Endocrine Abstracts

Arginine vasopressin deficiency (AVP-D), formerly known as central diabetes insipidus (CDI), is commonly treated with desmopressin, a synthetic analogue of antidiuretic hormone (ADH). While desmopressin is generally effective, rare adverse effects, including gastrointestinal upset and abdominal pain, may limit its use. Such symptoms are more commonly associated with oral formulations, less frequent with sublingual and intranasal routes, and exceedingly rare with subcutaneous delivery. We report a case of a 17-year-old female with familial arginine vasopressin deficiency (AVP-D) who was initially treated with oral desmopressin but she developed abdominal pain shortly after administration. The treatment was subsequently switched to a sublingual formulation, but the patient continued to experience similar abdominal discomfort. Attempts to use intranasal desmopressin were also unsuccessful, making it challenging to effectively manage her AVP-D symptoms over an extended period. Ultimately, a monitored inpatient trial of subcutaneous desmopressin was attempted; however, it also resulted in abdominal pain, confirming systemic intolerance regardless of the administration route. The symptoms resolved upon discontinuation of desmopressin. To effectively manage her symptoms, the patient was then transitioned to a thiazide diuretic, which reduces polyuria by inducing mild hypovolemia. This case highlights a rare, yet clinically significant, intolerance to desmopressin, marked by persistent gastrointestinal symptoms across multiple formulations, including the subcutaneous route. It emphasizes the need for individualized treatment strategies in managing AVP-D and supports thiazide diuretics as a viable alternative for patients who cannot tolerate desmopressin.