Plasma vasopressin and response to treatment in primary nocturnal enuresis
a Department of
Paediatrics General Infirmary, Leeds LS2 9NS, UK, b Clinical Psychology, Leeds
Community and Mental Health NHS Trust, Leeds LS2 9HM, UK, c Department of Statistics, University of Leeds,
Leeds LS2 9JT, UK
Correspondence to: Dr Holland.
Accepted 13
January 1999
AIMS
To examine
the relation between nocturnal vasopressin release and response to
treatment with the vasopressin analogue
1-desamino-8-D-arginine vasopressin (DDAVP) in children
with primary monosymptomatic nocturnal enuresis.
DESIGNChildren were
recruited from a specific enuresis clinic and entered into a defined
treatment programme. Nocturnal vasopressin concentrations were measured
every 15 minutes over a four hour period during overnight admission.
RESULTSSixty seven
children were eligible for entry into the study, 35 of whom agreed to
overnight sampling. There was a quadratic relation between mean plasma
AVP and response to treatment with DDAVP, with very high or very low
concentrations being unresponsive. Plasma AVP profiles ranged from low
concentrations with little variability to high concentrations with wide variability.
CONCLUSIONThe ability
to respond to DDAVP is related to endogenous AVP production and is
influenced by neuronal patterning in early infancy. The best predictors
of success with treatment were a past history of breast feeding, mean
nocturnal AVP concentration, and the height of the child. The response
was adversely affected by poor weight at birth and poor linear growth.
The study suggests differing causes of nocturnal enuresis related to
different patterns of AVP release.
Keywords: nocturnal enuresis; vasopressin; 1-desamino-8-D-arginine vasopressin
© 1999 by Archives of Disease in Childhood
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