Pathophysiology of arginine vasopressin disorders

Arginine vasopressin disorders (previously called diabetes insipidus) are a form of polyuria-polydipsia syndrome, which is caused by various acquired or hereditary lesions or disorders. Arginine vasopressin deficiency (previously called central diabetes insipidus) results from inadequate production and/or secretion of arginine vasopressin in the hypothalamic-neurohypophyseal system in response to osmotic stimulation. Acquired AVP-D is caused by disruption of the neurohypophysis, whereas hereditary AVP-D is due to mutations in AVP. Arginine vasopressin resistance (previously called nephrogenic diabetes insipidus) is the result of an inadequate response of the kidneys to AVP, either acquired (as an adverse effect of various drugs or due to electrolyte disorders) or hereditary (due to mutations in the genes encoding AVPR2 or the water channel AQP2). In gestational arginine vasopressin disorder, increased activity of arginine vasopressinase during pregnancy reduces the levels of AVP, leading to a presentation similar to that of AVP-D.