Vasopressin (Arginine vasopressin, argipressin, antidiuretic hormone) and its synthetic counterpart, desmopressin acetate, is an endocrine hormone produced by the neurohypophysis in the pituitary.
Vasopressin is responsible for renal water reabsorption by increasing water permeability of the collecting duct and distal convoluted tubule by inducing translocation of aquaporin-2 water channels in the collecting duct plasma membrane.
Vasopressin production by the pituitary can be interfered with by a number of condition associated with central diabetes insipidus, such as:
- Hypothalamic-pituitary trauma
- Post-transsphenoidal surgery for correction of hyperadrenocorticism
- Dorsally expanding cysts
- Inflammatory granuloma
- Lymphocytic hypophysitis
- Chiari malformations
- Neoplasms such as craniopharyngioma, pituitary chromophobe adenoma, pituitary chromophobe adenocarcinoma and metastatic mammary carcinoma, lymphoma, malignant melanoma and pancreatic carcinoma.
In nephrogenic diabetes insipidus, a different phenomenon occurs where nephron impairment results in lack of vasopressin sensitivity.
For treatment of diabetes insipidus, the recommended initial doses of desmopressin (100 µg/mL) is 1.0 - 5.0 μg once or twice daily as an intranasal or conjunctival drop. With the oral tablets, a starting dose of 0.05 mg - 0.2 mg (50 to 100 µg) once or twice daily is initiated.
Adverse effects of desmopressin are uncommon, but overdosage can lead to fluid retention, hyponatremia and decreased plasma osmolality.
The principle drawback with the use of any of the desmopressin preparations in the treatment of central diabetes insipidus is the drug’s considerable expense.
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