Acute colonic pseudo-obstruction with transient failure of oral desmopressin in adipsic arginine vasopressin deficiency

Abstract

We report the case of a middle-aged male with panhypopituitarism and adipsic arginine vasopressin deficiency (AVP-D) who presented with severe hyponatremia. During the correction of hyponatremia, he developed acute colonic pseudo-obstruction (ACPO or Ogilvie syndrome). Management included a bowel regimen, rectal tube placement, and endoscopic decompression. During hospitalization, repeated transitions from intravenous to oral desmopressin were consistently followed by brisk hypotonic polyuria and hypernatremia, raising concern for impaired enteral desmopressin absorption. After gastrointestinal recovery and separation of oral desmopressin and polyethylene glycol (PEG) by more than 4 hours, oral desmopressin again produced sustained antidiuresis. This case suggests that ACPO may transiently impair oral desmopressin absorption and that concurrent PEG administration may further reduce its efficacy.