Are you also constantly thirsty and urinate frequently? This could be due to Arginine Vasopressin Disorders (Diabetes Insipidus)

Imagine that no matter how much water you drink, you feel like you're thirsty. At the same time, you need to go to the bathroom frequently. You can't sleep well at night, and you have to get up several times. Isn't this a bit of a disturbing situation? Although many people think this is normal, sometimes it can be a symptom of some other problem inside our body. Today we are going to talk about such a rare, but treatable condition. That is Arginine Vasopressin Disorders, or Diabetes Insipidus as many people know it by its old name.

Simply put, what are Arginine Vasopressin Disorders?

Although the name is a bit complicated, it's very easy to understand what's happening. Simply put, this is a condition where our body is unable to retain the required amount of water. Therefore, the required amount of water is also excreted in the urine.

The main reason for this is a hormone in our body. It is called Arginine Vasopressin (AVP) . Some doctors also call it Antidiuretic Hormone (ADH) . This AVP hormone is like a manager who gives instructions to our kidneys. It is the one who tells the kidneys, "Okay, the body needs water now, so save some water and reduce the amount of water that is excreted as urine."

In this disease, this process can be disrupted in two main ways:

1. AVP Deficiency (AVP-D): This is when our brain does not produce the AVP hormone in the required amount. This means that there is no one to instruct the kidneys.

2. AVP Resistance (AVP-R): In this, even though the brain produces enough AVP hormone, the kidneys do not accept the advice. Just as the manager gives advice but the employees ignore it.

Either way, the end result is the same: the kidneys filter the water as they need and excrete it as urine. As a result, the body loses the water it needs.

What are the symptoms of this condition?

The main and most obvious symptoms of this condition are:

• Excessive thirst (polydipsia): Feeling like you're not thirsty no matter how much water you drink.
• Frequent urination: The need to get up several times to urinate, not only during the day, but also at night (nocturia).
• Excessive urination: The amount of urine produced is very large. The urine is colorless and watery.

These symptoms are a strong signal that something is not working properly inside your body. Therefore, if you have these symptoms, it is very important to see a doctor as soon as possible.

How do these symptoms appear in young children?

Young children may not be able to accurately say "I'm thirsty." So if they have this condition, the symptoms may look a little different.

• Severe dehydration
• Constipation
• Vomiting
• Frequent fever
• Constantly restless and crying
• Failure to thrive (not gaining weight)

Why does this situation occur?

There are several possible causes for this, depending on the type of condition.

Causes of Arginine Vasopressin Deficiency (AVP-D)

This is the most common type. It is caused by damage to the parts of the brain that produce the AVP hormone (the hypothalamus or pituitary gland).

• Head injuries or surgeries: These parts can be damaged by surgery or an accident to the brain.
• Tumors: Due to certain tumors that form in the brain.
• Inflammation: Inflammatory conditions caused by diseases such as sarcoidosis or tuberculosis.
• Genetic causes: Genetic changes that are inherited.
• Idiopathic: In some cases, about half of all cases, no specific cause can be found.

Causes of Arginine Vasopressin Resistance (AVP-R)

There's no problem with the brain producing the hormone, the problem lies in the kidneys.

• Genetic causes: Genetic problems that are passed down through generations.
• Certain medications: Especially some medications for mental illness, such as lithium.
• Urinary tract obstruction.
• Increased calcium levels in the blood (Hypercalcemia).
• Low blood potassium levels (Hypokalemia).

Special conditions that occur during pregnancy

Very rarely, women can develop this condition temporarily during pregnancy. This is because an enzyme produced by the placenta breaks down the mother's AVP hormone during pregnancy. This risk is higher for mothers who are carrying twins and for mothers who have conditions such as preeclampsia, which affect liver function. But the good news is that this condition usually goes away completely within two to three weeks after giving birth.

What complications can this cause?

The most dangerous and major complication of this condition is dehydration , which means the loss of enough water and electrolytes for the body to function.

Normally, you can compensate for the loss by drinking enough water to match the amount of urine you produce. But if for some reason you are unable to drink enough water, you can become severely dehydrated very quickly.

How does a doctor find this?

There are other common diseases that can cause frequent thirst and urination. For example, diabetes mellitus. Therefore, the first thing a doctor does is to check for other similar diseases.

Several tests are performed to accurately diagnose this disease.

• Water Deprivation Test: This is the most reliable way to diagnose this condition. In this test, you have to go without drinking any fluids for several hours. This is done in a hospital under the direct supervision of a doctor or nurse. This is because this can lead to dehydration. If you have this condition, your body will continue to produce large amounts of urine even though you have not drunk any water. In a healthy person, your urine output will be reduced, and you will only produce a small amount of dark yellow, concentrated urine.
• Other tests:
• Checking blood sugar levels (to make sure you don't have diabetes).
• Urinalysis - Check the concentration (osmolality) of the urine.
• Blood tests - measure something called Copeptin, which is related to the hormone AVP.
• MRI scan - to see if there is damage to the pituitary gland or hypothalamus in the brain.

What are the treatments for this?

Treatment options depend on whether you have AVP-D or AVP-R, but regardless of the treatment, drinking enough water is a must.

Treatment of AVP-D status

The main medication used for this is Desmopressin . This is a synthetic hormone that works to replace the missing AVP hormone. It can be taken as a pill, nasal spray, or injection. It is also sometimes given for temporary conditions that occur during pregnancy.

Treatment of AVP-R status

Treating this is a bit complicated. Because the problem here is not a lack of hormones, but rather the kidneys not responding to them. Therefore, different treatments have to be used together.

• Thiazide diuretics: Although these are a type of medication that increases urine output, they work differently in this condition and reduce urine output.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Some drugs in the painkiller category.
• If this condition is caused by another medication you are taking, your doctor will change that medication and prescribe another medication.

Why has the name been changed from 'Diabetes Insipidus' to 'Diabetes Insipidus'?

This is a problem that many people have. For a long time, this disease was called Diabetes Insipidus. But in 2022, several major medical organizations came together and decided to change this name.

The main reason is the confusion caused by the word "Diabetes". We usually use "Diabetes" to mean Diabetes Mellitus . It is a very common disease in our country. It is characterized by an increase in blood sugar levels. Although both diseases have common symptoms of frequent thirst and urination, these are two completely different diseases . The treatments are also completely different.

The name "Diabetes Insipidus" has led to some patients being misdiagnosed as having diabetes mellitus, and even treatment errors. To eliminate this confusion, the name "Arginine Vasopressin Disorder" is now used to refer to the condition.

Is it possible to live successfully with this condition?

Yes, it is definitely possible. If you get proper treatment for this condition and drink enough water as your doctor recommends, you usually won't have any serious problems.

However, some groups are at a slightly higher risk:

• Small babies
• People over 65 years of age
• People with certain mental health problems or developmental disabilities

These people may have difficulty recognizing when they are thirsty or asking for water at that time, which puts them at greater risk of dehydration.

If you feel like you're always living in the bathroom, and no matter how much you drink, you can't quench your thirst, remember that this is a manageable condition. Your doctor will develop a treatment plan that's right for you. He or she will also tell you how much water you should drink per day to avoid dehydration. So don't be afraid to seek medical advice.

Arginine Vasopressin Disorders, Diabetes Insipidus, Excessive Thirst, Frequent Urination, AVP, Dehydration, Desmopressin