REGULATION OF SALT METABOLISM AFTER HYPOPHYSECTOMY IN MAN*†

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Abstract
THE control of sodium metabolism in the absence of the pituitary gland has not been clearly defined in man. Experiments in patients with panhypopituitarism have been inconclusive because of the variability of anterior pituitary function and the reliance upon inappropriate tests. We shall present our experiences with the hypophysectomized patient subjected to sodium restriction and shall show that sodium conservation remains efficient in the absence of the anterior pituitary gland. There are decisive experimental data in animals (1) which demonstrate normal sodium metabolism after hypophysectomy. The secretion of aldosterone in response to sodium restriction and its relative independence of corticotropin (2) amply explain these findings. Aldosterone excretion has also been shown to be normal in the patient with panhypopituitarism (3) and to increase after hypophysectomy in response to sodium restriction (4). These considerations suggest that adrenal control of sodium metabolismis independent of pituitary function. METHODS These studies were conducted during the past two years on the Metabolic Ward of the James-Ewing Hospital. All patients had had surgical hypophysectomy for metastatic cancer. Hypophysectomy was considered complete in each, on the basis of either complete suppression of the pituitary-dependent glands or the autopsy findings. All had diabetes insipidus. Substitution therapy varied and is listed separately.