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Arginine vasopressin deficiency
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of arginine vasopressin deficiency are prepared by our editorial team based on guidelines from the Histiocyte Society (HS 2022), the American College of Radiology (ACR 2019), the European Thyroid Association (ETA 2018), the Society for Endocrinology (SE 2018), and the Endocrine Society (ES 2016).
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Diagnostic investigations
Initial evaluation: as per SE 2018 guidelines, obtain an urgent clinical assessment of volume and hydration status and measurement of serum sodium, potassium, and renal function.
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Diagnostic imaging
Evaluation for hypopituitarism (central adrenal insufficiency)
Evaluation for hypopituitarism (central hypothyroidism)
Medical management
Setting of care
As per SE 2018 guidelines:
Discuss cases of hospitalized patients with central diabetes insipidus with the endocrine team as soon as possible to ensure optimal inpatient care and specialist follow-up thereafter.
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Manage patients with hypernatremia as a medical emergency with a level 2-3 care or equivalent high dependency setting.
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Treatment goals
Fluid therapy
Desmopressin
Vasopressin
Inpatient care
Specific circumstances
Pregnant patients: as per ES 2016 guidelines, consider continuing desmopressin during pregnancy and adjusting doses if required in pregnant patients with preexisting diabetes insipidus.
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Patients with Langerhans cell histiocytosis
Patients with adrenal insufficiency