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Hypersecretion of arginine vasopressin in acromegaly.

ABSTRACT Four of 5 patients with untreated active acromegaly demonstrated prolonged antidiuresis and sustained release of arginine vasopressin (AVP) with nicotine stimulation of the neurohypophysis. This hyperresponsiveness was acutely suppressed by adrenal steroids in 2 subjects. Long-term estrogen treatment restored a normal nicotine response in one patient; another showed improved nicotine response after pituitary X-ray irradiation and a normal response with added estrogen therapy. Three additional active patients in clinical remission with estrogen medication showed normal responses to nicotine. These studies suggest that, in active acromegaly, there is a neurohypophyseal hyperresponsiveness to nicotine which improves with clinical remission of the disease. Since the osmoregulatory responses of the neurohypophysis to dehydration, hemodilution and induced hyperosmolality fell within the expected normal range, it appears to be a selective neurohypophyseal derangement.