ALTERATIONS IN WATER AND SALT METABOLISM AFTER BILATERAL ADRENALECTOMY IN MAN*†

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Abstract
Six bilaterally adrenalectomized cancer patients were studied during cortisone withdrawal, to determine the alterations in salt and water metabolism in acute adrenal insufficiency. Metabolic balance measurements of water and electrolytes were carried out in all patients, and in 2 subjects the volumes of distribution of inulin, antipyrine and radioactive Na were also determined. Profound clinical collapse occurred in all patients within 3-7 days after withdrawal of cortisone. In 7 withdrawal studies, water retention was the most frequently observed metabolic change. In the 2 patients studied, there was an apparent expansion of the inulin space of 15 and 21%, respectively, during cortisone withdrawal, with significant alterations in antipyrine space or in total exchangeable Na. Hyponatremia developed in 4 subjects, unassociated with significant renal salt-wastage. Serum K levels rose slightly in 2 patients and remained unchanged in 4 patients, during cortisone withdrawal. Although internal and external changes in salt and water metabolism were observed, these results tend to minimize the role of these phenomena in tne pathologic physiology of acute adrenal insufficiency in man. These data are considered unique, in that a specific salt-retaining factor was not included in the control medications.