Measurement of arginine vasopressin

Arginine vasopressin (AVP) is a peptide hormone synthesised in the hypothalamus and secreted from nerve terminals within the posterior pituitary gland. Secretion is primarily under osmoregulatory control and levels rise in plasma in response to a body water deficit and are suppressed in response to water overload. The responsive end organ in osmoregulation is the kidney, and an increase in plasma AVP normally results in urine concentration while a decrease results in urine dilution and a diuresis. The hormone is present in urine. The level of AVP in urine is directly related to the prevailing plasma concentration, but is also influenced by urine concentration, osmolal clearance, and renal metabolism. The measurement of AVP in plasma and urine is by radioimmunoassay (RIA). Prior extraction of the hormone is required to remove interfering substances and, particularly for plasma measurements, to concentrate the assayed sample. The secretion of AVP by the posterior pituitary gland is also stimulated by non-osmoregulatory factors such as reduced blood volume, reduced blood pressure, and nausea and is acutely suppressed by an oropharyngeal reflex. Plasma AVP measurement has a role in delineating complex osmoregulatory dysfunction, but protocols for study need to control the non-osmoregulated stimulatory and inhibitory factors. The urine AVP excretion rate corrected for osmolal clearance has a role in the assessment of renal responsiveness to its action.