{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T05:52:13Z","timestamp":1776145933915,"version":"3.50.1"},"reference-count":13,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T00:00:00Z","timestamp":1733356800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>An incorrect diagnosis of arginine vasopressin deficiency and resistance (AVP\u2010D and AVP\u2010R) results in the potentially dangerous use of desmopressin in healthy individuals. The water deprivation test is a central diagnostic test in patients with polydipsia polyuria syndrome (PPS). This study aims to determine the effectiveness of the current interpretation of reference ranges.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective analysis of 135 patients who underwent a water deprivation test between August 2014 and August 2023. All patient diagnoses were reviewed, and variability and receiver operating characteristic (ROC) curves were determined for serum osmolality, serum sodium and urine osmolality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Serum sodium demonstrated reduced variability compared with serum osmolality (0.72% vs. 1.16%, respectively, 37.5% reduction; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The standard serum osmolality cut\u2010off value of \u2265 300\u2009mOsm\/kg in diagnosing AVP\u2010D, AVP\u2010R, and primary polydipsia (PP) achieved a sensitivity of 76.19% and specificity of 76.92%. A serum sodium cut\u2010off value of \u2265 148\u2009mmol\/L demonstrated 100% specificity in excluding PP. This cut\u2010off was used alongside urine osmolality cut\u2010off values of &gt; 630\u2009mOsm\/kg (for PP) and &lt; 383\u2009mOsm\/kg (for AVP\u2010D\/AVP\u2010R). Review of post\u2010desmopressin urine osmolality and clinical monitoring was performed in equivocal diagnostic cases (<jats:italic>n<\/jats:italic>\u2009=\u20096), achieving 100% sensitivity and 100% specificity within the study sample.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study demonstrates that a serum sodium cut\u2010off of \u2265 148\u2009mmol\/L in tandem with urine osmolality yields the best diagnostic accuracy to differentiate between AVP\u2010D, AVP\u2010R, and PP. Serum sodium may be more reliable than serum osmolality in the investigation of patients with PPS, demonstrating lower biological and analytical variability.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.15172","type":"journal-article","created":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T07:31:12Z","timestamp":1733470272000},"page":"149-155","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Redefining Diagnostic Cut\u2010Offs for the Indirect Water Deprivation Test"],"prefix":"10.1111","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5193-3639","authenticated-orcid":false,"given":"Yash","family":"Akkara","sequence":"first","affiliation":[{"name":"Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism Digestion and Reproduction Imperial College London London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kavita","family":"Narula","sequence":"additional","affiliation":[{"name":"Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism Digestion and Reproduction Imperial College London London UK"},{"name":"Department of Endocrinology Imperial College Healthcare NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0758-7839","authenticated-orcid":false,"given":"Katharine","family":"Lazarus","sequence":"additional","affiliation":[{"name":"Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism Digestion and Reproduction Imperial College London London UK"},{"name":"Department of Endocrinology Imperial College Healthcare NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah","family":"Papadopoulou","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Imperial College Healthcare NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2429-005X","authenticated-orcid":false,"given":"Sirazum","family":"Choudhury","sequence":"additional","affiliation":[{"name":"Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism Digestion and Reproduction Imperial College London London UK"},{"name":"Department of Endocrinology Imperial College Healthcare NHS Trust London UK"},{"name":"Department of Clinical Biochemistry North West London Pathology London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1185-2762","authenticated-orcid":false,"given":"Niamh","family":"Martin","sequence":"additional","affiliation":[{"name":"Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism Digestion and Reproduction Imperial College London London UK"},{"name":"Department of Endocrinology Imperial College Healthcare NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7112-2756","authenticated-orcid":false,"given":"Karim","family":"Meeran","sequence":"additional","affiliation":[{"name":"Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism Digestion and Reproduction Imperial College London London UK"},{"name":"Department of Endocrinology Imperial College Healthcare NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,12,5]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/imj.13627"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgac381"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2007-0232"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2020.101398"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.4103\/2230-8210.172273"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-73-5-721"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-019-0103-2"},{"key":"e_1_2_9_9_1","unstructured":"S.Gubbi F.Hannah\u2010Shmouni C. A.Koch andJ. G.Verbalis \u201cDiagnostic Testing for Diabetes Insipidus \u201d in Endotext eds.K. R.Feingold B.Anawalt M. R.Blackman et al. (2000)."},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejm198112243052601"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-8529(18)30422-5"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiochem.2017.03.019"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1803760"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/edm2.399"}],"container-title":["Clinical Endocrinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cen.15172","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T13:16:33Z","timestamp":1735823793000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cen.15172"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,5]]},"references-count":13,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1111\/cen.15172"],"URL":"https:\/\/doi.org\/10.1111\/cen.15172","archive":["Portico"],"relation":{},"ISSN":["0300-0664","1365-2265"],"issn-type":[{"value":"0300-0664","type":"print"},{"value":"1365-2265","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,5]]},"assertion":[{"value":"2024-05-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-11-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}