Endocrine Abstracts

JOINT2605

Introduction: Arginine vasopressin (AVP) deficiency involves decreased release of arginine vasopressin (AVP) which could lead to polyuria. Hence, patients usually present with polyuria and polydipsia. Lack of AVP can be resulted from disorders that act at one or more of the sites involved in AVP synthesis and secretion. AVP deficiency is a rare disorder with prevalence of 1 in 25,000 individuals and most cases are acquired. The most common acquired causes include autoimmune neurohypophysitis, primary or secondary tumours, infiltrative diseases (such as Langerhans cell histiocytosis and sarcoidosis), neurosurgery and head trauma Here we discuss a case in which AVP deficiency possibly secondary to herbal remedies.

Case Presentation: A 53-year-old male was admitted with polyuria and polydipsia. Passing around 7Litres of urine daily which was disturbing his sleep. He had no significant past medical history. He was taking herbal remedies which including Rhodiola rosea root extract, cranberry extract, royal jelly extract and resveratrol 1.5months earlier he also completed 14 days of ciprofloxacin antibiotics for prostatitis. CT head showed no acute pathology. MRI pituitary showed no acute lesions or pathology. Bloods showed hypernatraemia 147 mmol/L. Urine osmolality of 162 and serum osmolality of 304, urinary sodium was<20. He was given a trial of oral desmopressin which did not help, however when changed to intravenous desmopressin 1 microgram the patients symptoms significantly improved and was able to concentrate the urine. Discharged with nasal spray desmopressin 10micrograms twice daily and his symptoms continued to improve. Discussed in Neuro-pituitary MDT.

Conclusion: AVP deficiency is one of the main entities of the polyuria-polydipsia syndrome. Most cases are acquired and commonly include head injury, neurosurgery, cranial tumours and neurohypophysitis. There have been very limited case reports on herbal remedies causing AVP deficiency such as olive extract. There are also few cases reporting on transient diabetes insipidus in patients using quinolone antibiotics. It is important especially in these rare cases to use an MDT approach to help manage patient’s symptoms. Questions for discussion Have you come across herbal remedies induced AVP deficiency? Could quinolones contribute to AVP deficiency?