Making Two Wrongs Right - Case of Using a Patient's Diabetes insipidus to Treat His Heart Failure: Experience with Vasopressin Antagonists from Animal Studies and Clinical Trials

摘要

The precise control of body water and solute concentrations is a function of several hormones acting on both the kidneys and circulatory system, with arginine vaso-pressin (AVP) playing a key role in this homeostatic process. Vasopressin, also known as antidiuretic hormone, is secreted from the posterior pituitary in response to signals generated from hypothalamic osmoreceptors when increased plasma osmolality is detected. Neurohormon-al activation in congestive heart failure results in a non-osmotic release of AVP which promotes vasoconstric-tion, water retention, and hyponatremia. Two of the receptor subtypes to which AVP binds, Via and V2, play a role in smooth muscle cell contraction and control the expression of aquaporins in the collecting duct. These receptors have become targets for the medical treatment of heart failure. Research has shown that vasopressin receptor blockers have the ability to favorably alter he-modynamics and stimulate diuresis in animal and human heart failure cases. We describe the case of a patient with central diabetes insipidus whose inability to create vasopressin was utilized to his advantage in the management of his nonischemic cardiomyopathy with heart failure.