New insights on diagnosis and treatment of AVP deficiency

Author:

Refardt JulieORCID,Atila CihanORCID,Christ-Crain MirjamORCID

Abstract

AbstractArginine vasopressin deficiency (AVP-D) is one of the main entities of the polyuria-polydipsia syndrome. Its correct diagnosis and differentiation from the other two causes - AVP resistance and primary polydipsia – is crucial as this determines the further management of these patients.Over the last years, several new diagnostic tests using copeptin, the stable surrogate marker of AVP, have been introduced. Among them, hypertonic saline stimulated copeptin was confirmed to reliably and safely improve the diagnostic accuracy to diagnose AVP-D. Due to its simplicity, arginine stimulated copeptin was put forward as alternative test procedure. Glucagon-stimulated copeptin also showed promising results, while the oral growth hormone secretagogue Macimorelin failed to provide a sufficient stimulus. Interestingly, an approach using machine learning techniques also showed promising results concerning diagnostic accuracy.Once AVP-D is diagnosed, further workup is needed to evaluate its etiology. This will partly define the further treatment and management. In general, treatment of AVP-D focuses on desmopressin substitution, with oral formulations currently showing the best tolerance and safety profile. However, in addition to desmopressin substitution, recent data also showed that psychopathological factors play an important role in managing AVP-D patients.

Funder

University of Basel

Publisher

Springer Science and Business Media LLC

Subject

Endocrinology,Endocrinology, Diabetes and Metabolism

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1. Challenging case of hypernatraemia in infancy;Archives of disease in childhood - Education & practice edition;2024-08-28

2. Copeptin as a surrogate marker for arginine vasopressin: analytical insights, current utility, and emerging applications;Critical Reviews in Clinical Laboratory Sciences;2024-07-31

3. Transient Arginine Vasopressin Deficiency Induced by Valproic Acid Intoxication: A Case Report;Cureus;2024-07-23

4. Setting analytical performance specifications for copeptin-based testing;Clinical Chemistry and Laboratory Medicine (CCLM);2024-06-12

5. Progress, challenges and perspectives in the management of hypopituitarism;Reviews in Endocrine and Metabolic Disorders;2024-05-27

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