Late recovery from chronic arginine vasopressin deficiency: a multicenter retrospective case-control study.
This multicenter retrospective case-control study found that 18 patients recovered from apparently chronic arginine vasopressin deficiency after a median of 6.3 years and identified clinical associations that may support periodic reassessment of desmopressin need, while separately presenting three pediatric recovery cases.
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This multicenter retrospective case-control study found that 18 patients recovered from apparently chronic arginine vasopressin deficiency after a median of 6.3 years and identified clinical associations that may support periodic reassessment of desmopressin need, while separately presenting three pediatric recovery cases.
Research significance
The evidence shows that late recovery from chronic AVP deficiency can occur and is associated with lower desmopressin doses and absence of some concurrent pituitary deficiencies; it is reasonable—but not proven by this retrospective study—to hypothesize that structured reassessment could identify selected pediatric tumor survivors who no longer require desmopressin, potentially reducing unnecessary treatment and toxicity risk.
Source abstract
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.