Late recovery from chronic arginine vasopressin deficiency: a multicenter retrospective case-control study
Clara O Sailer1,2, Francesca Galbiati1,2, Anna Aulinas3,4
1Section of Neuroendocrinology and Reproduction, Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA.
Context:
Arginine vasopressin deficiency (AVP-D), caused by hypothalamic/pituitary damage from tumor or surgery, can be transient or chronic. Chronic AVP-D is thought to be permanent though emergent research indicates the possibility of late recovery. Little is known about clinical characteristics that predict late recovery from chronic AVP-D.
Objective:
Describe characteristics associated with late recovery from chronic AVP-D.
Design:
Multicenter, retrospective case-control study of AVP-D Recovered (n = 18) vs AVP-D Non-recovered (n = 36; matched for sex and disease duration).
Main Outcome Measures:
Clinical characteristics assessed at hypothalamic/pituitary disease diagnosis, AVP-D diagnosis, AVP-D recovery, and most recent clinical evaluation. We also present characteristics of three pediatric cases with AVP-D recovery.
Results:
At diagnosis of hypothalamic/pituitary disease, AVP-D Recovered, compared to AVP-D Non-recovered, were older (45 ± 19 vs 33 ± 13 years, P = .006) and more likely to have functioning pituitary tumors (33.3% vs 8.3%, P = .05). Following diagnosis of AVP-D, AVP-D Recovered received lower total daily doses of desmopressin (100 [IQR; 50, 100] vs 200 [100, 200] µg oral or equivalent, P = .01). Recovery occurred after a median of 6.3 years [1.7, 12.0] and occurred earlier in those without hypothyroidism (P = .049) or adrenal insufficiency at diagnosis of AVP-D (P = .008).
Conclusion:
Our study supports the notion that chronic AVP-D may not be permanent across the lifespan. Continued requirement for desmopressin, particularly in those with a history of functioning pituitary tumors, low doses of desmopressin, and without concurrent hypothyroidism or adrenal insufficiency at diagnosis, should be regularly reassessed.
