Prognosis

Outcome and outlook depend on the underlying aetiology of arginine vasopressin deficiency (AVP-D) or arginine vasopressin resistance (AVP-R), as well as associated comorbidities. While AVP-D or AVP-R are often lifelong conditions, AVP-D resulting from pituitary surgery or traumatic brain injury may be transient and AVP-D developing in pregnancy typically resolves following delivery.​[3]​​ Similarly, AVP-R secondary to hypercalcaemia or hypokalaemia commonly resolves following treatment of the underlying electrolyte disorder.[5] Although drug-induced AVP-R may resolve following drug discontinuation, this is often not the case if lithium is the culprit.[43][68]​​​

The majority of patients with chronic AVP-D are well controlled on the synthetic, long-acting AVP analogue desmopressin (also known as DDAVP). Patients require lifelong follow-up for any associated intracranial pathology that may have caused the AVP-D. Other anterior pituitary hormone replacement therapy must also be monitored.

Patients with inherited AVP receptor pathway mutations resulting in AVP-R may be at increased risk of hypernatraemia and associated comorbidities. Effective treatment can mitigate these complications.[69]

Patients with large-volume polyuria will need regular renal or bladder imaging to detect and prevent occult bladder or renal tract abnormalities such as hydronephrosis and bladder dysfunction.[70]

Despite effective control of polyuria with desmopressin, patients with AVP-D often report reduced quality of life.[3]​ This may be due to chronic illness or possibly to oxytocin deficiency, with some studies suggesting a link between low oxytocin levels and reduced quality of life in individuals with AVP-D and other pituitary hormone deficiencies.[3]​ AVP-R can also have a substantial negative impact on quality of life, as patients often experience disrupted sleep due to nocturia and must continuously plan their daily routines around frequent urination and ensuring access to drinking water.[10]

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