Vasopressin and desmopressin stimulation test
- André Lacroix, MD
André Lacroix, MD
- Section Editor — Adrenal Disease
- Professor of Medicine
- University of Montreal, Quebec, Canada
Arginine-vasopressin (AVP) is the natural human nonapeptide, which (in addition to its antidiuretic, vasoconstrictive, glycogenolytic, and platelet aggregation actions) plays an important role in the regulation of the corticotropin (ACTH)-adrenal axis. AVP and some of its analogs, such as porcine 8-lysine-vasopressin (LVP) and desmopressin (1-deamino, 8-D arginine-vasopressin), have been used in a number of clinical settings.
This topic will review the various stimulation tests using vasopressin or its analogs in evaluating the pituitary-adrenal axis. (See "Corticotropin-releasing hormone stimulation test" and "Insulin-induced hypoglycemia test" and "Evaluation of the response to ACTH in adrenal insufficiency".)
Arginine-vasopressin (AVP) is synthesized in the magnicellular neurons of the supraoptic and paraventricular nuclei and is stored in neurosecretory granules in the axons, which project to the posterior pituitary. In addition, proAVP is co-secreted with corticotropin-releasing hormone (CRH) from smaller parvicellular neurons in a section of the paraventricular nuclei, which project their axons to the median eminence and portal system of the pituitary stalk . At this site, AVP promotes the secretion of corticotropin (ACTH) via activation of arginine-vasopressin receptor 1B (AVPR1B, previously named V1B or V3 receptor) present in corticotropes . The AVPR1A receptors in blood vessels mediate the vasoconstrictive effects of AVP; they are also present in adrenocortical cells and mediate the modest in vitro stimulatory effects of AVP on cortisol and aldosterone secretion . In addition, AVP itself is produced in the adrenal medulla and cortex, suggesting that AVP can exert an autocrine/paracrine control of adrenal steroids [4,5].
Cortisol inhibits the secretion of both CRH and AVP from the paraventricular nuclei . Cortisol deficiency decreases this inhibitory effect, leading to a persistent rise in vasopressin release, water retention, and hyponatremia [1,6,7]. The AVPR2 receptors on the cortical and medullary collecting kidney tubules mediate the antidiuretic response via the migration of aquaporin-2 water channels . AVPR2 on vascular endothelium can modulate the release of factor VIII and von Willebrand (VW) factor . Both AVPR1A and AVPR1B activate phospholipase C [2,10,11], while the AVPR2 is coupled to adenylyl cyclase [12,13].
AVP, 8-lysine-vasopressin (LVP), and terlipressin are expected to bind to all three receptors; desmopressin is a preferential AVPR2 receptor-selective agent and has only limited effects on AVPR1A and AVPR1B. (See "Hyponatremia and hyperkalemia in adrenal insufficiency".)
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- VASOPRESSIN PHYSIOLOGY
- CLINICAL USES
- TEST PROCEDURES
- Side effects
- ACTH-DEPENDENT CUSHING'S SYNDROME
- Identifying the cause
- Combined with CRH
- During petrosal sinus sampling
- Cushing's disease versus pseudo-Cushing's disease
- Evaluating for remission of Cushing's disease
- PRIMARY ADRENAL CUSHING'S SYNDROME
- Aberrant vasopressin receptors