COMBINED ANTERIOR PITUITARY AND NEUROHYPOPHYSEAL INSUFFICIENCY. STUDIES OF BODY FLUID SPACES AND RENAL FUNCTION*

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Abstract
Studies are reported of renal function and the acute responses to oral water and solute loading in 2 patients with space occupying lesions in the region of the sella turcica in whom a combined deficiency of anterior pituitary and neurohypophyseal activity seems reasonably certain. In the untreated state both patients ex creted a hypertonic urine at all times independent of water or solute loading. Urine flow was a function of solute excretion. Renal plasma flow and glomerular filtration rate were low and prompt water diuresis was impaired. The administration of thyroid hormone improved renal hemodynamics with a fall in urine osmolality, but free water clearance remained defective and urine flow dependent on solute excretion. The addition of cortisone restored renal plasma flow and glomerular filtration rate to normal as well as the capacity for prompt water diuresis. Because prompt water diuresis was still impaired in 1 case on inadequate cortisone therapy despite normal renal hemodynamics, it is suggested that cortisone may, in addition to raising the glomerular filtration rate, also affect renal tubular water transport. A comparison of the data obtained in the 2 patients with the combined defects with those obtained in a patient with diabetes insipidus and another patient with uncomplicated anterior hypopituitarism suggests that antidiuretic hormone and cortisone exert their effects independently in response to homeostatic requirements.