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Chapter 6
Endocrine system
CONTENTS
Antidiuretic hormone disorders
page 703
Diabetes insipidus
1.1
Syndrome of inappropriate antidiuretic hormone
1.2
secretion
Corticosteroid responsive conditions
Cushing’s syndrome and disease
2.1
Diabetes mellitus and hypoglycaemia
Diabetes mellitus
3.1
3.1a Diabetes, diagnosis and monitoring
Hypoglycaemia
3.2
3.2a Chronic hypoglycaemia
Disorders of bone metabolism
Dopamine responsive conditions
Gonadotrophin responsive conditions
Hereditary angioedema
6.1
Antidiuretic hormone
disorders
Posterior pituitary hormones and
antagonists
Posterior pituitary hormones
Diabetes insipidus
Vasopressin p. 706 (antidiuretic hormone, ADH) is used in
the treatment of pituitary (‘cranial’) diabetes insipidus as is its
analogue desmopressin p. 704. Dosage is tailored to produce
a slight diuresis every 24 hours to avoid water intoxication.
Treatment may be required for a limited period only in
diabetes insipidus following trauma or pituitary surgery.
Desmopressin is more potent and has a longer duration of
action than vasopressin; unlike vasopressin it has no
vasoconstrictor effect. It is given by mouth or intranasally
for maintenance therapy, and by injection in the
postoperative period or in unconscious patients.
Desmopressin is also used in the differential diagnosis of
diabetes insipidus. Following a dose intramuscularly or
intranasally, restoration of the ability to concentrate urine
after water deprivation confirms a diagnosis of cranial
diabetes insipidus. Failure to respond occurs in nephrogenic
diabetes insipidus.
In nephrogenic and partial pituitary diabetes insipidus
benefit may be gained from the paradoxical antidiuretic
effect of thiazides.
Carbamazepine p. 327 is sometimes useful in partial
pituitary diabetes insipidus [unlicensed]; it may act by
sensitising the renal tubules to the action of remaining
endogenous vasopressin.
Other uses
Desmopressin is also used to boost factor VIII concentration
in mild to moderate haemophilia and in von Willebrand’s
disease; it is also used to test fibrinolytic response.
Desmopressin may also have a role in nocturnal enuresis.
Endocrine system
Hypothalamic and anterior pituitary
page 783
hormone related disorders
Adrenocortical function testing
7.1
Assessment of pituitary function
7.2
Gonadotrophin replacement therapy
7.3
Growth hormone disorders
7.4
Sex hormone responsive conditions
Female sex hormone responsive conditions
8.1
8.1a Anti-oestrogens
Male sex hormone responsive conditions
8.2
8.2a Male sex hormone antagonism
Thyroid disorders
Hyperthyroidism
9.1
Hypothyroidism
9.2
Vasopressin infusion is used to control variceal bleeding in
portal hypertension, prior to more definitive treatment and
with variable results. Terlipressin acetate, a derivative of
vasopressin with reportedly less pressor and antidiuretic
activity, is used similarly.
Oxytocin p. 868, another posterior pituitary hormone, is
indicated in obstetrics.
Antidiuretic hormone antagonists
Demeclocycline hydrochloride p. 597 can be used in the
treatment of hyponatraemia resulting from inappropriate
secretion of antidiuretic hormone, if fluid restriction alone
does not restore sodium concentration or is not tolerable.
Demeclocycline hydrochloride is thought to act by directly
blocking the renal tubular effect of antidiuretic hormone.
Tolvaptan p. 706 is a vasopressin V2-receptor antagonist
licensed for the treatment of hyponatraemia secondary to
syndrome of inappropriate antidiuretic hormone secretion;
treatment duration with tolvaptan is determined by the
underlying disease and its treatment.
Rapid correction of hyponatraemia during tolvaptan
therapy can cause osmotic demyelination, leading to serious
neurological events; close monitoring of serum sodium
concentration and fluid balance is essential.
Diabetes insipidus
1.1
Other drugs used for Diabetes insipidus Chlortalidone,
p. 244
PITUITARY AND HYPOTHALAMIC HORMONES
AND ANALOGUES › VASOPRESSIN AND
ANALOGUES
PDF pages 724, 725, 726
