{"title":"精氨酸加压素缺乏症:诊断、管理和催产素缺乏症的相关性","authors":"Cihan Atila, Julie Refardt, Mirjam Christ-Crain","doi":"10.1038/s41574-024-00985-x","DOIUrl":null,"url":null,"abstract":"Polyuria–polydipsia syndrome can be caused by central diabetes insipidus, nephrogenic diabetes insipidus or primary polydipsia. To avoid confusion with diabetes mellitus, the name ‘central diabetes insipidus’ was changed in 2022 to arginine vasopressin (AVP) deficiency and ‘nephrogenic diabetes insipidus’ was renamed as AVP resistance. To differentiate the three entities, various osmotic and non-osmotic copeptin-based stimulation tests have been introduced in the past decade. The hypertonic saline test plus plasma copeptin measurement emerged as the test with highest diagnostic accuracy, replacing the water deprivation test as the gold standard in differential diagnosis of the polyuria–polydipsia syndrome. The mainstay of treatment for AVP deficiency is AVP replacement with desmopressin, a synthetic analogue of AVP specific for AVP receptor 2 (AVPR2), which usually leads to rapid improvements in polyuria and polydipsia. The main adverse effect of desmopressin is dilutional hyponatraemia, which can be reduced by regularly performing the so-called desmopressin escape method. Evidence from the past few years suggests an additional oxytocin deficiency in patients with AVP deficiency. This potential deficiency should be further evaluated in future studies, including feasible provocation tests for clinical practice and interventional trials with oxytocin substitution. Central diabetes insipidus has been renamed as arginine vasopressin deficiency. This Review discusses advances in diagnosis and management of arginine vasopressin deficiency. In addition, the possibility of oxytocin deficiency in these patients is considered, as well as oxytocin provocation testing and the future therapeutic potential of oxytocin replacement.","PeriodicalId":18916,"journal":{"name":"Nature Reviews Endocrinology","volume":"20 8","pages":"487-500"},"PeriodicalIF":31.0000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Arginine vasopressin deficiency: diagnosis, management and the relevance of oxytocin deficiency\",\"authors\":\"Cihan Atila, Julie Refardt, Mirjam Christ-Crain\",\"doi\":\"10.1038/s41574-024-00985-x\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Polyuria–polydipsia syndrome can be caused by central diabetes insipidus, nephrogenic diabetes insipidus or primary polydipsia. To avoid confusion with diabetes mellitus, the name ‘central diabetes insipidus’ was changed in 2022 to arginine vasopressin (AVP) deficiency and ‘nephrogenic diabetes insipidus’ was renamed as AVP resistance. To differentiate the three entities, various osmotic and non-osmotic copeptin-based stimulation tests have been introduced in the past decade. The hypertonic saline test plus plasma copeptin measurement emerged as the test with highest diagnostic accuracy, replacing the water deprivation test as the gold standard in differential diagnosis of the polyuria–polydipsia syndrome. The mainstay of treatment for AVP deficiency is AVP replacement with desmopressin, a synthetic analogue of AVP specific for AVP receptor 2 (AVPR2), which usually leads to rapid improvements in polyuria and polydipsia. The main adverse effect of desmopressin is dilutional hyponatraemia, which can be reduced by regularly performing the so-called desmopressin escape method. Evidence from the past few years suggests an additional oxytocin deficiency in patients with AVP deficiency. This potential deficiency should be further evaluated in future studies, including feasible provocation tests for clinical practice and interventional trials with oxytocin substitution. Central diabetes insipidus has been renamed as arginine vasopressin deficiency. This Review discusses advances in diagnosis and management of arginine vasopressin deficiency. In addition, the possibility of oxytocin deficiency in these patients is considered, as well as oxytocin provocation testing and the future therapeutic potential of oxytocin replacement.\",\"PeriodicalId\":18916,\"journal\":{\"name\":\"Nature Reviews Endocrinology\",\"volume\":\"20 8\",\"pages\":\"487-500\"},\"PeriodicalIF\":31.0000,\"publicationDate\":\"2024-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Nature Reviews Endocrinology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.nature.com/articles/s41574-024-00985-x\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Nature Reviews Endocrinology","FirstCategoryId":"3","ListUrlMain":"https://www.nature.com/articles/s41574-024-00985-x","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
Arginine vasopressin deficiency: diagnosis, management and the relevance of oxytocin deficiency
Polyuria–polydipsia syndrome can be caused by central diabetes insipidus, nephrogenic diabetes insipidus or primary polydipsia. To avoid confusion with diabetes mellitus, the name ‘central diabetes insipidus’ was changed in 2022 to arginine vasopressin (AVP) deficiency and ‘nephrogenic diabetes insipidus’ was renamed as AVP resistance. To differentiate the three entities, various osmotic and non-osmotic copeptin-based stimulation tests have been introduced in the past decade. The hypertonic saline test plus plasma copeptin measurement emerged as the test with highest diagnostic accuracy, replacing the water deprivation test as the gold standard in differential diagnosis of the polyuria–polydipsia syndrome. The mainstay of treatment for AVP deficiency is AVP replacement with desmopressin, a synthetic analogue of AVP specific for AVP receptor 2 (AVPR2), which usually leads to rapid improvements in polyuria and polydipsia. The main adverse effect of desmopressin is dilutional hyponatraemia, which can be reduced by regularly performing the so-called desmopressin escape method. Evidence from the past few years suggests an additional oxytocin deficiency in patients with AVP deficiency. This potential deficiency should be further evaluated in future studies, including feasible provocation tests for clinical practice and interventional trials with oxytocin substitution. Central diabetes insipidus has been renamed as arginine vasopressin deficiency. This Review discusses advances in diagnosis and management of arginine vasopressin deficiency. In addition, the possibility of oxytocin deficiency in these patients is considered, as well as oxytocin provocation testing and the future therapeutic potential of oxytocin replacement.
期刊介绍:
Nature Reviews Endocrinology aspires to be the foremost platform for reviews and commentaries catering to the scientific communities it serves. The journal aims to publish articles characterized by authority, accessibility, and clarity, enhanced with easily understandable figures, tables, and other visual aids. The goal is to offer an unparalleled service to authors, referees, and readers, striving to maximize the usefulness and impact of each article. Nature Reviews Endocrinology publishes Research Highlights, Comments, News & Views, Reviews, Consensus Statements, and Perspectives relevant to researchers and clinicians in the fields of endocrinology and metabolism. Its broad scope ensures that the work it publishes reaches the widest possible audience.