Resistance to vasopressin action on the kidney in patients with Cushing's disease

1997 ◽  
pp. 162-166 ◽  
Author(s):  
M Knoepfelmacher ◽  
MJ Pradal ◽  
RD Dio ◽  
LR Salgado ◽  
M Semer ◽  
...  
Keyword(s):  
Normal Control ◽  
Arginine Vasopressin ◽  
Cushing’S Disease ◽  
Plasma Levels ◽  
Water Deprivation ◽  
Plasma Osmolality ◽  
Normal Subjects ◽  
Cushing's Disease ◽  
Urinary Osmolality ◽  
Normal Individuals

OBJECTIVE: To assess the plasma levels and action of arginine vasopressin (AVP) in patients with Cushing's disease. There are many reports that patients with Addison's disease have increased AVP levels associated with hyponatraemia and hypoosmolality, but none on the dynamics of secretion of this neurohormone during osmolality-based stimulation in patients with chronic hypercortisolism. DESIGN AND SUBJECTS: The plasma AVP concentration and the urinary and plasma osmolality after a 7.5-h water deprivation test (WDT) were evaluated in 13 patients with Cushing's disease and 15 normal (control) individuals. In patients with Cushing's disease we also assessed the urinary osmolality in response to 10 micrograms i.v. desmopressin (DDAVP) administered at the end of the WDT. RESULTS: At the end of the WDT, urinary osmolality was significantly lower in patients with Cushing's disease (511.5 +/- 148.5 mOsm/l) than in the normal subjects (981.1 +/- 107.1 mOsm/l, P < 0.001), whereas plasma osmolality did not differ between the two groups. Consequently, the urine/plasma osmolality ratio (Uosm/Posm) was lower in patients with Cushing's disease than in normal individuals (1.8 +/- 0.5 compared with 3.4 +/- 0.4, P < 0.001). The AVP concentration also was greater (7.3 +/- 3.1 pmol/l) in those with Cushing's disease than in the controls (3.9 +/- 2.3 pmol/l, P < 0.005). After administration of DDAVP to the hypercortisolaemic patients, the urinary osmolality attained (718.0 +/- 200.0 mOsm/l) was still lower than that in the normal group at the end of WDT (P < 0.005). CONCLUSIONS: Patients with Cushing's disease presented higher AVP levels and smaller Uosm/Posm ratios than normal subjects. After DDAVP, the patients with Cushing's disease were unable to concentrate the urine adequately. These data suggest that the kidney shows resistance to the action of both endogenous and exogenous AVP in patients with Cushing's disease.

Influence of a Met-enkephalin analogue on CRF-induced ACTH release in normal individuals and patients with Cushing's disease

1985 ◽  
Vol 110 (1_Suppla) ◽  
pp. S17
Author(s):  
B. ALLOLIO ◽  
U. DEUSS ◽  
W. WINKELMANN ◽  
D. KAULEN ◽  
U. LEONHARDT ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Cushing's Disease ◽  
Normal Individuals ◽  
Acth Release

Impairment of osmotically stimulated AVP release in patients with primary polydipsia

1993 ◽  
Vol 265 (6) ◽  
pp. R1247-R1252 ◽  
Author(s):  
A. M. Moses ◽  
B. Clayton
Keyword(s):  
Diabetes Insipidus ◽  
Arginine Vasopressin ◽  
Plasma Osmolality ◽  
Normal Subjects ◽  
Urine Concentration ◽  
Published Data ◽  
Posterior Pituitary ◽  
Primary Polydipsia ◽  
Number Of Factors

The secretion of arginine vasopressin (AVP) from the posterior pituitary is primarily and finely regulated by the osmolality of plasma. Even though a number of factors alter osmolality-induced release of AVP, there are no published data in humans that have addressed the role of chronic overhydration on this phenomenon. To address this problem we have identified eight patients with primary polydipsia using criteria not involving measurement of AVP, and have subjected them to standardized infusions of hypertonic saline. These patients had less AVP in both plasma and urine in relation to plasma osmolality than was found in normal subjects. In addition, their rate of rise of plasma and urine AVP was less than in normal subjects. Their osmotic threshold for AVP release may have been higher than normal. These data demonstrate that chronic overhydration in humans downregulates the release of AVP in response to hypertonicity. This phenomenon may explain the impairment of urine concentration in patients with primary polydipsia and emphasizes the basis of the difficulty that may occur clinically in differentiating between patients with primary polydipsia and partial central diabetes insipidus.

Suppression of cortisol secretion by low-dose dexamethasone testing in Cushing's disease

1983 ◽  
Vol 58 (1) ◽  
pp. 129-132 ◽  
Author(s):  
Lucille W. King ◽  
Kalmon D. Post ◽  
Israel Yust ◽  
Seymour Reichlin
Keyword(s):  
Cushing’S Disease ◽  
Low Dose ◽  
Dexamethasone Suppression Test ◽  
Cushing's Disease ◽  
Cortisol Secretion ◽  
Content Type ◽  
Normal Individuals ◽  
Suppression Test ◽  
Peripheral Clearance ◽  
Dexamethasone Suppression

✓ Pituitary-adrenal function in a patient with classical features of Cushing's disease, increased urinary excretion of cortisol, and documented pituitary adenoma was found to be suppressed by dexamethasone in doses even less than those required to inhibit secretion in normal individuals. This response was shown to be due to inappropriately high levels of dexamethasone in plasma, presumed to be the consequence of decreased peripheral clearance. Because the dexamethasone suppression test is so widely used for diagnosis of Cushing's disease, it is important to recognize that this situation can occasionally occur.

Plasma vasopressin and atrial natriuretic hormone levels in hypopituitarism with and without hydrocortisone treatments: responses to an acute water load

1992 ◽  
Vol 126 (3) ◽  
pp. 217-223 ◽  
Author(s):  
Tokihisa Kimura ◽  
Kozo Ota ◽  
Masaru Shoji ◽  
Minoru Inoue ◽  
Kazutoshi Sato ◽  
...  
Keyword(s):  
Arginine Vasopressin ◽  
Plasma Osmolality ◽  
Normal Subjects ◽  
Natriuretic Hormone ◽  
Water Load ◽  
Blood Volume Expansion ◽  
Atrial Natriuretic Hormone ◽  
Plasma Arginine ◽  
Glucocorticoid Deficiency ◽  
Atrial Natriuretic

To assess whether arginine vasopressin and atrial natriuretic hormone participate in impaired urinary dilution and excretion in glucocorticoid deficiency secondary to hypopituitarism. an acute oral water load of 20 ml·kg−1 BW was undertaken in the absence and presence of an oral hydrocortisone (60 mg) treatment in patients with ACTH deficiency (N= 7) and panhypopituitarism (N = 2). Plasma arginine vasopressin and atrial natriuretic hormone and renal water handling were simultaneously determined and compared with those in similarly water-loaded normal subjects. Plasma arginine vasopressin did not fall in response to decreased blood osmolality after an acute water load in the absence of hydrocortisone; plasma atrial natriuretic hormone did not change despite blood volume expansion; and impairment in urinary dilution and excretion remained. On the other hand, in the presence of hydrocortisone, plasma arginine vasopressin fell in response to a decrease in plasma osmolality and plasma atrial natriuretic hormone increased, thereby restoring urinary dilution and excretion. These results demonstrate that the impaired arginine vasopressin response to acute water loading play an essential role in deranged renal water and electrolyte handling in the state of glucocorticoid deficiency; the impaired release of atrial natriuretic hormone also may affect these disorders.

Effects of high altitude and water deprivation on arginine vasopressin release in men

2004 ◽  
Vol 286 (1) ◽  
pp. E20-E24 ◽  
Author(s):  
C. M. Maresh ◽  
W. J. Kraemer ◽  
D. A. Judelson ◽  
J. L. VanHeest ◽  
L. Trad ◽  
...  
Keyword(s):  
High Altitude ◽  
Sea Level ◽  
Arginine Vasopressin ◽  
Water Deprivation ◽  
Urine Volume ◽  
Plasma Osmolality ◽  
Vasopressin Release ◽  
Altitude Exposure ◽  
Blood Pressures ◽  
Healthy Males

High-altitude exposure changes the distribution of body water and electrolytes. Arginine vasopressin (AVP) may influence these alterations. The purpose of this study was to examine the effect of a 24-h water deprivation trial (WDT) on AVP release after differing altitude exposures. Seven healthy males (age 22 ± 1 yr, height 176 ± 2 cm, mass 75.3 ± 1.8 kg) completed three WDTs: at sea level (SL), after acute altitude exposure (2 days) to 4,300 m (AA), and after prolonged altitude exposure (20 days) to 4,300 m (PA). Body mass, standing and supine blood pressures, plasma osmolality (Posm), and plasma AVP (PAVP) were measured at 0, 12, 16, and 24 h of each WDT. Urine volume was measured at each void throughout testing. Baseline Posm increased from SL to altitude (SL 291.7 ± 0.8 mosmol/kgH2O, AA 299.6 ± 2.2 mosmol/kgH2O, PA 302.3 ± 1.5 mosmol/kgH2O, P < 0.05); however, baseline PAVP measurements were similar. Despite similar Posm values, the maximal PAVP response during the WDT (at 16 h) was greater at altitude than at SL (SL 1.7 ± 0.5 pg/ml, AA 6.4 ± 0.7 pg/ml, PA 8.7 ± 0.9 pg/ml, P < 0.05). In conclusion, hypoxia appeared to alter AVP regulation by raising the osmotic threshold and increasing AVP responsiveness above that threshold.

Satiety and inhibition of vasopressin secretion after drinking in dehydrated dogs

1981 ◽  
Vol 240 (4) ◽  
pp. E394-E401 ◽  
Author(s):  
T. N. Thrasher ◽  
J. F. Nistal-Herrera ◽  
L. C. Keil ◽  
D. J. Ramsay
Keyword(s):  
Arginine Vasopressin ◽  
Water Deprivation ◽  
Extracellular Fluid ◽  
Plasma Osmolality ◽  
Rapid Decline ◽  
Vasopressin Secretion

The roles of oropharyngeal and gastric factors in satiation and arginine vasopressin (AVP) secretion were examined in water-deprived dogs. Dogs were prepared with chronic gastric fistulas and received six treatments after 24 h of water deprivation: rehydration with H2O or extracellular fluid (ECF) with the fistula closed; rehydration with H2O or ECF with the fistula open; gastric administration of H2O or ECF via the fistula. Drinking occurred immediately after presentation and was always completed by 6 min. At the end of the 60-min period of observation, water was offered in order to assess the degree of satiety. No differences were observed between the volumes of H2O or ECF consumed. However, only absorption of the water drunk produced complete satiety assessed 60 min later. Drinking H2O caused a fall in plasma AVP 6 min before a detectable decline in osmolality and reached water-replete levels by 15 min after drinking. Drinking H2O or ECF plus removal via the fistula and drinking ECF also brought about a rapid decline in plasma AVP without any change in plasma osmolality. Gastric administration of H2O caused a fall in plasma AVP that coincided with the fall in osmolality, and gastric administration of ECF had no effect on plasma AVP. We conclude that oropharyngeal factors account for temporary satiety and the rapid inhibition of vasopressin secretion.

Sign in / Sign up

Export Citation Format

Share Document