at the receptor site in the kidney and that a nearly physiological level of antidiuretic hormone may cause de novo synthesis of cyclic AMP in the kidney and exert its biological action.

Topics: Adult; Aged; Arginine Vasopressin; Cyclic AMP; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Immunoassay; Middle Aged; Water-Electrolyte Balance

Topics: Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Complications; Diabetes Insipidus; Diabetes Mellitus; Humans; Insulin; Male; Water-Electrolyte Imbalance

A patient is described who developed diabetes insipidus during pregnancy. During a revised Carter test performed at 36 wk gestation using DDAVP (1-desamino-8-D-arginine-vasopressin), uterine activity was recorded with a maximum activity of 120 Montevideo Units. The induction of uterine activity by DDAVP in our patient might be related to the high endogenous oxytocin levels or to the far advanced state of amenorrhea. Post partum, the patient reported decreased vision, and the visual fields were found to be abnormal. A neurosurgical procedure followed, and the diagnosis of craniopharyngioma was made.

Topics: Adult; Craniopharyngioma; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Oxytocin; Pituitary Neoplasms; Pregnancy; Pregnancy Complications; Uterine Contraction

Topics: Adult; Carbamazepine; Chlorpropamide; Chlorthalidone; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hydrochlorothiazide; Pituitary Function Tests; Vasopressins

Topics: Arginine Vasopressin; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Swimming

Topics: Animals; Arginine Vasopressin; Chlorpropamide; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Homozygote; Male; Osmolar Concentration; Prostaglandins E; Prostaglandins F; Rats; Sex Factors; Urine; Vasopressins

1. Urinary PGE is elevated above normal in patients with Bartter's syndrome, central and nephrogenic diabetes insipidus. 2. K+ loading, Mg2+ infusion, and water-loading-all of which increased urine volume-were associated with augmented urinary PGE in Bartter's syndrome, while fluid restriction decreased urinary PGE to normal. 3. Antidiuresis in central diabetes insipidus with DDAVP, and with indomethacin or ibuprofen in nephrogenic diabetes insipidus, is associated with a decrease in urinary PGE. 4. High urine volume may be a contributing factor to the elevated urinary PGE in Bartter's syndrome, central and nephrogenic diabetes insipidus.

Topics: Bartter Syndrome; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hyperaldosteronism; Kidney; Magnesium; Male; Potassium; Prostaglandins E; Urine

Topics: Child; Chlorpropamide; Clofibrate; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Diuresis; Humans; Lypressin; Thyroid Function Tests; Vasopressins

Topics: Adult; Aged; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Female; Humans; Male; Middle Aged; Valine

Topics: Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Pregnancy; Pregnancy Complications

Topics: Benzothiadiazines; Carbamazepine; Chlorpropamide; Clofibrate; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuretics; Humans; Lypressin; Sodium Chloride Symporter Inhibitors; Vasopressins

Two cases of diabetes insipidus (hypothalamic and nephrogenic) with massive nonobstructive trabeculation and dilation of the bladder and hydroureteronephrosis are reported. The cases are evaluated thoroughly--radiologically and urodynamically. Treatment options are discussed, including the use of an important new drug, dDAVP. The general subject of diabetes insipidus and its urologic implications is reviewed.

Topics: Adult; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Dilatation, Pathologic; Humans; Hydronephrosis; Male; Ureteral Diseases; Urinary Bladder Diseases; Urologic Diseases

Diabetes insipidus can be delineated in the context of the normal physiology of water metabolism. This approach highlights the common pathway taken by the variety of diseases that can progress to an insufficiency of antidiuretic hormone (ADH) and to diabetes insipidus. A simple diagnostic approach uses homeostatic pathways to separate diabetes insipidus from the other polyuric states. New developments in the biochemical alteration of ADH have improved the ability to individualize hormonal replacement and promise better therapy in the near future.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Osmolar Concentration; Urine; Vasopressins; Water Deprivation; Water-Electrolyte Balance

Topics: Age Factors; Arginine Vasopressin; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Male

The effectiveness of 1-deamino-8-d-arginine-vasopressin (DDAVP) has been evaluated in a case of insipid hypothalamo-hypophyseal familial diabetes. The polyuric-poly-dipsic syndrome was well controlled and there were no notalbe side-effects. The advantages of this treatment in comparison with more traditional methods are underlined.

Topics: Adult; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Evaluation; Female; Humans; Hypothalamo-Hypophyseal System; Pedigree

Topics: Adolescent; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Male; Swimming

Topics: Administration, Intranasal; Animals; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Rats

Topics: Administration, Intranasal; Adolescent; Arginine Vasopressin; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Male

Topics: Adolescent; Adult; Aged; Arginine Vasopressin; Brain Diseases; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Middle Aged; Pregnancy; Pregnancy Complications

Topics: Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Kidney Concentrating Ability

Antibodies to either AVP or dDAVP were sought in the serum of a patient suffering from diabetes insipidus and treated with Adiuretin (Spofa) to which the patient had become refractory. Neither the antibodies nor the presence of enzymes inactivating LVP was detected in the serum.

Topics: Animals; Antibodies; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Pregnancy; Swine

DDAVP, 1-desamino-8-D-arginine-vasopressin, is a synthetic analog of arginine vasopressin which produces prolonged antidiuresis after intranasal administration to patients with complete central diabetes insipidus. We have studied the mechanism of the prolonged antidiuretic effect by specific radioimmunossay of DDAVP in plasma of patients and by in vitro studies on the adenylate cyclase-cylic AMP system of the rat outer renal medulla. When DDAVP was administredd to patients, all responded, but the duration of response among patients varied from 5-21 h. The peak level of DDAVP in plasma was achieved up to 4 h after administration indicating a slow absorption from the nasal mucosa. The disappearance time of DDAVP from plasma correlated significantly with the duration of antidiuresis, P less than 0.001. On a molar basis DDAVP was 3-fold greater than AVP in its stimulation of outer medullary adenylate cyclase activity and 10-fold greater than AVP in its stimulation of cyclic AMP content. The prolonged antidiuresis of intranasally administered DDAVP is due to slow absorption, presistence in plasma, and enchanced effect on the kidney.

Topics: Adenylyl Cyclases; Adult; Arginine Vasopressin; Cyclic AMP; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Kidney Medulla; Middle Aged

Topics: Administration, Intranasal; Adolescent; Attitude; Child; Child Behavior; Child Development; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Vasopressins

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Vasopressins

An account is given of experience acquired with the prolonged administration of a new vasopressin analogue, 1-deamino-8-D-arginine vasopressin (DDAVP), to patients with diabetes insipidus. The antidiuretic effect of this compound was compared with that of the long-acting Pitressin Tannate, containing a pituitary extract. It was found that DDAVP induces a far more significant antidiuretic effect than does Pitressin Tannate. Its application is not accompanied by any side effects, nor is its effectiveness decreassed after repeated administration. Similar conclusions were reached with the outpatient treatment of diabetes insipidus patients. The results indicate that nasally-administered Adiuretein-SD can be well utilized in the prolonged treatment of diabetes insipidus.

Topics: Adult; Aged; Deamino Arginine Vasopressin; Depression, Chemical; Diabetes Insipidus; Diuresis; Female; Humans; Male; Middle Aged; Osmolar Concentration; Tissue Extracts; Vasopressins

The effectiveness of therapy with carbamazepine and clofibrate (oral therapy), intramuscular pitressin-in-oil, and intranasal 1-deamino-8-D-arginine vasopressin has been compared in 15 children with partial or complete central diabetes insipidus. Mean daily urine volume without therapy was 5.4 l and dropped to 1.1 and 1.6 l/day while receiving pitressin and DDAVP, respectively. Oral agents decreased the daily urine volume to 2.2 l in patients with partial DI, with good symptomatic control except for some nocturia. These agents had no effect in patients with complete DI and did not alter pitressin requirements. Duration of pitressin action was 24 to 36 hours with a significant incidence of hyponatremia. The duration of DDAVP effect was 8 to 20 hours, varying in individual patients. Children with partial DI required smaller doses of DDAVP and the duration of action was longer than in those with complete DI. Control of serum electrolytes was excellent using two doses per day and nocturia was eliminated. All patients who had received pitressin had growth hormone antibodies, but continued to grow normally unless there was pre-existing growth hormone deficiency. These antibodies gradually disappeared after approximately one year of therapy with oral agents or DDAVP. DDAVP did not alter growth hormone, cortisol, or prolactin levels during sleep. DDAVP is the antidiuretic therapy of choice in children with either complete or partial DI; to date, no side effects have been demonstrated.

Topics: Adolescent; Carbamazepine; Child; Child, Preschool; Clofibrate; Deamino Arginine Vasopressin; Diabetes Insipidus; Growth Hormone; Humans; Hydrocortisone; Infant; Oils; Osmolar Concentration; Prolactin; Time Factors; Vasopressins

Topics: Adolescent; Adult; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Male; Vasopressins

Modification of the natural vasopressin molecule to form desmopressin acetate (DDAVP) resulted in a compound with prolonged antidiuretic activity and virtual elimination of vasopressor activity. Twenty-one patients with central diabetes insipidus who ranged in age from 3 to 68 years were treated with DDAVP, which was administered intranasally in a dosage ranging from 10 microgram every 12 hours to 20 microgram every eight hours. Effective control of symptoms was obtained in all cases. There were no consequential toxic effects. As previously reported, DDAVP appears to be the preferred drug for the management of central diabetes insipidus. Biochemical alteration of hormones may enhance desired therapeutic activity and eliminate toxic effects. The development of DDAVP is an example of the potential for development of useful therapeutic peptides.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Male; Middle Aged; Vasopressins

The effects of a synthetic analogue of vasopressin, DDAVP (1-deamino-8-D-arginine vasopressin) were investigated in 98 patients with cranial diabetes insipidus. In all patients, intranasal administration of DDAVP one to three times daily, usually twice daily, was found to be satisfactory in the control of diabetes insipidus. Thus, by DDAVP administration, daily urinary volume changed from 3520 +/- 2150 ml to 1620 +/- 830 ml (mean +/- SD), and urinary osmolarity changed from 126 +/- 75 mOsm/kgH2O to 446 +/- 194 mOsm/kgH2O (mean +/- SD). A daily dose of DDAVP ranged from 2.0 to 20 microgram in children (average dose 12.8 microgram), while 10 to 20 microgram of DDAVP was usually required in adult patients (average dose 14.2 microgram). No serious side effects have been observed. It is concluded that DDAVP is safe and effective in the treatment of cranial diabetes insipidus.

Topics: Administration, Intranasal; Adolescent; Adult; Arginine Vasopressin; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Administration Schedule; Drug Evaluation; Female; Humans; Male; Middle Aged

Desmopressin acetate is a synthetic vasopressin analogue administered by the intranasal route. It is long-acting and well tolerated and may be the agent of choice for treating central diabetes insipidus.

Topics: Administration, Intranasal; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Mellitus; Drug Evaluation; Humans; Kidney

The pharmacokinetic parameters and biological duration of action of DDAVP were measured in five patients with central diabetes insipidus of differing severity. Plasma half-life correlated significantly with the duration of action (r = 0.89, P less than 0.05), 0ut there was no correlation between the severity of diabetes insipidus and either plasma half-life or duration of action of DDAVP.

Topics: Adult; Aged; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Half-Life; Humans; Kinetics; Male; Metabolic Clearance Rate

Topics: Adolescent; Arginine Vasopressin; Child; Child, Preschool; Craniotomy; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Male; Postoperative Complications; Specific Gravity

Topics: Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant; Male

Thirty patients with central diabetes insipidus were treated with 1-deamino-9-D-arginine vasopressin (DDAVP) during the period of 3--10 years. DDAVP was applicated in 1--3 intranasal doses daily. The dosage varied between 7--42 microgram/24 h. The diuresis before the treatment ranged between 28,000--7,600 ml/24 h (mean 13,883 ml/24 h) and was decreased by DDAVP below 2000 ml/24 h in 21 patients (70%) and to 2000--4000 ml/24 h in 8 patients (26.6%). In a single case it was not possible to reduce the diuresis from 20,000 ml below 8,000 ml/24 h. Favourable properties of DDAVP: absence of reduction of potency, lack of important side-effects and prolonged action were not lost even in the course of the long term treatment. No harmful effects of DDAVP were noted. Blood count as well as renal function tests were not affected by the treatment. All the patients preferred DDAVP to their previous therapy.

Topics: Adult; Aged; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Dose-Response Relationship, Drug; Female; Hematocrit; Hemoglobins; Humans; Kidney Function Tests; Leukocyte Count; Male; Middle Aged

Twenty children with diabetes inspidus, 19 children and adolescents and one baby of 2 months, were treated with DDAVP. The drug was very effective, the average urine volume being 1.7 L/24 hours. The control of the diuresis in the baby was very satisfactory. There were no secondary effects and the only episode of water intoxication occurred in a girl with corticosteroid deficiency which was not well controlled. The effects of this drug are discussed in the light of the biochemistry and pharmacology and the activity compared with that of Lysine vasopressin (LVP). Plasma levels of DDAVP and LVP showed that DDAVP persists for longer which may explain its greater potency and duration of action.

Topics: Adenosine Diphosphate; Adolescent; Adult; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Dose-Response Relationship, Drug; Drug Evaluation; Female; Humans; Infant; Lypressin; Male; Vasopressins

In 13 patients with hypothalamic diabetes insipidus after daily single intravenous (0.04-24 mug) and single intranasal (5-320 mug) doses of 1-deamino-8-D-arginine vasopressin (DDAVP) the relationships between the log doses and antidiuretic responses (log osmolalities of 24-hour urine samples) were compared. On the basis of such comparisons the ratio of nasal per venous daily single dose requirement was determined and found to be 26:1. Similarly, the relative potency of venous DDAVP was investigated in two subgroups of patients classified according to their response to peroral drugs. Seven times more DDAVP was required for patients treated previously with high doses of peroral antidiuretics. It was concluded that in groups of patients with divergent peroral dose requirements different DDAVP single-dose treatment schedules should be planned.

Topics: Administration, Intranasal; Deamino Arginine Vasopressin; Diabetes Insipidus; Dose-Response Relationship, Drug; Drug Administration Schedule; Humans; Injections, Intravenous; Vasopressins

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Lypressin; Vasopressins

Topics: Adenylyl Cyclases; Animals; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Enzyme Activation; Fluorides; Glucose; Guanine Nucleotides; Heterozygote; Kidney; Lypressin; Male; Rats; Species Specificity; Vasopressins; Water Intoxication

Topics: Adolescent; Adult; Brain Injuries; Brain Neoplasms; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Female; Humans; Kidney Diseases; Male; Vasopressins

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hydrolyzable Tannins; Male; Middle Aged; Vasopressins

In three cases of established cranial diabetes insipidus, the effectiveness of the new vasopressin analogue 1-desamino-8-D-arginine vasopressin (DDAVP) in controlling diabetes insipidus is demonstrated. A single dose of 20 micrograms of DDAVP given intranasally had an antidiuretic action from 16 to 24 hours in the three cases, and 10 micrograms given twice daily intranasally was effective in controlling the diabetes insipidus with no side effects. All the patients preferred this form of therapy to their previous treatment.

Topics: Adult; Deamino Arginine Vasopressin; Depression, Chemical; Diabetes Insipidus; Diuresis; Female; Humans; Male; Middle Aged; Vasopressins

The treatment of a patient with diabetes insipidus (DI) is described, and the general treatment of the syndrome is reviewed. The patient was a 16-year-old male who had experienced pain, inflammation and tenderness in the left gluteal region owing to an abcess at the site of intramuscular injection of vasopressin tannate in oil (VTO). (He had been diagnosed as having DI at age 8. Since then, he had been maintained on VTO, lypressin and posterior pituitary snuff.) After the abscess healed during hospital treatment, VTO was stopped and the patient's urinary output increased sharply; urine specific gravity and osmolarity decreased correspondingly. Three days after stopping VTO, the investigational drug, 1-deamino-8-D-arginine vasopressin (DDAVP), was begun at 10 microgram every 12 hours. The dose was eventually increased to 20 microgram every 12 hours, and the patient was discharged on this regimen which controlled his urine output, specific gravity and osmolarity. Other treatments reviewed include antidiuretic-hormone-replacement agents (vasopressin, lypressin) and drugs used to potentiate low ADH levels (chlorpropamide, clofibrate and carbamazepine).

Topics: Adolescent; Carbamazepine; Chlorpropamide; Clofibrate; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Synergism; Drug Therapy, Combination; Humans; Lypressin; Male; Vasopressins

Topics: Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Drinking; Female; Humans; Male; Osmotic Pressure

Topics: Adolescent; Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Vasopressins

1. After administration of a new vasopressin analogue (DDAVP), a marked and prolonged antidiuresis occurred in 10 patients with pituitary diabetes insipidus. 2. The antidiuretic effects of single intravenous doses of 0.04--24 mug DDAVP and single intranasal doses of 5--320 mug DDAVP were investigated. Time curves of the antidiuretic responses expressed in changes of urine osmolality (Uosm) and free water clearance per 100 ml GFR (CH2O X 100/GFR) are described. 3. Maximal "peak" response was obtained after an intravenous dose of 1 mug within the first 12 hrs (Uosm was 7--800 mOsm/KgH2O). Further increase of dosage resulted only in prolongation of duration of action (up to 48 hrs) and peak ("plateau") effect (up to 24 hrs). 4. There was a linear relationship between the log dose and log osmolality of urine collected in the second 12 hours after administration of single intravenous and intranasal doses of DDAVP. 5. Comparison of the effects of 1 mug lysine-vasopressin and 1 mug DDAVP revealed only slight differences in peak effects, but extreme differences in duration of action. 6. It is concluded that in the evaluation of a synthetic vasopressin analogue the maximal antidiuretic ability and the prolongation of action have to be analysed separately.

Topics: Absorption; Administration, Intranasal; Deamino Arginine Vasopressin; Depression, Chemical; Diabetes Insipidus; Diuresis; Humans; Injections, Intravenous; Kidney Concentrating Ability; Lypressin; Nasal Mucosa; Osmolar Concentration; Time Factors; Vasopressins

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Evaluation; Humans; Time Factors; Vasopressins

Duration of action of single intravenous and intranasal doses of 1-Deamino-8D-Arginine Vasopressin (DDAVP) was lengthened by "ineffective" doses of clofibrate (not affecting water metabolism when administered alone) in patients with pituitary diabetes insipidus. This interaction was observed when as low doses as 0.02 mug DDAVP were administered intravenously to one patient and as high doses as 1 and 2 mug DDAVP were given intravenously to another patient. Administration of less or more DDAVP than "optimal" for the interaction resulted in decreased or absent potentiation by clofibrate. The exact cause of the interaction is unknown.

Topics: Clofibrate; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Drug Synergism; Humans; Time Factors; Vasopressins

The symptomatic treatment of diabetes insipidus with pitressin is well known and very effective. The only problem concerns the type of pitressin to be used. In the past, pitressin snuff and various other intranasal instillations have been used, but these either have not been very effective, or have resulted in unpleasant side effects such as rhinitis. Until recently, the only effective form of the drug available in Australia has been pitressin tannate in oil. This often has to be given as a daily injection, which, like all intramuscular injections, is painful and, being in an oily base, is particularly likely to result in abscess formation. The recent introduction of 1-deamino-8-D-arginine-vasopressin (DDAVP), which can be simply instilled into the nostril, appears to present an advance in therapy.

Topics: Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Male; Vasopressins

Topics: Adult; Benzothiadiazines; Carbamazepine; Chlorpropamide; Clofibrate; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuretics; Humans; Male; Sodium Chloride Symporter Inhibitors; Vasopressins

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hypoglycemic Agents; Vasopressins

Marked interindividual differences were found in the height and duration of the antidiuretic action induced by increasing single intravenous doses (0.5 mug and 8 mug) of DDAVP in patients with pituitary diabetes insipidus. It was assumed that differences in the duration of action reflected individual variations in the rate of removal of vasopressin.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Genetic Variation; Humans; Time Factors; Vasopressins

Topics: Adult; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Enuresis; Humans; Kidney; Kidney Concentrating Ability; Vasopressins

DDAVP, 1-desamino-8-d-arginine-vasopressin, is a synthetic analogue of vasopressin with increased antidiuretic activity and decreased pressor activity. Whereas the antidiuretic-to-pressor ratio of arginine vasopressin is 1, the antidiuretic-to-pressor ratio of DDAVP is 4000. When administered as an intranasal spray, 5 to 20 mug of DDAVP produced eight to 20 hours of antidiuresis in patients with complete central diabetes insipidus. The minimum recommended therapeutic dose resulted in a maximum antidiuresis in most patients. No side effects of the drug were noted in clinical trials. DDAVP thus gives promise of becoming the standard treatment of severe central diabetes insipidus.

Topics: Catheterization; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Nose; Time Factors; Vasopressins

Topics: Adolescent; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Male; Vasopressins

Topics: Administration, Intranasal; Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Female; Humans; Infant; Male; Vasopressins

The antidiuretic action of a number of vasopressin analogues has been measured in the rat and man in water diuresis. These analogues had the following categories of structural alteration: a) substitution of -CH2CH2-(dicarba) and -SCH2-(6-monocarba) for the natural -SS- bridge between residues 1 and 6, b) changes in the nature of the C-terminal tripeptide produced by substitution of D-arginine and L-Nalpha-methylarginine for L-arginine in sequence position 8 and L-leucine for proline in position 7, and c) combinations of a and b. In addition, a highly active analogue which results when valine is substituted for glutamine in position 4 was tested. Trained, unanesthetized rats and normal human volunteers were complemented by a volunteer patient with posttraumatic diabetes insipidus (DI) in the total group of experimental subjects. The only change in the C-terminal tripeptide which was associated with a high antidiuretic action was D-Arg substitution. The meArg and Leu analogues showed low to very little activity and no signs of antidiuretic antagonist action. All of the carba analogues showed both high potency and prolongation of antidiuretic action in the following order (for both potency and duration): monocarba + 8-D-Arg greater than 4-Val + 8-D-Arg greater than 8-D-Arg alone, all in deamino form. None of the 8-D-Arg analogues had any side effects on the cardiovascular system, gut, uterus, bladder, etc. The prolongation was such that even with a DI patient refractory to the action of lysine-vasopressin and relatively resistant to deamino-[8-D-Arg]-vasopressin, water turnover could be reduced from untreated levels of 20 to 30 liters/day to less than 2 liters/day with only a single administration of deamino-6-carba-[8-D-Arg]-vasopressin as nose drops. The significance of these structural alterations in the vasopressin molecule for interaction with both antidiuretic and smooth muscle receptors was discussed.

Topics: Adult; Animals; Arginine Vasopressin; Chemical Phenomena; Chemistry; Deamino Arginine Vasopressin; Diabetes Insipidus; Disulfides; Diuresis; Dose-Response Relationship, Drug; Female; Humans; Male; Peptides; Pregnancy; Rats; Structure-Activity Relationship; Vasopressins

The case of a girl with Laurence-Moon-Biedl syndrome without polydactyly is described. Additional features were small stature, diabetes insipidus neurohormonalis and a renal disorder. The diabetes insipidus neurohormonalis was successfully treated with a new vasopressin analogue, DDAVP. The importance of renal studies in patients with Laurence-Moon-Biedl syndrome is emphasized.

Topics: Child; Child, Preschool; Chlorides; Deamino Arginine Vasopressin; Diabetes Insipidus; Drinking; Female; Fever; Humans; Infant; Infant, Newborn; Kidney; Laurence-Moon Syndrome; Osmolar Concentration; Sodium

Topics: Clofibrate; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Vasopressins

The effect on water metabolism of 1-deamino-8-D-arginine vasopressin and lysine vasopressin have been studied and compared in 20 vasopressin-sensitive and 2 ADH-resistant diabetes insipidus patients. In every case of ADH-sensitive diabetes insipidus, diuresis decreased and the urinary osmolality increased more markedly and for a longer time with the former than with the latter drug. Both drugs were ineffective in patients with ADH-resistant diabetes insipidus. Administration of 1-deamino-8-D-arginine vasopressin did not cause any side effect. It is concluded that 1-deamino-8-D-arginine vasopressin can successfully be employed in the treatment of ADH-sensitive diabetes insipidus.

Topics: Administration, Intranasal; Adolescent; Adult; Chemical Phenomena; Chemistry; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Female; Humans; Injections, Intravenous; Lypressin; Male; Middle Aged; Osmolar Concentration; Time Factors; Vasopressins

A definite relationship was found between the dose of DDAVP (1-24 mug intravenously and 5-320 mug intranasally) and the antidiuretic effects (expressed in changes in free water clearance per 100 ml GFR and in urine osmolality determined in 24 hour urine collection periods) in 7 patients with diabetes insipidus. The relationship was more conspicuous when the second 12 hour antidiuretic responses were considered, indicating a dose-dependent prolongation of the antidiuretic action. Time-curves of the antidiuretic responses proved the dose-dependent prolongation of the duration of antidiuretic action. Second 12 hour antidiuretic response increased more markedly when DDAVP was given divided in two doses a day as compared to the effects of the same quantity of the drug given as a single dose; only by the administration of excessive single doses the effects of the divided doses could be reproduced.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Dose-Response Relationship, Drug; Glomerular Filtration Rate; Osmolar Concentration; Urine; Vasopressins

Topics: Animals; Arginine; Blood Pressure; Deamination; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Female; Muscle Contraction; Rats; Rats, Inbred Strains; Structure-Activity Relationship; Uterus; Valine; Vasopressins

Topics: Amyl Nitrite; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Polyuria; Pregnancy; Pregnancy Complications; Vasopressins