Diabetes insipidus occurs when problems with antidiuretic hormone (ADH) cause the body to remove too much water. A synthetic version of ADH can help restore a person’s levels and treat some types of the condition.
The condition that healthcare professionals previously referred to as diabetes insipidus is now called arginine vasopressin disorder (AVD). This is because it results from problems with arginine vasopressin, or antidiuretic hormone (ADH).
AVD is a rare condition that occurs when the body does not produce enough ADH or becomes less sensitive to its effects. The hypothalamus and pituitary glands are responsible for producing ADH and sending it into the bloodstream.
There are multiple types of AVD that result from different causes. However, they all lead to increased volumes of urine that is weak and diluted. People with AVD pass urine often and feel constant, extreme thirst.
When AVD is the result of a lack of ADH, people can use a synthetic version of ADH to relieve many of the condition’s effects. However, ADH may not be a suitable treatment for all types of AVD.
Vasopressin is the hormone that helps regulate the amount of water in the body and the concentration of the urine the kidneys release. People may also refer to this hormone as ADH or
The hypothalamus in the brain makes vasopressin, and the pituitary gland stores it. The pituitary gland releases vasopressin into the bloodstream when not enough fluid is present in the body.
The kidneys can detect vasopressin through receptors in the kidney cells. After interacting with vasopressin, these receptors tell the kidneys to move fluid from the urine back to the bloodstream.
In people with AVD, not enough vasopressin reaches the kidney receptors or the receptors do not respond effectively, so the kidneys do not withdraw enough water from the urine. Instead, the fluids leave the body in the urine, leading to excessive urination.
Different
Arginine vasopressin deficiency (AVP-D)
Healthcare professionals previously referred to this condition as central diabetes insipidus. It happens either when the hypothalamus does not produce enough vasopressin or when the pituitary gland cannot release enough vasopressin.
Damage to these parts of the brain as a result of surgery, trauma, genetic mutations, autoimmune disorders, or infections can affect their ability to make or release vasopressin.
AVP resistance (AVP-R)
Healthcare professional previously called this nephrogenic diabetes insipidus. It develops when kidney receptors do not respond correctly to vasopressin.
The possible causes of nephrogenic AVD include medications, potassium and calcium imbalances, blocked urinary tracts, inherited mutations, and — in rare cases — chronic kidney disease.
Primary polydipsia
Healthcare professionals also refer to this type as dipsogenic diabetes insipidus. It occurs due to problems with the hypothalamus and results in extreme, ongoing thirst, causing a person to drink more fluids.
This type can result from hypothalamus damage due to infection, inflammation, tumors, head injury, or surgery, as well as from some medications and mental health conditions.
Gestational form of AVD
Healthcare professionals previously called this type gestational diabetes insipidus. It occurs during pregnancy when placenta tissues produce more of an enzyme called vasopressinase that breaks down vasopressin more quickly.
It is more common leading up to the third trimester, when vasopressinase levels are highest. This is the rarest type of AVD, and it resolves after a person gives birth.
Natural ADH is available only from a person’s own hypothalamus, but doctors can prescribe a synthetic version called desmopressin (DDAVP) to mimic its effects. People
Desmopressin does not cure AVD, and people may need to supplement for the rest of their lives, depending on the underlying cause. However, it can replace vasopressin in the body and reduce the amount of urine a person produces.
Desmopressin can help treat AVP-D and the gestational form of AVD, but it will not help treat AVP-R or primary polydipsia.
Desmopressin can also help doctors diagnose AVD. A doctor may recommend a water deprivation test, in which a person avoids consuming water for 8 hours and has regular checks of their urine volume and urine concentration.
A person will often receive an AVD diagnosis if they still produce large volumes of highly diluted urine after hours of water deprivation. However, after the test, the doctor often gives the person desmopressin to gauge their body’s response.
If urine volume reduces within a couple of hours, the person likely has central AVD. If urine levels do not seem to respond to desmopressin, the doctor may diagnose AVP-R.
According to the Society for Endocrinology, people with AVP-R will not have a strong response to desmopressin. AVP-R occurs when vasopressin receptors in the kidneys do not react enough to vasopressin. Therefore, adding more vasopressin will not change the amount of water the kidneys reabsorb into the bloodstream.
Additionally, the use of DDAVP in a person with primary polydipsia can result in health complications such as hyponatremia. Currently, there are no known treatments available for primary polydipsia.
Desmopressin is the main treatment for several types of AVD. It is often the only treatment that is necessary for AVP-D and the gestational form of AVD.
However, people also need to treat the underlying cause when possible. For example, a surgeon may need to remove a pituitary tumor that is causing AVD while managing vasopressin levels with desmopressin.
Instead of taking desmopressin, people with AVP-R might need to
For severe AVP-R, a medical professional may prescribe a water pill, or diuretic, known as hydrochlorothiazide or amiloride. They may also prescribe ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), to help people with this type produce less urine over time.
Antidiuretic hormone (ADH), also known as vasopressin, is an important hormone for water balance. Problems with this hormone can result in arginine vasopressin disorder (AVD).
A synthetic version of ADH known as desmopressin can help doctors diagnose AVD. Desmopressin can also help treat some types of AVD, including arginine vasopressin deficiency (AVP-D) and the gestational form of AVD.
However, desmopressin is not helpful for AVP resistance (AVP-R). People with this type of AVD do not respond to ADH, so supplementing desmopressin does not help treat the condition.