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Horm Metab Res 2024; 56(03): 206-213
DOI: 10.1055/a-2198-7207
Original Article: Endocrine Care

Desmopressin Dose Requirements in Adults with Congenital and Acquired Central Diabetes Insipidus

Aslak Nykjær Pedersen 
1   Department of Endocrinology and Metabolism, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
,
Mikkel Andreassen
1   Department of Endocrinology and Metabolism, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
,
Aase Krogh Rasmussen
1   Department of Endocrinology and Metabolism, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
,
Jesper Krogh
2   Department of Endocrinology, Zealand University Hospital Koge, Koge, Denmark
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Abstract

Central diabetes insipidus is a rare disorder characterized by a deficiency of vasopressin. The first line drug to treat this disorder is a synthetic analogue of vasopressin, desmopressin.The primary aim of this retrospective register study was to compare desmopressin dose requirements in patients with acquired and congenital DI, and secondly to assess the influence of BMI on dose requirement and risk of hyponatremia with different drug administrations. We included all patients with suspected DI attending the endocrine department at Rigshospitalet, Copenhagen, Denmark in 2022. We identified 222 patients who were included whereof 130/222 (58.6%) were females and median age was 53 years (IQR 35 to 63). The etiology included 7/222 (3.2%) congenital and 215/222 (96.8%) acquired. After converting nasal and sublingual doses to equivalent oral doses, the median daily dose requirement was 600 μg in patients with congenital etiology compared to 200 μg in patients with acquired etiology (p=0.005). We found no association between BMI and desmopressin dose requirements (p=0.6). During the past 12 months, 66/215 (30.7%) had sodium levels<136 mmol/l including 20/215 (9.3%) with sodium levels<131 mmol/l. No increased risk of hyponatremia was found, when nasal and oral were compared (p=0.9). Daily desmopressin dose requirements were higher in patients with congenital DI compared to patients with acquired DI. However, this result was associated with uncertainty due to the small congenital group. BMI did not influence daily dose requirements and nor did type of administration influence the risk of hyponatremia.

Key words

desmopressin - central diabetes insipidus - intranasal - oral - arginine vasopressin - adults

Supplementary Material



Publication History

Received: 21 June 2023

Accepted after revision: 25 October 2023

Accepted Manuscript online:
25 October 2023

Article published online:
08 December 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Almutlaq N, Eugster EA. Variability in oral desmopressin dose requirements in children with central diabetes insipidus. J Pediatr 2021; 239: 228-230
    CrossrefPubMedGoogle Scholar
  • 2 Di Iorgi N, Napoli F, Allegri AE. et al. Diabetes insipidus--diagnosis and management. Horm Res Paediatr 2012; 77: 69-84
    CrossrefPubMedGoogle Scholar
  • 3 Garcia-Castano A, Madariaga L, Perez de Nanclares G. et al. Forty-one individuals with mutations in the AVP-NPII gene associated with familial neurohypophyseal diabetes insipidus. J Clin Endocrinol Metab 2020; 105: 1112-1118
    CrossrefPubMedGoogle Scholar
  • 4 Moeller HB, Rittig S, Fenton RA. Nephrogenic diabetes insipidus: essential insights into the molecular background and potential therapies for treatment. Endocr Rev 2013; 34: 278-301
    CrossrefPubMedGoogle Scholar
  • 5 Robertson GL. Diabetes insipidus: differential diagnosis and management. Best Pract Res Clin Endocrinol Metab 2016; 30: 278-301
    CrossrefPubMedGoogle Scholar
  • 6 Christ-Crain M, Bichet DG, Fenske WK. et al. Diabetes insipidus. Nat Rev Dis Primers 2019; 5: 54
    CrossrefPubMedGoogle Scholar
  • 7 Ooi HL, Maguire AM, Ambler GR. Desmopressin administration in children with central diabetes insipidus: a retrospective review. J Pediatr Endocrinol Metab 2013; 26: 1047-1052
    PubMedGoogle Scholar
  • 8 Teare H, Argente J, Dattani M. et al. Challenges and improvement needs in the care of patients with central diabetes insipidus. Orphanet J Rare Dis 2022; 17: 58
    CrossrefPubMedGoogle Scholar
  • 9 Nozaki A, Ando T, Akazawa S. et al. Quality of life in the patients with central diabetes insipidus assessed by Nagasaki diabetes insipidus questionnaire. Endocrine 2016; 51: 140-147
    CrossrefPubMedGoogle Scholar
  • 10 Garrahy A, Moran C, Thompson CJ. Diagnosis and management of central diabetes insipidus in adults. Clin Endocrinol (Oxf) 2019; 90: 23-30
    CrossrefPubMedGoogle Scholar
  • 11 Joshi RS, Pereira MP, Osorio RC. et al. Identifying risk factors for postoperative diabetes insipidus in more than 2500 patients undergoing transsphenoidal surgery: a single-institution experience. J Neurosurg 2022; 137: 1-11
    CrossrefPubMedGoogle Scholar
  • 12 Patti G, Ibba A, Morana G. et al. Central diabetes insipidus in children: Diagnosis and management. Best Pract Res Clin Endocrinol Metab 2020; 34: 101440
    CrossrefPubMedGoogle Scholar
  • 13 Angelousi A, Alexandraki K, Tsoli M. et al. Hypophysitis (including IgG4 and immunotherapy). Neuroendocrinology 2020; 110: 822-835
    CrossrefPubMedGoogle Scholar
  • 14 Kottke D, Burckhardt BB, Knaab TC. et al. Development and evaluation of a composite dosage form containing desmopressin acetate for buccal administration. Int J Pharm X 2021; 3: 100082
    PubMedGoogle Scholar
  • 15 Fjellestad-Paulsen A, Wille S, Harris AS. Comparison of intranasal and oral desmopressin for nocturnal enuresis. Arch Dis Child 1987; 62: 674-677
    CrossrefPubMedGoogle Scholar
  • 16 Hammer M, Vilhardt H. Peroral treatment of diabetes insipidus with a polypeptide hormone analog, desmopressin. J Pharmacol Exp Ther 1985; 234: 754-760
    PubMedGoogle Scholar
  • 17 Boulgourdjian EM, Martinez AS, Ropelato MG. et al. Oral desmopressin treatment of central diabetes insipidus in children. Acta Paediatr 1997; 86: 1261-1262
    CrossrefPubMedGoogle Scholar
  • 18 De Guchtenaere A, Van Herzeele C, Raes A. et al. Oral lyophylizate formulation of desmopressin: superior pharmacodynamics compared to tablet due to low food interaction. J Urol 2011; 185: 2308-2313
    CrossrefPubMedGoogle Scholar
  • 19 van Kerrebroeck P, Nørgaard JP. Desmopressin for the treatment of primary nocturnal enuresis. Pediatr Health 2009; 3: 311-327
    CrossrefPubMedGoogle Scholar
  • 20 Fukuda I, Hizuka N, Takano K. Oral DDAVP is a good alternative therapy for patients with central diabetes insipidus: experience of five-year treatment. Endocr J 2003; 50: 437-443
    CrossrefPubMedGoogle Scholar
  • 21 Behan LA, Sherlock M, Moyles P. et al. Abnormal plasma sodium concentrations in patients treated with desmopressin for cranial diabetes insipidus: results of a long-term retrospective study. Eur J Endocrinol 2015; 172: 243-250
    CrossrefPubMedGoogle Scholar
  • 22 Woods C, Thompson CJ. Risk of diabetes insipidus after pituitary surgery. Expert Rev Endocrinol Metab 2008; 3: 23-27
    CrossrefPubMedGoogle Scholar
  • 23 Schreckinger M, Walker B, Knepper J. et al. Post-operative diabetes insipidus after endoscopic transsphenoidal surgery. Pituitary 2013; 16: 445-451
    CrossrefPubMedGoogle Scholar