2. Explain the biochemical basis of the patient’s condition.

Vasopressin is a hormone that is synthesized in the supraoptic nucleus of hypothalamus and is

stored in the posterior pituitary gland. It is also called antidiuretic hormone because it stimulates water
resorption in the distal renal tubule. It is a nonpeptide that regulates water resorption in the distal
tubule of the kidney to control the osmotic pressure of the blood. It conserves body water by
decreasing urine output, that’s why it is an antidiuretic. In the hypothalamus, it is bound to a
neurophysin protein carrier, packaged in granules and is transported by intracellular transport to nerve
terminals in the posterior pituitary. Vasopressin is secreted from the granules in response to elevated
extracellular osmolarity detected by the hypothalamic osmoreceptors thru atria signaling, stretch
receptors or after an increase in angiotensin II levels. Excess secretion of antidiuretic hormone can result
to “water intoxication” and hyponatremia while lack of this hormone can lead to excess loss of free
water and hypernatremia. One of the most common causes of lack in vasopressin is head trauma,
particularly if the posterior pituitary stalk is cut, injured or destroyed.

Increased resorption of water in the renal distal tubule is stimulated by vasopressin by activating
insertion of water channels or aquaporins into the apical membrane of kidney tubules. Across the renal
epithelium, water is resorbed into the blood making the plasma osmolarity decrease and urine
osmolarity increase. In Diabetic Insipidus, this process is impaired, resulting to excessive production of
urine. Without vasopressin, the kidney cannot resorb water and it is excreted out of the body as urine.
This condition can be due to a deficiency in the secretion of vasopressin from the posterior pituitary
because of hypothalamic tumors, injury or infection. Alternately, this can also be caused by mutations in
the vasopressin receptor or aquaporin genes or other diseases damaging renal response to vasopressin.