Smokeless Nicotinergic Stimulation of Vasopressin Secretion in Patients with Persisting Nocturnal Enuresis and Controls

Abstract

Objective: This study aimed to evaluate the effect of nicotine stimulation on pituitary release of plasma arginine vasopressin (P_AVP) in patients with primary monosymptomatic nocturnal enuresis (PMNE) and healthy control subjects. Material and methods: Postpubertal teenagers and adult enuretics as well as control subjects were enrolled into the study and admitted to hospital for measurements of P_AVP in relation to intake of orally administered nicotine. Sixteen patients with PMNE (9 females, 7 males; aged 15-51 years, mean 23.5) and nine normal subjects (4 females, 5 males; aged 24-31 years, mean 27.3) were studied. The enuretics were characterized prior to investigation as either 1-desamino-8-D-arginine vasopressin (DDAVP) responders (n = 8; 16-51 years, mean 28.9) or DDAVP non-responders (n = 8; 15-24 years, mean 18.1) based on the reduction in the number of wet nights. P_AVP, mean arterial blood pressure (MAP) and heart rate (HR) were measured 0, 5, 10, 15 and 30 min, and plasma osmolality (P_osm) 0 and 30 min after receiving 4 mg nicotine (Nicorette®, Pharmacia & Upjohn) chewing gum. Results: In the compiled material a slight but statistically significant increase was observed in P_AVP at 30 min compared with baseline levels, concurrent with significant rises in MAP and HR above baseline levels at 15 and 30 min. No difference was seen in P_osm before and after nicotine administration. No other significant variation over time, assessed by an ANOVA, was detected. No difference was encountered in any measured parameter between controls and enuretics or between DDAVP responders and non-responders. Conclusion: Smokeless nicotine chewing gum induces non-osmotic vasopressin release in humans. The secretory AVP capacity to this stimulation is normal in PMNE.