WATER DIURESIS IN ADRENAL CORTICAL INSUFFICIENCY

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Abstract
A study of the diuretic response to ingested water with and without prior corticosteroid administration was made in 238 subjects. Maximum urine flow rates following water ingestion below 2-3 ml/min., which on repetition were doubled when 100 mg cortisone was taken orally some 4-6 hr. prior to water ingestion, were characteristic of most subjects who were subsequently shown to have adrenal cortical insufficiency. A failure of normal water diuresis to follow water drinking, which was uninfluenced by prior corticosteroids, was found in some patients with intrinsic renal disease, myxedema, cirrhosis and idiopathic steatorrhea. Falsely positive tests, where diuresis was enhanced with cortisone, were encountered in 2 cases of congestive cardiac failure. When adequate precautions are taken with respect to bladder emptying and correction of salt depletion, the test procedure was a useful clinical index of adrenal cortical function in subjects without overt cardiac or renal failure. Because it can be performed without laboratory aid, and is a relatively safe procedure, the water test of Oleesky lends itself to the selection of patients for more elaborate and specific tests of adrenal cortical function.