Physiological basis of arginine vasopressin deficiency (AVP-D, formerly central diabetes insipidus) and AVP-resistance (AVP-R, formerly nephrogenic diabetes insipidus)

Abstract

This review explored the physiological mechanisms underlying arginine vasopressin deficiency (AVP-D, formerly central diabetes insipidus) and AVP resistance (AVP-R, formerly nephrogenic diabetes insipidus), with a focus on water balance regulation. Vital components include the hypothalamic-pituitary-AVP axis, renal AVP responsiveness, and neural mechanisms of thirst regulation. Recent insights on thirst generation within circumventricular brain nuclei (subfornical organ, median preoptic nucleus, and organum vasculosum of the lamina terminalis) are discussed, along with the diagnostic utility of copeptin in polyuric states. This review highlighted the critical role of hypothalamic-pituitary integrity and renal AVP responsiveness in maintaining water-electrolyte homeostasis. Understanding these mechanisms provided the foundation for optimizing therapeutic strategies and advancing research on AVP-related disorders.