SAT-058 Clinical factors influencing the long term maintenance dose of desmopressin in adults with central diabetes insipidus, an outpatient based study

Abstract Disclosure: K. Kim: None. The majority of studies on desmopressin dosing in central diabetes insipidus have focused on hospitalized patients during the acute postoperative period. However, since most patients with central diabetes insipidus require lifelong hormone therapy and the acute-phase desmopressin dose often changes in outpatient settings, it is crucial to investigate factors influencing long-term desmopressin dosing in outpatient settings.This study included 459 adult patients with central diabetes insipidus undergoing oral desmopressin medication from 2005 to 2024. In the outpatient setting, the maintenance dose of desmopressin was defined as the dose that remained unchanged for at least six months after being titrated based on regular monitoring of urine output, body weight, and serum sodium levels. Median age at diagnosis was 47(34-60) years, and 52.72% patients were women. On average, the patients took oral desmopressin at a dose of 200(range 50–1800) µg/day, administered twice a day. It took up to 14 (range 0-14) months to reach the maintenance dose in the outpatient setting. Desmopressin dose requirements correlated with age (r=-0.155, P=0.001*) and body weight (r=0.159, P=0.001*). It was not differed by gender, initial serum sodium levels, or serum and urine osmolality. The causes of diabetes insipidus were identified as craniopharyngioma in 34.42% and pituitary adenoma in 29.85% of cases. Patients with craniopharyngioma had significantly higher body weight and desmopressin doses compared to those with pituitary adenomas (200[range 50-800] vs. 250[range 50-1200] µg/day, P=0.004*). A total of 348 patients had concurrent ACTH/cortisol deficiency, of which 276 were receiving hydrocortisone and 72 were receiving prednisolone. While overall steroid replacement and dosage did not statistically affect the desmopressin dose, a positive correlation was observed between hydrocortisone dose and desmopressin dose specifically in patients taking hydrocortisone (r=0.151, P=0.012*). Additionally, 48.80(224/459)% of the patients had growth hormone deficiency, with significantly lower desmopressin doses compared to those without growth hormone deficiency (200[range 50-900] vs. 200[range 50-1800] µg/day, Z=-2.146, P=0.032*). Among 113 patients with gonadotropin deficiency, 59 patients received sex hormone replacement, and these patients had marginally higher desmopressin doses than those not receiving replacement therapy (P=0.051). In conclusion, maintenance dose of desmopressin was influenced by age, body weight, and underlying disease with craniopharyngioma and those receiving concurrent hormonal therapies. The daily desmopressin dose should be tailored based on those factors. Presentation: Saturday, July 12, 2025