Baroregulation of Vasopressin Release in Adipsic Diabetes Insipidus (original) (raw)
Related papers
Hypothalamic adipic hypernatraemia syndrome with normal osmoregulation of vasopressin
European Journal of Pediatrics, 2004
Adipsic hypernatraemia is an uncommon disorder in childhood caused by a defect in the osmoregulation of thirst, leading to impairment of water homeostasis and chronic hyperosmolality of body fluids. Adipsia is often associated with an abnormality in osmoregulated vasopressin secretion due to the close proximity of the hypothalamic osmoreceptors that control thirst with those regulating vasopressin secretion. Hypothalamic lesions of diverse aetiology (vascular abnormalities, neoplasms, granulomatous diseases, trauma etc.) have been described in this syndrome. We report a 12-year-old boy with evident weight loss due to hypernatraemic dehydration with a selective defect in osmoregulation of thirst and normal vasopressin secretion with no demonstrable structural lesion. To date, only six paediatric patients with this condition have been described in the literature. Conclusion: Hypothalamic adipsic hypernatraemia syndrome must be suspected when a dehydrated patient denies thirst. The study of antidiuretic function is necessary because the osmoregulation of vasopressin secretion could be altered.
Heterogenous patterns of recovery of thirst in adult patients with adipsic diabetes insipidus
QJM : monthly journal of the Association of Physicians, 2015
The natural history of adipsic diabetes insipidus (ADI) is not well described, and reports of recovery of thirst are rare. Case histories presentation. ADI was identified by demonstrating absent thirst and AVP responses to hypertonic saline infusion. 12 patients with ADI were identified (craniopharyngioma 5, anterior communicating artery aneurysm(ACOM) repair 4, congenital 1, neurosarcoidosis 1, prolactinoma 1). Three patients died. Six patients had permanent adipsic diabetes insipidus. Three patients had recovery of thirst, with a heterogenous pattern of recovery. In the first case, ADI had developed after clipping of an ACOM aneurysm. Ten years after surgery; he sensed the return of thirst; repeated hypertonic saline infusion showed recovery of thirst and AVP secretion.In the second case, a 41-year-old female with an intrasellar craniopharyngioma developed postoperative ADI with persistent hypernatremia. Two years postoperatively, she complained of thirst, and hypertonic saline in...
Diabetologia, 1999
Hyperosmolar non-ketotic coma (HONK) is characterised by marked hypernatraemic dehydration, which is the major cause of the associated mortalityrate of 50 % [1]. It is associated with thiazide diuretics and corticosteroid therapy [1], underlying infection [2] and residence in long-term institutions, but there is no unifying hypothesis to explain why some patients with Type II (non-insulin-dependent) diabetes mellitus develop HONK. The key homeostatic mechanisms which prevent dehydration are the antidiuretic action of arginine vasopressin (AVP) and the sensation of thirst, which stimulates water intake [3]. Increased plasma AVP concentrations have been reported in HONK [4] but poorly controlled diabetes causes renal resistance to AVP [5], and marked glycosuria causes nephrogenic diabetes insipidus [3]. Thus, high plasma AVP concentrations fail to promote antidiuresis in HONK, and patients depend on adequate fluid intake to prevent hypertonic dehydration. Thirst responses to dehydration are diminished in the elderly, particularly those in long-term institutions [6]. Most patients who develop HONK are el-Diabetologia (1999) 42: 534±538
Plasma and cerebrospinal fluid vasopressin and osmolality in relation to thirst
Pflügers Archiv European Journal of Physiology, 1984
Conscious dogs chronically implanted with a device for cerebrospinal fluid (CSF) sampling from the anterior 3rd ventricle were submitted to 24 h dehydration. During rehydration by drinking the total water intake (TWI) after 16 min was determined in 8 and after 90 rain in 14 experiments. Samples were simultaneously drawn to determine the osmolalities (P .... CSFosm) and AVP concentrations (PAvP, CSFAvP) of plasma and CSF. After 24 h dehydration all of these parameters were significantly elevated in comparison to euhydrated dogs investigated on 19 occasions. In 8 experiments 60 % of the final TWI had been ingested within the first 16 rain with no changes of P .... CSFos m and CSFAve, but a significant decrease of PAVP at this time. TWI per kg body weight (TWI 9 kg-1) after 90 min was significantly correlated with the osmolalities and AVP levels in plasma and CSF prior to rehydration. The decreases of P .... CSF~osm and PAW, but not ofCSFAw , were significantly correlated with TWI 9 kg-1. The results indicate that Paw and CSFav v are subject to long term control by body fluid tonicity exhibiting a feedback relationship to water intake. In addition, Paw but not CSFAvv seems to be under short term, possibly nonosmotic, control during water intake.
IOSR Journals , 2019
We examined the renal, hormonal and central thirst and arginine vasopressin (AVP) osmoregulatory systems that accompany the aging process and how these influence the risk of altered water and electrolyte balance in the elderly. When deprived of fluid or confronted with a hyperosmotic or hypovolemic stimulus, elderly people exhibit a decreased perception of thirst and reduced fluid intake. Altered hydromineralbalance is a common feature in elderly people due to impaired capacity to restore and maintain fluid balance. The consequent hypovolemia appears to be induced by decreased thirst sensation and baroreceptor sensitivity. More so, there is reduced oropharyngeal-induced inhibition of AVP release after drinking and the kidneys gradually become unresponsive to even higher levels of circulating AVP, thereby either leading to volume overload or reducing the body's water retention capacity. These defects combine to increase the susceptibility of elderly people to disturbances in water and electrolyte balance, which manifest as dehydration/hypovolemia and hypernatremia, or overhydration and hyponatremia.
Osmoregulation of thirst and vasopressin release in severe chronic renal failure
Kidney International, 1991
Osmoregulation of thirst and vasopressin release in severe chronic renal failure. Subjects with severe chronic renal failure (CRF) have higher plasma ~oncentrations of arginine vasopressin (A VP) than normal subjects , and some develop severe thirst. Eight patients with CRF and seven matched controls underwent hypertonic saline infusion to explore the relationship of thirst and plasma A VP with plasma osmolality. Differences in urea concentration between the two groups were controlled for by correcting measured osmolality to a urea of zero. Linear regression analysis of the relationships between plasma AVP and thirst with plasma osmolality (corrected for urea) was performed. Mean results were: control, pAVP = 0.26 (pOsmc-283.7) versus CRF, pAVP = 0.72 (pOsmc-282.0); and control, thirst = 4.0 (pOsmc-279.4) versus CRF, thirst = 3.5 (pOsmc-281.8). The apparent sensitivity (slope) of AVP release was greater in severe CRF than in normal controls (P = 0.04). There was no significant difference between the groups in thirst sensitivity, threshold for thirst onset and threshold for AVP release. Osmoregulated thirst 'was normal in severe CRF, but increasing osmolality leads to higher concentrations of A VP than would be expected.