pituitrin and Urination-Disorders

Arginine vasopressin (AVP), also known as vasopressin or anti-diuretic hormone, is a neuropeptide produced in the hypothalamus. It is primarily responsible for osmoregulation and thus maintains body fluid homeostasis. It is also a potent vasoconstrictor, may have a role in higher cognitive functions and affects metabolism. All the biological and cellular effects of vasopressin are mediated by the interaction of this hormone with three G-protein-coupled receptors - V(1a), V(1b) and V(2).Urological applications are based on the rationale that V(2) receptors mediate water conservation and increase urine osmolality. Due to their anti-diuretic properties mediated by the V(2) receptors, synthetic vasopressin agonists, such as desmopressin, are now commonly used for the treatment of nocturnal polyuria, central diabetes insipidus and nocturnal enuresis and potentially in urinary incontinence. Desmopressin has been licenced worldwide for haematological indications of haemophilia and von Willebrand disease. Vasopressin receptor antagonists correct hyponatremia by blocking the activation of the V(2) receptor and induce a free water diuresis without an accompanying natriuresis or kaliuresis; an effect termed 'aquaresis'. Interfering with vasopressin signalling by administering vasopressin antagonists may have clinical benefits in acute and chronic heart failure.

Topics: Animals; Hormone Antagonists; Humans; Receptors, Vasopressin; Signal Transduction; Urinary Bladder; Urination Disorders; Vasopressins; Water-Electrolyte Balance

Nocturia is common in older people and it may be bothersome for both patients and carers. It is most commonly related to bladder storage difficulties and nocturnal polyuria. The former results most frequently from an uninhibited overactive bladder. The latter occurs as a consequence of age-associated changes in the circadian rhythm of urine excretion. The management of an overactive bladder includes both behavioural and drug treatment. The management options for nocturnal polyuria include an afternoon diuretic and desmopressin, but caution is required, particularly with the latter, as it can cause significant hyponatraemia.

Topics: Adult; Aged; Aged, 80 and over; Arginine Vasopressin; Atrial Natriuretic Factor; Circadian Rhythm; Humans; Kidney Diseases; Life Style; Male; Middle Aged; Sleep Wake Disorders; Sodium; Urinary Bladder Diseases; Urination Disorders; Vasopressins; Water-Electrolyte Imbalance

Nocturia is a common symptom in the elderly, which profoundly influences general health and quality of life. One consequence of nocturia is sleep deterioration, with increased daytime sleepiness and loss of energy and activity. Accidents, e.g., fall injuries, are increased both at night and in the daytime in elderly persons with nocturia. Nocturia is caused by nocturnal polyuria, a reduced bladder capacity, or a combination of the two. Nocturnal polyuria can be caused by numerous diseases, such as diabetes insipidus, diabetes mellitus, congestive heart failure, and sleep apnoea. In the nocturnal polyuria syndrome (NPS), the 24-h diuresis is normal or only slightly increased, while there is a shift in diuresis from daytime to night. NPS is caused by a disturbance of the vasopressin system, with a lack of nocturnal increase in plasma vasopressin or, in some cases, no detectable levels of the hormone at any time of the 24-h period. The calculated prevalence of NPS is about 3% in an elderly population, with no gender difference. In NPS, there are serious sleep disturbances, partly due to the need to get up for micturition, but there is also increased difficulty in falling asleep after nocturnal awakenings and increased sleepiness in the morning. The treatment of NPS may include avoidance of excessive fluid intake, use of diuretics medication in the afternoon rather than the morning, and desmopressin orally at bedtime.

Topics: Aged; Aging; Diuretics; Drinking; Female; Humans; Male; Prevalence; Quality of Life; Urination Disorders; Vasopressins

Topics: Adult; Aged; Diabetes Insipidus, Nephrogenic; Humans; Middle Aged; Urination Disorders; Urine; Vasopressins

1. The nocturnal polyuria syndrome (NPS) is characterized by an increased nocturnal urine output. The diurnal rhythm in the antidiuretic hormone (ADH) system is absent, and often there is no detectable ADH in the plasma at all during the night. The 24-hr urine output is normal or only moderately increased. Men without nocturnal micturition, normally have a substantial increase in their nocturnal plasma ADH, while those with a need to micturate during the night have the same ADH level at night as in the daytime. Women have lower ADH levels than men, and no nocturnal increase in ADH irrespective of nocturnal voiding. Subjects with an increased nocturnal voiding frequency due to increased nocturnal urine output have an increased thirst, most markedly at night. They often avoid drinking in the evening, but they are unable to resist the impulse to drink during the night. People with polyuria at night wake up often because of the need to void, and accordingly are often tired during the day. 2. An increased nocturnal urine output can be reduced by administration of desmopressin at night. In a short-term study of elderly sufferers from NPS, treated with 20 micrograms desmopressin as nose drops in the evening the nocturnal urine output was reduced from 65 +/- 8% of the 24-hr urine output before treatment to 50 +/- 15% during treatment. In another study elderly with NPS were treated with 40 micrograms desmopressin as an intranasal aerosol in the evening.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Atrial Natriuretic Factor; Diuresis; Humans; Sleep; Thirst; Urination Disorders; Vasopressins

Topics: Adrenal Insufficiency; Diuresis; Glucocorticoids; Humans; Hypothyroidism; Kidney; Kidney Failure, Chronic; Osmolar Concentration; Urination Disorders; Vasopressins; Water; Water Intoxication

A patient with a giant ovarian tumor weighing about 7 kg was successfully removed by operation. However, her ECG demonstrated ischemic changes after the operation. We report a case of ischemic heart disease due to persistent diuresis after giant ovarian tumor resection. A 75-year-old, 56.5 kg, 143.5 cm woman was admitted to our hospital for ovarian tumor resection. The preoperative ECG showed normal sinus rhythm and no ischemic changes. Both general anesthesia and epidural anesthesia were planed. An epidural catheter was inserted at T12-L1. Anesthesia was induced with propofol 100 mg, fentanyl 100 microg and vecuronium 8 mg under 100% oxygen inhalation. General anesthesia was maintained with sevoflurane while epidural anesthesia was achieved using 0.375% ropivacaine 6 ml. During the operation, blood pressure was 90-110/70-80 mmHg, with SaO2, 100% and heart rate, 70-80 beats x min(-1). The content of tumor was suctioned for 30 minutes. Surgery was successfully finished without any other incidence. After extubation, her ECG changed to atrial fibrillation from normal sinus rhythm and showed ST-T depression. And then her systolic blood pressure became 80 mmHg or below, but we found continued diuresis at about 10 ml x kg(-1) x hr(-1) for over 2 hr. The total of 7 unit vasopressin was intermittently given for vasoconstriction and antidiuresis. Her hemodynamic was immediately restored, and ECG turned to normal ST-T. The patient had uneventful postoperative recovery.

Topics: Aged; Anesthesia, Epidural; Anesthesia, General; Antidiuretic Agents; Atrial Fibrillation; Diuresis; Electrocardiography; Female; Humans; Myocardial Ischemia; Ovarian Neoplasms; Postoperative Complications; Treatment Outcome; Urination Disorders; Vasopressins

Symptoms of hyponatremia and diuresis due to cerebral salt wasting syndrome (CSWS) are often observed after aneurysmal subarachnoid hemorrhage (SAH). Inadequately treated CSWS is known to work as a trigger of symptomatic vasospasm in SAH patients. Therefore, it is indispensable to detect and treat CSWS as early as possible in ICU. A 36-year-old man with SAH was admitted to our ICU. His urine volume increased excessively 3 days after ICU admission, and it reached a peak (39,250 ml x day(-1)) on the 6th day in ICU. Since infusion volume was controlled with regard to daily urinary output, hyponatremia was not noticeable and excessive urine volume stood out conspicuously. Though vasopressin and desmopressin were administered, the symptoms of natriuresis and hyponatremia were aggravated, associated with hyper secretion of natriuretic peptides (ANP 160 pg x dl(-1), BNP 172 pg x dl(-1)). Recent studies revealed that hyponatremia and hypovolemia following SAH might be caused by exaggerated secretion of natriuretic peptides. Experimental studies showed that the administration of vasopressin and desmopressin cause excessive secretion of natriuretic peptides under the circumstance of volume expansion in rats. We infer that the administration of vasopressin and desmopressin to our patient deterionated natriuresis in CSWS as in the previous experimental findings.

Topics: Adult; Animals; Atrial Natriuretic Factor; Brain Diseases; Contraindications; Humans; Hyponatremia; Hypovolemia; Male; Natriuresis; Rats; Subarachnoid Hemorrhage; Syndrome; Urination Disorders; Vasopressins

The present study aims to evaluate the effect of desmopressin treatment on urine output, density and glomerular filtration rate (GFR) in patients with posterior urethral valve (PUV) and the factors affecting the response to this treatment.. A total of 68 PUV patients who were followed-up after valve ablation were examined with the fluid intake, urine output and GFR. Sixteen patients who were polyuric (a urine output more than 30 ml/kg/day) and had hypoosmolar urine (urinary density of 1015 or lower) included in the study. Blood chemistry and serum ADH level were studied. Following 5 days of observation, patients were given DDAVP perorally with a dosage of 0.4 mg/day, two equal doses per day. After 7 days and after a 3 month period of treatment, voiding characteristics, day-time and night-time urine densities and also GFR have been re-evaluated.. The mean age was 6.8 years (range 2 to 11 years). The mean age at valve ablation was 20.7 months (range 5 months to 6 years). The mean daily urine output during first week and at the third month of the treatment had decreased significantly (p=0.004 and p=0.006). There was increase in night-time and day-time urine density in 10 patients (62%) and in 13 patients (81%) respectively at the third month evaluation. Increments in urine density were statistically significant for the third month evaluation. Nine (56%) patients had ADH levels within normal (<7 pcg/ml) levels and 7 patients had higher levels. There was no statistically significant difference between pretreatment and posttreatment micturation characteristics. However patients with voiding dysfunction responded better to DDAVP treatment.. Desmopressin treatment improves polyuria in PUV patients. The responses are better particularly in PUV patients with significant bladder dysfunction. This supports the harmful role of polyuria on bladder dysfunction. The DDAVP treatment improves the day-time and night-time in PUV patients. Combination of DDAVP treatment with overnight catheterization may be a good alternative that needs to be evaluated by further prospective randomized studies.

Topics: Antidiuretic Agents; Child; Child, Preschool; Deamino Arginine Vasopressin; Follow-Up Studies; Glomerular Filtration Rate; Humans; Infant; Male; Polyuria; Urination Disorders; Urine; Urodynamics; Vasopressins

The circadian rhythm of urine formation was studied in younger (27 +/- 8 yr) and aged (76 +/- 3 yr) males. In 11 younger healthy examined persons a decrease of diuresis during the night as compared with the day time was due to a rise of solute free water reabsorption. In 31 aged males the change of the urine formation rhythm with increase of the nocturnal diuresis is based on a rise of osmolal clearance combined with an increase of the solute free water reabsorption. It is shown that blockade of autacoid secretion leads to normalization of the diuresis circadian rhythm. In 10 aged men, nocturia was due to a decrease of vasopressin secretion which resulted in a decrease of the solute free water reabsorption and an increase of diuresis. The obtained data are considered as an evidence for the role of renal autacoids, alongside with vasopressin, in regulation of the circadian rhythm of the kidney function.

Topics: Adult; Aged; Aging; Autacoids; Circadian Rhythm; Diuresis; Humans; Kidney; Male; Natriuresis; Osmolar Concentration; Prostatic Hyperplasia; Urination Disorders; Vasopressins; Water; Water-Electrolyte Balance

To investigate the circadian variation of plasma antidiuretic hormone (ADH) and urine output in patients with severe nocturia (> three times per night) and to assess the effect of oral desmopressin on nocturnal urine output in these patients.. Twelve patients with severe nocturia and five age-matched controls without were assessed over 24 h (circadian sampling) during a 72-h hospital admission. Blood levels of ADH and changes of urine output were measured in the patients before and after the oral administration of desmopressin (0.2 mg, at 22.00 hours in the second day), and in the controls not treated with desmopressin.. Compared with the normal control, the patients had no diurnal variation in urine output and greater nocturnal urine production, associated with a lack of nocturnal increase in ADH level. Compared with the baseline urine output, desmopressin significantly decreased night-time (23.00-08.00 hour) urine output in the patients (P < 0.05). Desmopressin significantly increased the osmolality of night-time urine (P < 0.05), and there was no systemic adverse reaction.. Severe nocturia in a large proportion of elderly men with lower urinary tract symptoms is caused by nocturnal polyuria and natriuresis, because they have no nocturnal increase in ADH. These results suggest that desmopressin may be effective in decreasing nocturnal urine production in patients with severe nocturia who do not respond to conventional treatment.

Topics: Aged; Aged, 80 and over; Biomarkers; Case-Control Studies; Circadian Rhythm; Humans; Male; Middle Aged; Urinary Bladder Diseases; Urination; Urination Disorders; Urodynamics; Vasopressins

Early morning urine osmolality was tested in two urinary specimens, one taken immediately upon awakening and the other approximately 30 min thereafter, in 52 enuretic and 15 non-enuretic children. In a follow-up study, using the same study population, urine osmolality and volume were measured sequentially at 3-h intervals at 19.00, 22.00, 01.00, 04.00 and 07.00 h. Thereafter, all enuretics were treated by intranasal DDAVP for a 6-month period. There were no differences in urinary osmolality between enuretic and non-enuretic children when comparing the two early morning specimens. Nor were there any differences between groups in urine osmolalities at 19.00, 01.00 and 07.00 h. In contrast, at 04.00 h, urine osmolality was significantly lower in 17 of 52 enuretics [designated as ADH-negative (ADH-)] compared to the remaining enuretics [designated as ADH-positive (ADH+)] and non-enuretic children (610 +/- 251 vs 995 +/- 195 and 1089 +/- 195 mosmol/kg H2O, respectively, p < 0.05). This decreased osmolality was paralleled by an increase in urine production during the time period 01.00-04.00 (83 +/- 24 vs 52 +/- 18 and 45 +/- 22 ml, respectively, p < 0.05). At the end of the 6-month period of DDAVP treatment, the percentage response was similar between the ADH- and ADH+ enuretics (79% vs 75%). However, the time taken to achieve a response was quicker in the ADH- subjects. These data suggest the existence of a subgroup of enuretics whose underlying pathophysiology is the development of nocturnal polyuria probably due to a relative night-time ADH deficiency. Nocturnal sequential monitoring of urinary osmolality, as described above, allows identification of this subgroup.

Topics: Child; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Osmolar Concentration; Polyuria; Renal Agents; Time Factors; Urination Disorders; Urine; Vasopressins

Persistence of nocturia after prostatic resection in healthy patients without symptoms referred to residual bladder instability and to pathological polyuria seems to be caused by an increased urine production at night. The more accreditate mechanism involved is the relevant decreased ADH secretion pattern which occurs at night. In our study, patients with nocturnal poliuria showed significantly low plasmatic vasopressin levels compared with a control group. The aim of this study was to evaluate whether the persistence of nocturia after prostatic resection in healthy patients, without symptoms referred due to residual bladder instability and important polyuria, could be due to a decrease or a lack of increase in antidiuretic hormone (ADH) nocturnal levels following increased urine production at night. Serum ADH, atrial natriuretic peptide (ANP) and osmolality were assessed at 4-h intervals in 12 patients complaining of residual nocturia (group A) and in a control group of 13 patients who had undergone a complete resolution of nocturia after prostate ablation (group B). In the 25 patients involved in the study (mean age 65.8 years), no significant differences were observed in the two groups concerning mean age (67.5 years for group A, 64 years for group B). Mean nocturnal urine volume (1080 +/- 490 ml) in group A patients was significantly higher than in group B (500 +/- 100 ml) (p < 0.001), while no significant differences were found in diurnal diuresis. Mean plasma vasopressin levels of the 12 patients showing an increased nocturnal micturition were found to be significantly lower at all 4-h intervals when compared with the control group (p < 0.05). Individual fluctuations in serum osmolality were slight and insignificant within the normal range in all patients. The diurnal variation of plasma atrial natriuretic peptide was within the reference limits for all subjects during the 24-h period. Our results lead us to believe that residual nocturia after prostatic resection seems to be caused by an increased urine production at night due to a decreased ADH secretion pattern.

Topics: Aged; Atrial Natriuretic Factor; Case-Control Studies; Circadian Rhythm; Diuresis; Humans; Male; Osmolar Concentration; Prostatectomy; Urinary Retention; Urination Disorders; Vasopressins

Topics: Aged; Aging; Circadian Rhythm; Deamino Arginine Vasopressin; Humans; Male; Prostatic Hyperplasia; Renal Agents; Urination Disorders; Vasopressins

Topics: Central Nervous System; Circadian Rhythm; Enuresis; Humans; Kidney; Monitoring, Physiologic; Pressure; Urinary Bladder; Urinary Incontinence; Urination Disorders; Vasopressins

This study describes changes in diuresis during a two-month treatment with 40 micrograms desmopressin (Minirin) in a group of elderly persons with increased nocturnal diuresis and decreased ADH secretion. The average age of the men (n = 7) was 72 +/- 4 years and of the women (n = 14) 73 +/- 6 years. Nocturnal diuresis decreased after one and two months by 21% and 20% in the men and by 36% and 34% in the women, respectively. Half of the change persisted among the women but not among the men one month after the treatment. The decrease in nocturnal diuresis was greatest among those who, before the treatment, had a large part of their diuresis during the night. Diuresis during the day changed only insignificantly. Body weight did not change during treatment, nor did blood pressure, osmolality, sodium or potassium in serum. Sleep improved during treatment. In one case, side-effects were observed, with a feeling of swelling in the body and decreased diuresis in the morning.

Topics: Administration, Intranasal; Aged; Atrial Natriuretic Factor; Circadian Rhythm; Deamino Arginine Vasopressin; Diuresis; Female; Humans; Long-Term Care; Male; Urination Disorders; Vasopressins

A questionnaire study was carried out among elderly subjects (mean age 73.6 +/- 6.1 years (SD)) with a response rate of 74% (n = 1,115). It covered various aspects of health, symptoms and disease. 26% (n = 287) stated that they had two or more micturitions per night. A subgroup consisting of healthy older people, 39 men and 56 women with an average age of 73.9 +/- 4.9 years and 70.8 +/- 5.3 years, respectively, was studied concerning the distribution of diuresis and the frequency of voiding. The combined 24-hour diuresis (average for three 24-hour periods) was 1,400-1,600 ml, with a quotient between day and night of about 1, except the group with only one micturition at night (12 hours), where it was 1.8. The micturition volume between 08-20 h was less than between 20-08 h. The micturition volumes during both periods were significantly less with an increase in the number of voidings between 20-08 h. The quotient between the micturition volume 08-20 h and 20-08 h was strikingly constant (about 0.7). The finding of equally large urine volumes both day and night differs from that among younger adults in whom the diuresis is twice as large in the day as in the night.

Topics: Aged; Aged, 80 and over; Circadian Rhythm; Diuresis; Female; Humans; Male; Middle Aged; Reference Values; Sleep Initiation and Maintenance Disorders; Urination Disorders; Urodynamics; Vasopressins

The mechanism whereby glucocorticoid deficiency impairs renal water excretion was studied in the conscious mineralocorticoid-replaced, adrenalectomized rat. Control animals received physiologic replacement with prednisolone, and experimental animals were deprived of glucocorticoid hormone for either 1 or 14 days. The control animals excreted 95 +/- 1.9% of an acute water load (30 ml/kg) in 3 hours, a value significantly higher than the volume excreted by animals deprived fo glucocorticoid hormone for 1 day (70.0 +/- 3.6%, P less than 0.01) and 14 days (40.0 +/- 3.9%, P less than 0.01). Following the acute water load, plasma vasopressin levels, as measured by radioimmunoassay, was 1.08 pg/ml in the control rats, a value significantly lower than values obtained after the water load in rats deprived of glucocorticoid hormone for 1 day (2.5 +/- 0.2 pg/ml, P less than 0.01) and 14 days (2.4 +/- 0.3 pg/ml, P less than 0.01). To further examine the effect of plasma vasopressin in the impaired water excretion of glucocorticoid deficiency, we performed studied in Brattleboro rats with central diabetes insipidus. In these animals with absence of vasopressin, a defect in water excretion was observed after 14 days, but no 1 day, of glucocorticoid deficiency. In Sprague-Dawley rats, the impaired water excretion after 14 days of glucocorticoid deficiency was associated with a significantly lower cardiac index (209 +/- 14 vs. 291 +/- 11 ml/min/kg, P less than 0.01) and renal blood flow (3.8 +/- 0.3 vs. 5.7 +/- 0.2 ml/min/g, P less than 0.01) than that observed after 1 day of glucocorticoid deficiency. In diabetes insipidus rats, after 14 days of glucocorticoid deficiency, the percentage of an acute water load excreted (121 +/- 7% vs. 158.7 +/- 7.0%, P less than 0.01) was lower than that observed after 1 day of glucocorticoid deficiency. In summary, the present results indicate that glucocorticoid deficiency impairs renal water excretion by both vasopressin-dependent and vasopressin-independent mechanisms. The vasopressin-dependent renal mechanism is associated with a marked decrease in both systemic and renal hemodynamics.

Topics: Adrenalectomy; Animals; Blood Pressure; Blood Volume; Glucocorticoids; Hemodynamics; Kidney; Male; Rats; Time Factors; Urination Disorders; Vasopressins; Water-Electrolyte Balance

Topics: Aged; Creatinine; Desoxycorticosterone; Diuresis; Edema; Heart Failure; Humans; Hypertension; Infusions, Parenteral; Male; Middle Aged; Osmolar Concentration; Prostatic Hyperplasia; Prostatic Neoplasms; Prostatitis; Sodium; Time Factors; Urea; Urinary Catheterization; Urination Disorders; Vasopressins; Water-Electrolyte Balance

Topics: Aerosols; Body Weight; Child; Child, Preschool; Chlorothiazide; Diabetes Insipidus; Diuresis; Drinking Behavior; Drug Resistance; Follow-Up Studies; Humans; Male; Oils; Osmolar Concentration; Polyuria; Psychophysiologic Disorders; Thirst; Urination Disorders; Vasopressins; Water Deprivation; Water-Electrolyte Balance

Topics: Aged; Central Nervous System Diseases; Chlorpropamide; Diabetes Mellitus; Female; Humans; Hyponatremia; Natriuresis; Osmolar Concentration; Syndrome; Time Factors; Urination Disorders; Vasopressins

Topics: Aldosterone; Asthma; Calcium; Chlorides; Circadian Rhythm; Female; Humans; Hydrocortisone; Hydrogen-Ion Concentration; Kidney Tubules; Middle Aged; Phosphates; Potassium; Prednisone; Sodium; Urination Disorders; Vasopressins; Water; Water-Electrolyte Balance

Topics: Bacteriuria; Creatinine; Female; Humans; Kidney; Kidney Concentrating Ability; Male; Urea; Urinary Bladder Diseases; Urinary Catheterization; Urinary Tract Infections; Urination Disorders; Vasopressins

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adult; Aged; Cerebrovascular Disorders; Circadian Rhythm; Creatinine; Diffuse Cerebral Sclerosis of Schilder; Encephalitis; Female; Humans; Middle Aged; Potassium; Sodium; Tuberculosis, Meningeal; Urination Disorders; Vasopressins; Water-Electrolyte Balance

Topics: Aged; Blood Urea Nitrogen; Glomerular Filtration Rate; Humans; Kidney Function Tests; Kidney Tubules; Male; Middle Aged; Prostatectomy; Prostatic Hyperplasia; Urination Disorders; Vasopressins

Topics: Aged; Blood Urea Nitrogen; Chlorides; Humans; Male; Prostatic Hyperplasia; Sodium; Urination Disorders; Vasopressins; Water Intoxication

Topics: Aged; Humans; Male; Prostatitis; Secretory Rate; Urinary Catheterization; Urination Disorders; Vasopressins; Water Intoxication

Topics: Animals; Cobalt; Cobalt Radioisotopes; Gamma Rays; Polydipsia; Polyuria; Rats; Thirst; Urination Disorders; Vasopressins

Topics: Arginine Vasopressin; Humans; Polyuria; Urination Disorders; Vasopressins

Topics: Animals; Arginine Vasopressin; Edema; Female; Humans; Menstruation; Ovulation; Papio; Papio hamadryas; Papio ursinus; Polyuria; Urination Disorders; Vasopressins