Does desmopressin (DDAVP) stop adrenal insufficiency?

From the Guidelines

Desmopressin does not treat adrenal insufficiency, and patients with this condition require treatment with glucocorticoids and sometimes mineralocorticoids to replace the hormones that the adrenal glands are not producing adequately. Adrenal insufficiency is a condition where the adrenal glands do not produce enough cortisol and sometimes aldosterone, which are essential hormones for various bodily functions 1. The treatment of adrenal insufficiency involves replacing these hormones with medications such as hydrocortisone, prednisone, or dexamethasone, and sometimes mineralocorticoids like fludrocortisone 1.

Key Points to Consider

• Desmopressin is a synthetic analog of vasopressin (antidiuretic hormone) that is primarily used to treat diabetes insipidus, nocturnal enuresis, certain bleeding disorders, and to manage excessive urination 1.
• Adrenal insufficiency requires lifelong hormone replacement therapy, and patients should wear medical alert identification to prevent life-threatening adrenal crisis, especially during illness or stress 1.
• The diagnosis of primary adrenal insufficiency should be considered in patients presenting with unexplained collapse, hypotension, vomiting, or diarrhea, and hyperpigmentation, hyponatremia, hyperkalemia, acidosis, and hypoglycemia increase clinical suspicion of primary adrenal insufficiency 1.

Treatment Recommendations

• Patients with adrenal insufficiency should take 15–25 mg of hydrocortisone daily in split doses, and most patients with primary adrenal insufficiency should take 50–200 µg of fludrocortisone as a single daily dose 1.
• Adrenal crisis should be treated immediately with intravenous or intramuscular hydrocortisone, 100 mg followed by 100 mg 6–8 hourly until recovered, and isotonic sodium chloride solution should usually be administered at an initial rate of 1 L/h until hemodynamic improvement 1.

From the Research

Adrenal Insufficiency and Desmopressin

• Desmopressin is used to treat central diabetes insipidus, a condition that can occur in patients with hypopituitarism 2.
• Adrenal insufficiency is a life-threatening condition that requires lifelong glucocorticoid substitution therapy, as well as stress adaptation to prevent adrenal crises 3.
• The treatment of adrenal insufficiency typically involves glucocorticoid replacement therapy, such as hydrocortisone, and mineralocorticoid replacement therapy, such as fludrocortisone 4, 5.
• Desmopressin is not typically used to treat adrenal insufficiency, but rather to treat central diabetes insipidus, which can be a related condition in patients with hypopituitarism 2.

Treatment of Adrenal Insufficiency

• The goal of treatment for adrenal insufficiency is to replace the deficient hormones and prevent adrenal crises 3.
• Glucocorticoid replacement therapy is typically given as a twice or thrice daily hydrocortisone preparation 4.
• Mineralocorticoid replacement therapy is typically given as fludrocortisone, aiming to achieve normotension, normokalaemia, and a plasma renin activity in the upper normal range 5.
• Novel strategies to replicate the cortisol rhythm using hydrocortisone infusion pumps and oral modified release hydrocortisone have been developed and confirmed to offer benefits to patients 6.

Stopping Adrenal Insufficiency with Desmopressin

• There is no evidence to suggest that desmopressin can stop adrenal insufficiency 4, 5, 3, 6, 2.
• Desmopressin is used to treat central diabetes insipidus, not adrenal insufficiency 2.
• The treatment of adrenal insufficiency typically involves glucocorticoid and mineralocorticoid replacement therapy, not desmopressin 4, 5, 3, 6.