{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:05:54Z","timestamp":1792807554025,"version":"4.5.0"},"reference-count":19,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,1,9]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>Polyuria-polydipsia syndrome is composed of arginine vasopressin deficiency, arginine vasopressin resistance and primary polydipsia and are characterised by severe polyuria with hypotonic urine. The water deprivation test is commonly used to indirectly assess the vasopressin response to water deprivation. We report a woman in her 20s who demonstrated severe polyuria (11\u201312\u2009L\/day) on submitting a 24-hour urine sample for analysis. She subsequently mentioned having had polyuria and polydipsia for 10 years after an Epstein-Barr virus infection. A water deprivation test with copeptin measurement confirmed arginine vasopressin deficiency. Treatment with desmopressin transformed her life. Further investigation revealed possible concurrent subclinical mixed connective tissue disease. We suspect Epstein-Barr virus infection to be the cause of the arginine vasopressin deficiency and possibly the trigger for the subclinical mixed connective tissue disease. This case also highlights the utility of copeptin measurements in differentiating the various polyuria-polydipsia syndromes.<\/jats:p>","DOI":"10.1136\/bcr-2024-262036","type":"journal-article","created":{"date-parts":[[2025,1,19]],"date-time":"2025-01-19T20:50:26Z","timestamp":1737319826000},"page":"e262036","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnosis of arginine vasopressin deficiency in a patient with 10 years of polyuria and polydipsia following an Epstein-Barr virus infection"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4104-9674","authenticated-orcid":false,"given":"Samson Oghenetsovwe","family":"Oyibo","sequence":"first","affiliation":[{"name":"Diabetes and Endocrinology, North West Anglia NHS Foundation Trust, Peterborough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poonam","family":"Sharma","sequence":"additional","affiliation":[{"name":"Rheumatology, North West Anglia NHS Foundation Trust, Peterborough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika Dham","family":"Kohli","sequence":"additional","affiliation":[{"name":"Biochemistry, North West Anglia NHS Foundation Trust, Peterborough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,1,19]]},"reference":[{"key":"2025082701184558000_18.1.e262036.1","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.ecl.2020.05.012","article-title":"Diabetes Insipidus: An Update","volume":"49","author":"Refardt","year":"2020","journal-title":"Endocrinol Metab Clin North Am"},{"key":"2025082701184558000_18.1.e262036.2","doi-asserted-by":"publisher","DOI":"10.1111\/joim.13261"},{"key":"2025082701184558000_18.1.e262036.3","article-title":"Recurrent Multiple Dyselectrolytemias Secondary to Episodic Water Intoxication in a Young Lady: A Case Report","volume":"12","author":"Galloway","year":"2020","journal-title":"Cureus"},{"key":"2025082701184558000_18.1.e262036.4","doi-asserted-by":"publisher","DOI":"10.1097\/00008480-200006000-00016"},{"key":"2025082701184558000_18.1.e262036.5","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2020.587380","article-title":"Epstein-Barr Virus and Systemic Autoimmune Diseases","volume":"11","author":"Houen","year":"2020","journal-title":"Front Immunol"},{"key":"2025082701184558000_18.1.e262036.6","unstructured":"Somasundaram NP , Gunatilake SSC , et al . Infections in endocrinology: viruses. In: Feingold KR , Anawalt B , Blackman MR , eds. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc, 2000."},{"key":"2025082701184558000_18.1.e262036.7","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.eprac.2024.03.004","article-title":"A Comprehensive Review of Empty Sella and Empty Sella Syndrome","volume":"30","author":"Lundholm","year":"2024","journal-title":"Endocr Pract"},{"key":"2025082701184558000_18.1.e262036.8","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2022.925378","article-title":"A Multicenter Cohort Study in Patients With Primary Empty Sella: Hormonal and Neuroradiological Features Over a Long Follow-Up","volume":"13","author":"Carosi","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"2025082701184558000_18.1.e262036.9","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.berh.2016.03.002","article-title":"Mixed connective tissue disease","volume":"30","author":"Gunnarsson","year":"2016","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"2025082701184558000_18.1.e262036.10","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-73-5-721"},{"key":"2025082701184558000_18.1.e262036.11","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-1981"},{"key":"2025082701184558000_18.1.e262036.12","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.2003.01647.x"},{"key":"2025082701184558000_18.1.e262036.13","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.2001.281.1.F163"},{"key":"2025082701184558000_18.1.e262036.14","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1803760"},{"key":"2025082701184558000_18.1.e262036.15","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1111\/cen.13991","article-title":"Copeptin and its role in the diagnosis of diabetes insipidus and the syndrome of inappropriate antidiuresis","volume":"91","author":"Refardt","year":"2019","journal-title":"Clin Endocrinol (Oxf)"},{"key":"2025082701184558000_18.1.e262036.16","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-4507"},{"key":"2025082701184558000_18.1.e262036.17","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1038\/s41574-024-00985-x","article-title":"Arginine vasopressin deficiency: diagnosis, management and the relevance of oxytocin deficiency","volume":"20","author":"Atila","year":"2024","journal-title":"Nat Rev Endocrinol"},{"key":"2025082701184558000_18.1.e262036.18","doi-asserted-by":"crossref","unstructured":"Newell-Price J , Drummond JB , Gurnell M , et al . Approach to the patient with suspected hypotonic polyuria. 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