Maccabi Healthcare Services, Haifa, Israel.
Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel.
Pituitary. 2024 Oct;27(5):731-736. doi: 10.1007/s11102-024-01451-7. Epub 2024 Sep 6.
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.
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.
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.
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.
胰高血糖素样肽-1 受体激动剂（GLP-1 RAs）对钠和水稳态有多种影响。它们可降低口渴感知，潜在地抑制精氨酸加压素（AVP）的产生，并诱导利钠作用。我们报告了 3 例 AVP 缺乏症（AVP-D）患者，GLP-1 RA 起始治疗导致去氨加压素剂量减少。
3 例 AVP-D 患者在稳定接受去氨加压素治疗的基础上，因 2 型糖尿病或肥胖开始使用 GLP-1 RA。随着体重减轻和口渴减少，所有患者均减少了去氨加压素剂量，同时保持正常的口渴和尿量。
GLP-1 RAs 通过多种机制影响钠和水稳态。在 AVP 系统完整的个体中，GLP-1 RA 可能直接抑制 AVP 的产生，并在肾脏中诱导利钠作用，导致水排泄增加。在 AVP-D 中，外源性去氨加压素替代内源性 AVP，集合管的渗透通透性主要受去氨加压素剂量的影响。因此，增加远端液流输送可能允许使用较低剂量的去氨加压素来维持水平衡。
我们的发现表明 GLP-1 RA 和 AVP-D 中的去氨加压素之间存在潜在的相互作用。临床医生在开始 GLP-1 RA 治疗时应重新评估去氨加压素剂量。
