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Arginine vasopressin deficiency or resistance (Diabetes insipidus)

Última revisão: 9 Aug 2025
Última atualização: 12 Mar 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • history of pituitary/hypothalamic disease
  • family history/genetic mutations
  • history of lithium therapy (or certain other drugs)
  • history of autoimmune disorders
  • polyuria
  • increased thirst/polydipsia
Detalhes completos

Outros fatores diagnósticos

  • nocturia
  • signs of volume depletion
  • nonspecific central nervous system symptoms of hypernatremia
  • visual field defects
  • endocrine signs
  • focal motor deficits
  • sensorineural deafness and visual failure
  • skin lesions
Detalhes completos

Fatores de risco

  • pituitary surgery
  • craniopharyngioma
  • pituitary stalk lesions
  • traumatic brain injury
  • congenital pituitary abnormalities
  • use of certain drugs
  • hypophysitis
  • autoimmune disease
  • family history/genetic mutations
  • pregnancy
  • subarachnoid hemorrhage
  • renal sarcoidosis
  • renal amyloidosis
  • hypercalcemia or hypokalemia
  • release of obstructive uropathy
  • previous central nervous system infections
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • urine osmolality
  • serum osmolality
  • serum glucose
  • serum sodium
  • serum potassium
  • serum BUN
  • serum calcium
  • urine dipstick
  • 24-hour urine collection for volume
  • water deprivation test
  • AVP (desmopressin) stimulation test
  • hypertonic saline-stimulated test with measurement of copeptin
Detalhes completos

Investigações a serem consideradas

  • pituitary MRI (contrast-enhanced)
  • genetic testing
  • antithyroid peroxidase autoantibodies
  • serum and cerebrospinal fluid alpha-fetoprotein and beta-human chorionic gonadotropin
  • serum growth hormone (GH)
  • serum insulin-like growth factor 1 (IGF-1)
  • provocative growth hormone (GH) tests
  • serum LH
  • serum follicle-stimulating hormone
  • morning serum testosterone
  • serum thyroid-stimulating hormone and triiodothyronine/thyroxine (T3/T4)
  • morning serum cortisol and adrenocorticotropic hormone (ACTH)
  • cosyntropin stimulation test
  • serum prolactin
Detalhes completos

Algoritmo de tratamento

Inicial

hypernatremia at any stage

AGUDA

acute arginine vasopressin deficiency (AVP-D)

CONTÍNUA

chronic arginine vasopressin deficiency (AVP-D)

arginine vasopressin resistance (AVP-R)

Colaboradores

Autores

Miles Levy, ​​MBBS, MD, FRCP

Consultant Endocrinologist

University Hospitals of Leicester

Hon. Associate Professor at Leicester University

Leicester

UK

Declarações

Mark Sherlock MB, MRCPI, MD, PhD,

Consultant Endocrinologist

Beaumont Hospital

Professor of Medicine

Royal College of Surgeons in Ireland

Dublin

Ireland

Declarações

MS has received consultancy fees for Ferring (manufacturers of desmopressin).

Agradecimentos

Professor Miles Levy and Professor Mark Sherlock wish to gratefully acknowledge Professor Stephen Ball, a previous contributor to this topic.

Declarações

SB declares that he has no competing interests.

Revisores

Janet Amico, MD

Professor of Medicine

Division of Endocrinology and Metabolism

University of Pittsburgh School of Medicine

Pittsburgh

PA

Declarações

At the time of peer review, JA received research grants from the National Institutes of Health, the Department of Veterans' Affairs, and the Department of Defense. We were made aware that Professor Amico is now deceased.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Christ-Crain M, Bichet DG, Fenske WK, et al. Diabetes insipidus. Nat Rev Dis Primers. 2019 Aug 8;5(1):54. Resumo

Garrahy A, Moran C, Thompson CJ. Diagnosis and management of central diabetes insipidus in adults. Clin Endocrinol (Oxf). 2019 Jan;90(1):23-30.Texto completo  Resumo

Kavanagh C, Uy NS. Nephrogenic diabetes insipidus. Pediatr Clin North Am. 2019 Feb;66(1):227-34. Resumo

Bockenhauer D, Bichet DG. Pathophysiology, diagnosis and management of nephrogenic diabetes insipidus. Nat Rev Nephrol. 2015 Oct;11(10):576-88. Resumo

Knepper MA, Kwon TH, Nielsen S. Molecular physiology of water balance. N Engl J Med. 2015 Apr 2;372(14):1349-58. Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Diagnósticos diferenciais

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  • Diretrizes

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  • Folhetos informativos para os pacientes

    Diabetes insipidus

    Mais Folhetos informativos para os pacientes
  • Calculadoras

    Osmolality Estimator (serum)

    Mais Calculadoras
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