endocrine and metabolic disorders
ArginineVasopressin Deficiency (Central Diabetes Insipidus)
Key Points
Argininevasopressindeficiency is caused by a deficiency ofvasopressin, which decreases the kidneys' ability to reabsorb water, resulting in massive polyuria (3 to 30 L/day). The cause may be a primary genetic disorder or various tumors, infiltrative lesions, injuries, or infections that affect the hypothalamic-pituitary system. Diagnose using a water deprivation test; patients cannot maximally concentrate urine following dehydration but can concentrate urine after receiving exogenousvasopressin. Lowvasopressinor copeptin levels are diagnostic, butvasopressinand copeptin levels are difficult to measure, and the tests are not routinely available. Address any treatable causes and givedesmopressin, a synthetic analog ofvasopressin. 