Late Recovery from Chronic Arginine Vasopressin Deficiency: A Multicenter Retrospective Case-Control Study

Abstract Context Arginine vasopressin deficiency (AVP-D), caused by hypothalamic/pituitary damage from tumor or surgery, can be transient or chronic. Chronic AVP-D is thought to be permanent though emergent research indicates the possibility of late recovery. Little is known about clinical characteristics that predict late recovery from chronic AVP-D. Objective Describe characteristics associated with late recovery from chronic AVP-D. Design Multicenter, retrospective case-control study of AVP-D Recovered (n=18) vs AVP-D Non-recovered (n=36; matched for sex and disease duration). Main Outcome Measures Clinical characteristics assessed at hypothalamic/pituitary disease diagnosis, AVP-D diagnosis, AVP-D recovery, and most recent clinical evaluation. We also present characteristics of three pediatric cases with AVP-D recovery. Results At diagnosis of hypothalamic/pituitary disease, AVP-D Recovered, compared to AVP-D Non-recovered, were older (45±18 vs 33±13 years, p=0.006) and more likely to have functioning pituitary tumors (33.3% vs 8.3%, p=0.05). Following diagnosis of AVP-D, AVP-D Recovered received lower total daily doses of desmopressin (100 [IQR; 50, 100] vs 200 [100, 200] µg oral or equivalent, p=0.01). Recovery occurred after a median of 6.3 years [1.7, 12.0] and occurred earlier in those without hypothyroidism (p=0.049) or adrenal insufficiency at diagnosis of AVP-D (p=0.008). Conclusion Our study supports the notion that chronic AVP-D may not be permanent across the lifespan. Continued requirement for desmopressin, particularly in those with history of functioning pituitary tumors, low doses of desmopressin, and without concurrent hypothyroidism or adrenal insufficiency at diagnosis, should be regularly reassessed.