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Reviews in Endocrine and Metabolic Disorders

Open Access 13-12-2023 | Central Diabetes Insipidus

New insights on diagnosis and treatment of AVP deficiency

Authors: Julie Refardt, Cihan Atila, Mirjam Christ-Crain

Published in: Reviews in Endocrine and Metabolic Disorders

Abstract

Arginine 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.

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Title: New insights on diagnosis and treatment of AVP deficiency
Authors: Julie Refardt
Cihan Atila
Mirjam Christ-Crain
Publication date: 13-12-2023
Publisher: Springer US
Keywords: Central Diabetes Insipidus
Diagnostics in Endocrinology
Hyponatremia
Published in: Reviews in Endocrine and Metabolic Disorders
Print ISSN: 1389-9155
Electronic ISSN: 1573-2606
DOI: https://doi.org/10.1007/s11154-023-09862-w

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