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Adipsic arginine vasopressin deficiency: challenges in managing the intricate interplay of adipsia with polyuria
  1. Aayush Malik,
  2. Rekha Singh,
  3. Alpesh Goyal and
  4. Rahul Gupta
  1. Endocrinology and Metabolism, All India Institute of Medical Science, Bhopal, Madhya Pradesh, India
  1. Correspondence to Dr Rahul Gupta; rahul.endo{at}aiimsbhopal.edu.in

Abstract

Adipsic arginine vasopressin deficiency (AAVP-D) is caused by hypothalamic dysfunction (HD) due to varied aetiologies, including craniopharyngiomas. Its management is extremely challenging because two of the three regulatory mechanisms (thirst, arginine vasopressin, and renal medullary tonicity) for maintaining plasma osmolality are impaired (thirst, arginine vasopressin). These individuals develop severe dehydration and hypernatraemia, necessitating multiple emergency visits despite the administration of arginine vasopressin analogue (desmopressin). Here, we describe a case with HD secondary to craniopharyngioma treatment manifesting as AAVP-D, short stature, central hypothyroidism, hypoadrenalism and probable hypogonadism. AAVP-D was managed by fixing the renal water losses (using desmopressin) and water intake in a predetermined range. The treatment monitoring was done using total body weight and weekly to fortnightly serum sodium. Using this approach, the serum sodium was maintained in the range of 140–150 mmol/L, and there were no emergency visits for hypernatraemia or hyponatraemia (dysnatraemia) at 3 months.

  • Endocrine system
  • Pituitary disorders

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Footnotes

  • X @RahulEndo

  • Contributors AM managed the patient, collected the data and drafted and revised the manuscript. RS and AG managed the patient and revised the manuscript. RG managed the patient, collected the data, created figures and drafted and revised the manuscript. RG is responsible for the overall content as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.