Treatment of Neurohypophyseal Diabetes Insipidus

Oiso, Yutaka; Robertson, Gary; Nørgaard, Jens Peter; Juul, Kristian Vinter

doi:10.1210/jc.2013-2326

Cited by 90 publications

(56 citation statements)

References 66 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although hyponatraemia is a well-recognised side effect of CDI with desmopressin, the incidence of hyponatraemia is unknown in this group of patients (5). In addition, the incidence of dysnatraemia in patients with CDI admitted to hospital is not well described.…”

Section: Introductionmentioning

confidence: 98%

Abnormal plasma sodium concentrations in patients treated with desmopressin for cranial diabetes insipidus: results of a long-term retrospective study

Behan

Sherlock

Moyles

et al. 2015

European Journal of Endocrinology

View full text Add to dashboard Cite

Context and objective: Patients with cranial diabetes insipidus (CDI) are at risk of developing both hypernatraemia and hyponatraemia, due to the condition itself or secondary to treatment with vasopressin-analogues or during administration of i.v. fluids. We aimed to assess the frequency and impact of dysnatraemias in the inpatient (INPT) and outpatient (OPT) setting in desmopressin-treated CDI, comparing those with normal thirst with those with abnormal thirst. Design: The study included 192 patients with cranial diabetes, who were identified from the Beaumont Pituitary Database, a tertiary referral centre. Retrospective case note audit was performed and the clinical and biochemical information of 147 patients with CDI were available for analysis. Results: A total of 4142 plasma sodium measurements for 137 patients with normal thirst, and 385 plasma sodium measurements for ten patients with abnormal thirst were analysed. In those with normal thirst, the most common OPT abnormality was mild hyponatraemia (pNa C 131-134 mmol/l) in 27%, while 14.6% had more significant hyponatraemia (pNa C %130 mmol/l). Of those patients with normal thirst, 5.8% were admitted due to complications directly related to hyponatraemia. Compared with patients with normal thirst, those with abnormal thirst were more likely to develop significant OPT hypernatraemia (20% vs 1.4%, PZ0.02) and significant INPT hyponatraemia (50% vs 11.1%, P 0.02). Conclusion: OPT management of CDI is complicated by a significant incidence of hyponatraemia. In contrast, OPT hypernatraemia is almost exclusively a complication seen in adipsic CDI, who also had more frequent INPT hyponatraemia. CDI associated with thirst disorder requires increased physician attention and patient awareness of potential complications.

show abstract

Section: Introductionmentioning

confidence: 98%

Abnormal plasma sodium concentrations in patients treated with desmopressin for cranial diabetes insipidus: results of a long-term retrospective study

Behan

Sherlock

Moyles

et al. 2015

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…Patients with CDI are treated with desmopressin, an analogue of AVP, which is usually given twice or three times per day [7]. The concentration of desmopressin in blood reaches a peak soon after administration, and the antidiuretic action remains maximal for several hours [8][9][10][11].…”

mentioning

confidence: 99%

Comparison of incidence of hyponatremia between intranasal and oral desmopressin in patients with central diabetes insipidus

et al. 2015

Self Cite

View full text Add to dashboard Cite

ARGININE VASOPRESSIN (AVP) is the antidiuretic hormone which is synthesized in the magnocellular neurons in the supraoptic and paraventricular nuclei [1,2]. AVP is axonally transported to the posterior pituitary, released into the systemic circulation, and acts through V2 receptor in the kidney in order to promote reabsorption of free water [1,2]. The osmoregulation of AVP release is so precise that increases in plasma osmolality of only 1-2% lead to increases in plasma AVP [1,3,4]. As a result, plasma osmolality in most cases is controlled at levels of around 280 mOsm/kg, which is the threshold of AVP release [1,3,4].The deficiency of AVP causes a disorder called cen- Abstract. Central diabetes insipidus (CDI), which is characterized by polyuria and polydipsia, is caused by a deficiency of the antidiuretic hormone arginine vasopressin (AVP). While CDI is treated with desmopressin, an analogue of AVP, the intranasal formulation is inconvenient and CDI patients reportedly prefer the oral formulation to the intranasal one. In Japan, intranasal desmopressin had been the only formulation for the treatment of CDI until 2012, when the desmopressin orally disintegrating tablet (ODT) was approved for treatment. In this study we analyzed 26 patients with CDI in whom intranasal desmopressin was switched to desmopressin ODT. The mean daily dose of intranasal desmopressin was 10 ± 8 μg/day, and that of desmopressin ODT was 142 ± 59 μg/day. The mean serum sodium levels were 140 ± 5 mmol/L and 140 ± 3 mmol/L with intranasal desmopressin and desmopressin ODT, respectively, and there were no significant differences between these values. The frequency of hyponatremia (<135 mmol/L) with intranasal desmopressin was 11.7% and that with desmopressin ODT was 7.6%, while the frequency of hyponatremia (<130 mmol/L) with intranasal desmopressin was 4.2% and that with desmopressin ODT was 1.3%. Statistical analyses revealed that incidence of hyponatremia was significantly decreased after the switch to desmopressin ODT. Thus, it is suggested that water balance is better controlled with desmopressin ODT than with intranasal desmopressin in patients with CDI.Key words: Desmopressin, Central diabetes insipidus, Hyponatremia, Vasopressin tral diabetes insipidus (CDI), which is characterized by polyuria accompanied by thirst and polydipsia [5,6]. Patients with CDI are treated with desmopressin, an analogue of AVP, which is usually given twice or three times per day [7]. The concentration of desmopressin in blood reaches a peak soon after administration, and the antidiuretic action remains maximal for several hours [8][9][10][11]. Due to the pharmacokinetics/pharmacodynamics of desmopressin, its most frequent side effect in the treatment of CDI is hyponatremia [12,13].In Japan, intranasal desmopressin had been the only formulation for the treatment of CDI until 2012, when desmopressin orally disintegrating tablet (ODT) was approved for treatment. Because the efficiency and safety of desmopressin ODT have been demonstrated [13,14], and oral form...

show abstract

“…Por un lado, se utiliza la desmopresina para reducir la poliuria 1,8 y, por otro, un lactante requiere un elevado aporte lácteo para alcanzar un desarrollo normal. En este escenario, si la hidratación no se planifica correctamente, existe el riesgo de retención hídrica e hiponatremia, la complicación más frecuente de la desmopresina.…”

Section: Discussionunclassified

“…3,[14][15] La vía oral (preferentemente) y la nasal son las más utilizadas para el tratamiento de una DIC; la DS se ha comenzado a utilizar recientemente 1,[6][7][8][9][10][11][12][13] Episodios hiponatrémicos frecuentes, dificultades en la dosificación, técnica y patologías locales dificultan el uso nasal. 1,3,[5][6][7]15 La administración oral, aunque menos habitual, no está exenta de complicaciones hiponatrémicas, [5][6][7][8] sobre todo, cuando hay malformaciones cerebrales. 6 De acuerdo con la experiencia clínica, pareciera que la absorción de la DS por la mucosa bucal logra controles de natremia y diuresis más regulares que por otras vías.…”

Section: Discussionunclassified

“…Se puede administrar por vía oral, nasal, parenteral y sublingual. 1,3,5,[8][9][10] La desmopresina sublingual (DS) es la última formulación liberada al mercado y el uso en lactantes con DIC es muy limitado, pero, al parecer, con buenos resultados. [10][11][12][13] El objetivo de esta comunicación es describir el uso de la DS en dos lactantes con DIC e hidranencefalia, con resultados satisfactorios.…”

Section: Introductionunclassified

See 1 more Smart Citation

Tratamiento con desmopresina sublingual en dos lactantes con hidranencefalia y diabetes insípida central

2018

Arch Argent Pediatr

View full text Add to dashboard Cite

Presentación de casos clínicos RESUMENLa diabetes insípida central es una patología infrecuente en pediatría ocasionada por un déficit de vasopresina. Sus manifestaciones clínicas principales son poliuria y polidipsia. Las malformaciones cerebrales son una de las principales causas. La desmopresina es la droga sintética de elección para el tratamiento. Una de las vías de administración es la sublingual y su uso en lactantes es muy limitado. Se describe a dos lactantes con hidranencefalia y diabetes insípida central que fueron tratados satisfactoriamente con desmopresina sublingual. Palabras clave: diabetes insípida central, desmopresina, hidranencefalia, malformaciones del sistema nervioso. ABSTRACTCentral diabetes insipidus is a rare disease in children caused by a deficiency of vasopressin. Its main clinical manifestations are polyuria and polydipsia. Brain malformations are one of the main causes. Desmopressin is the synthetic drug of choice for the treatment. One of the routes of administration is sublingual and its use in infants is very limited. We describe two infants with central diabetes insipidus and hydranencephaly who were successfully treated with sublingual desmopressin.

show abstract

Treatment of Neurohypophyseal Diabetes Insipidus

Abstract: Desmopressin can provide effective and safe therapy for all patients with neurohypophyseal or gestational DI if given in doses and by a route that takes into account the determinants of fluid intake.

Cited by 90 publications

References 66 publications

Abnormal plasma sodium concentrations in patients treated with desmopressin for cranial diabetes insipidus: results of a long-term retrospective study

Abnormal plasma sodium concentrations in patients treated with desmopressin for cranial diabetes insipidus: results of a long-term retrospective study

Comparison of incidence of hyponatremia between intranasal and oral desmopressin in patients with central diabetes insipidus

Tratamiento con desmopresina sublingual en dos lactantes con hidranencefalia y diabetes insípida central

Contact Info

Product

Resources

About