Differentiating AVP deficiency and primary polydipsia: a clinical and biochemical perspective

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Aims: The polyuria–polydipsia syndrome encompasses three major disorders—arginine vasopressin (AVP) deficiency, AVP resistance, and primary polydipsia. This study aimed to differentiate AVP deficiency from primary polydipsia by evaluating clinical features, biochemical markers, and anterior pituitary hormone levels, using the water deprivation test as the primary diagnostic modality. Methods: This retrospective observational study included 34 adult patients with polyuria–polydipsia syndrome who underwent a standardized inpatient water deprivation test. Patients were categorized into AVP deficiency (complete or partial) or primary polydipsia based on urine osmolality responses to dehydration and desmopressin. Clinical data, daily fluid intake, and nocturia frequency were recorded. Serum electrolytes and anterior pituitary hormones (LH, GH) were analyzed. Results: AVP deficiency was diagnosed in 76.4% of patients (58.8% complete, 17.6% partial), while 23.5% had primary polydipsia. LH and GH levels were significantly higher in the primary polydipsia group (p=0.011 and p=0.028, respectively), whereas AVP deficiency was associated with lower gonadotropin levels, especially in postoperative cases. Serum sodium, chloride, and magnesium levels were significantly lower in primary polydipsia (p

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