Test ID: AVP
Arginine Vasopressin, Plasma
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Diagnosis and characterization of diabetes insipidus
Diagnosis of psychogenic water intoxication
As an adjunct in the diagnosis of syndrome of inappropriate secretion of antidiuretic hormone secretion (SIADH), including ectopic arginine vasopressin production
Method Name A short description of the method used to perform the test
Radioimmunoassay (RIA)
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Antidiuretic Hormone
Arginine Vasopressin, Plasma
AVP
Diabetes Insipidus
SIDAH
Vasopressin/ADH
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Specimen Type: Platelet-poor plasma
Collection Container/Tube: Lavender top (EDTA) iced tube
Submission Container/Tube: Plastic vial
Specimen Volume: 2 mL
Collection Instructions:
1. Have patient fast and thirst for 6 hours (no liquids, including water, are allowed).
2. Process 5 mL of EDTA whole blood as follows:
a. Spin down in a refrigerated centrifuge at approximately 1,000 x G (2,000 rpm for a 20-cm radius centrifuge) for 10 minutes.
b. Remove plasma, carefully avoiding the platelet/buffy coat.
Additional Information: This test should not be requested on patients who have recently received radioactive material.
Forms: If not ordering electronically, submit a General Request Form (Supply T239) with the specimen.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK; Gross OK |
| Lipemia | Mild OK; Gross OK |
| Icterus | Mild OK; Gross OK |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Plasma EDTA | Frozen (preferred) | 14 days |
| Refrigerated | 24 hours |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Arginine vasopressin (AVP), also known as antidiuretic hormone (ADH), is a hypothalamic polypeptide that is transported along the axons of the synthesizing neurons into the posterior pituitary gland. From there it is released into the systemic circulation after appropriate stimuli. The main regulators of AVP secretion are osmotic stimuli, provided by osmoreceptors located in the anteromedial hypothalamus, and volume stimuli, provided by receptors in neck vessels and heart. Under physiological conditions, volume stimuli always override osmotic stimuli.
The absence or presence of AVP is the major physiologic determinant of urinary free water excretion or retention. AVP acts principally on renal collecting tubules to increase water reabsorption. The antidiuretic effects of AVP are mediated by V2 vasopressin receptors. AVP can also increase vascular resistance through stimulation of V1 receptors.
Diabetes insipidus (DI) is characterized by the inability to appropriately concentrate urine in response to volume and osmol stimuli. The main causes for DI are decreased AVP production (central DI) or decreased renal response to AVP (nephrogenic DI).
AVP can also be secreted inappropriately in certain situations, particularly in elderly patients, leading to water retention and dilutional hyponatremia. Inappropriate AVP secretion might be observed with central nervous system pathology, such as head injury, stroke, or cerebral tumor, or as a side effect of central acting drugs that interfere with the hypothalamic regulation or AVP. Noncentral causes of inappropriate AVP secretion include peripheral stimuli that mimic central vascular hypovolemia, in particular severe low-output cardiac failure, and ectopic AVP secretion (usually by a bronchogenic carcinoma).
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Adults: <1.7 pg/mL
Reference values were determined on platelet-poor EDTA plasma from individuals fasting no longer than overnight.
Interpretation Provides information to assist in interpretation of the test results
Central DI can be differentiated from nephrogenic DI by measuring arginine vasopressin (AVP) during a state of maximal, or near maximal, stimulus for AVP release (water deprivation test: perform under medical supervision; stop once plasma osmolality >295 mOsm/kg water or > or =5% loss in body weight) and assessing the antidiuretic response to exogenous administration of the AVP at the conclusion of a water deprivation test:
-If AVP is low despite elevated serum osmolality, and the urine osmolality increases significantly after administration of exogenous AVP, the diagnosis is compatible with central DI.
-If stimulated AVP is elevated and the administration of exogenous AVP results in little or no increase in urine concentration, the patient likely has nephrogenic DI.
-Mixed forms of DI can exist, and both central and peripheral DI may be incomplete, complicating the interpretation of results.
Patients with psychogenic polydipsia will either have a normal response to water deprivation or, in particular in long-standing cases, will show a pattern suggestive of mild nephrogenic DI due to loss of concentrating gradient across the nephron as a result of salt-washout by long-standing polydipsia.
An elevated plasma AVP level in a hyponatremic, euvolemic patient might be indicative of SIADH. Confirmation of euvolemia is critical in such patients, since an elevated AVP level represents a physiological response to hypovolemia.
Seizures, cerebral hemorrhages, cerebral trauma, cerebral tumors, neurosurgery, electroconvulsive therapy, central nervous system acting drugs, and a variety of conditions that reduce apparent blood volume or pressure in central vessels (eg, severe low output cardiac failure) can all result in inappropriate AVP elevations. Depending on the clinical course, these might be short lived. If none of these conditions is present, ectopic AVP secretion, most commonly caused by bronchial carcinoma, should be suspected.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Reference values were determined on platelet-poor EDTA plasma from individuals fasting no longer than overnight. A significant amount of circulating arginine vasopressin (AVP) is associated with platelets. Therefore, various conditions affecting platelets may also affect AVP levels. Platelet-rich specimens have been shown to have AVP levels on the order of 10 times the value of platelet-poor specimens.
AVP levels obtained in the process of a water deprivation test can be difficult to interpret because of the many non standardized variables in this test. Expert consultation is recommended in these circumstances.
This test should not be requested in patients who have recently received radioisotopes, therapeutically or diagnostically, because of potential assay interference. A recommended time period before collection cannot be made because it will depend on the isotope administered, the dose given, and the clearance rate in the individual patient. Specimens will be screened for radioactivity prior to analysis. Radioactive samples received in the laboratory will be held and assayed after the radioactivity has sufficiently decayed. This will result in a test delay.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
Robertson GL: Antidiuretic hormone. Normal and disordered function. Endocrinol Metab Clin North Am 2001 September;30(3):671-694
Method Description Describes how the test is performed and provides a method-specific reference
Cartridge extraction of acidified plasma is used to prepare the specimen for this Mayo-developed radioimmunoassay (RIA). After acidification, the specimen is centrifuged, applied to a phenyl cartridge, washed, and eluted. The extract is dried under nitrogen, reconstituted with assay buffer and measured for arginine vasopressin by RIA.(Skowsky WR, Rosenbloom AA, Fisher DA: Radioimmunoassay measurement of arginine vasopressin in serum: development and application. J Clin Endocrinol Metab 1974 February;38[2]:278-287)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Wednesday; 12 p.m.
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
84588
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 80344 | Arginine Vasopressin, P | 3126-0 |
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