GLP-1 receptor agonists may enhance the effects of desmopressin in individuals with AVP deficiency: a case series and proposed mechanism.

IF 3.3 2区医学 Q2 ENDOCRINOLOGY & METABOLISM Pituitary Pub Date : 2024-09-06 DOI:10.1007/s11102-024-01451-7

Afif Nakhleh, Naim Shehadeh, Bshara Mansour

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Abstract

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have diverse effects on sodium and water homeostasis. They decrease thirst perception, potentially inhibit arginine vasopressin (AVP) production, and induce natriuresis. We present three cases of AVP deficiency (AVP-D) where GLP-1 RA initiation led to desmopressin dose reduction.

Cases: Three patients with AVP-D on stable desmopressin therapy started GLP-1 RAs for type 2 diabetes mellitus or obesity. Following weight loss and decreased thirst, all patients reduced their desmopressin dose while maintaining normal thirst and urine output.

Discussion: GLP-1 RAs influence sodium and water homeostasis through various mechanisms. In individuals with intact AVP systems, GLP-1 RAs may directly suppress AVP production and induce natriuresis in the kidney leading to increased water excretion. In AVP-D, with exogenous desmopressin replacing endogenous AVP, the osmotic permeability of collecting ducts is primarily influenced by desmopressin dose. Thus, increased distal fluid delivery may allow for lower desmopressin doses to maintain water balance.

Conclusion: Our findings indicate a potential interaction between GLP-1 RAs and desmopressin in AVP-D. Clinicians should reassess desmopressin dosage upon initiating GLP-1 RA therapy.

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GLP-1 受体激动剂可增强去氨加压素对 AVP 缺乏症患者的作用：一个病例系列和拟议机制。

背景：胰高血糖素样肽-1 受体激动剂（GLP-1 RAs）对钠和水的平衡有多种影响。它们会降低口渴感，可能会抑制精氨酸加压素（AVP）的产生，并诱导利尿。我们介绍了三例 AVP 缺乏症（AVP-D）病例，在这些病例中，GLP-1 RA 的启动导致去氨加压素剂量的减少：病例：三位正在接受去氨加压素稳定治疗的 AVP-D 患者因 2 型糖尿病或肥胖症开始服用 GLP-1 RA。在体重下降和口渴减少后，所有患者都减少了去氨加压素的剂量，同时保持正常的口渴和尿量：讨论：GLP-1 RAs 通过各种机制影响钠和水的平衡。在 AVP 系统完好的个体中，GLP-1 RAs 可直接抑制 AVP 的分泌，诱导肾脏的利尿作用，从而增加水的排泄。在 AVP-D 中，外源性去氨加压素取代了内源性 AVP，集合管的渗透性主要受去氨加压素剂量的影响。因此，增加远端液体输送可使去氨加压素剂量降低以维持水平衡：我们的研究结果表明，GLP-1 RAs 和去氨加压素在 AVP-D 中可能存在相互作用。临床医生在开始 GLP-1 RA 治疗时应重新评估去氨加压素的剂量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pituitary 医学-内分泌学与代谢

CiteScore

7.10

自引率

7.90%

发文量

审稿时长

6 months

期刊介绍： Pituitary is an international publication devoted to basic and clinical aspects of the pituitary gland. It is designed to publish original, high quality research in both basic and pituitary function as well as clinical pituitary disease. The journal considers: Biology of Pituitary Tumors Mechanisms of Pituitary Hormone Secretion Regulation of Pituitary Function Prospective Clinical Studies of Pituitary Disease Critical Basic and Clinical Reviews Pituitary is directed at basic investigators, physiologists, clinical adult and pediatric endocrinologists, neurosurgeons and reproductive endocrinologists interested in the broad field of the pituitary and its disorders. The Editorial Board has been drawn from international experts in basic and clinical endocrinology. The journal offers a rapid turnaround time for review of manuscripts, and the high standard of the journal is maintained by a selective peer-review process which aims to publish only the highest quality manuscripts. Pituitary will foster the publication of creative scholarship as it pertains to the pituitary and will provide a forum for basic scientists and clinicians to publish their high quality pituitary-related work.