Arginine vasopressin deficiency (AVP-D) is one of the main entities of the polyuria-polydipsia syndrome. Its correct diagnosis and differentiation from the other two causes - AVP resistance and primary polydipsia – is crucial as this determines the further management of these patients.

Over the last years, several new diagnostic tests using copeptin, the stable surrogate marker of AVP, have been introduced. Among them, hypertonic saline stimulated copeptin was confirmed to reliably and safely improve the diagnostic accuracy to diagnose AVP-D. Due to its simplicity, arginine stimulated copeptin was put forward as alternative test procedure. Glucagon-stimulated copeptin also showed promising results, while the oral growth hormone secretagogue Macimorelin failed to provide a sufficient stimulus. Interestingly, an approach using machine learning techniques also showed promising results concerning diagnostic accuracy.

Once AVP-D is diagnosed, further workup is needed to evaluate its etiology. This will partly define the further treatment and management. In general, treatment of AVP-D focuses on desmopressin substitution, with oral formulations currently showing the best tolerance and safety profile. However, in addition to desmopressin substitution, recent data also showed that psychopathological factors play an important role in managing AVP-D patients.

精氨酸加压素缺乏症 （AVP-D） 是多尿-烦渴综合征的主要实体之一。它的正确诊断和与其他两个原因 - AVP 抵抗和原发性烦渴 - 的鉴别至关重要，因为这决定了这些患者的进一步管理。

在过去的几年里，已经引入了几种使用 copeptin（AVP 的稳定替代标志物）的新诊断测试。其中，高渗盐水刺激和肽素被证实可靠、安全地提高诊断 AVP-D 的准确性。由于其简单性，精氨酸刺激的和肽素被提出作为替代测试程序。胰高血糖素刺激的和肽素也显示出有希望的结果，而口服生长激素促分泌剂马西莫瑞林未能提供足够的刺激。有趣的是，一种使用机器学习技术的方法在诊断准确性方面也显示出有希望的结果。

一旦诊断为 AVP-D，则需要进一步检查以评估其病因。这将部分定义进一步的治疗和管理。一般来说，AVP-D 的治疗侧重于去氨加压素替代，口服制剂目前显示出最佳的耐受性和安全性。然而，除了去氨加压素替代外，最近的数据还表明，精神病理学因素在管理 AVP-D 患者中起着重要作用。