STUDIES CONCERNING THE MECHANISM OF WATER RETENTION IN ADDISON'S DISEASE AND IN HYPOPITUITARISM

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Abstract
ADISTURBANCE of renal function has been known to be present in adrenal insufficiency since 1916, when Marshall and Davis (1) reported that adrenalectomized cats have a markedly depressed kidney function before the phase of terminal failure. In 1931 Rowntree and Snell (2) made similar observations in Addison's disease. They reported that the dilution test disclosed “a decided lag in the onset of diuresis and in the total secretion of water.” This observation—failure of prompt diuresis—was later taken up by Robinson, Power and Kepler (3) and made the basis of a useful screening test for Addison's disease. Many studies have been made to determine the mechanism of the faulty water excretion in adrenal insufficiency and these have been reviewed by Gaunt (4, 5) and Levy, Power and Kepler (6). The phenomenon has not appeared to be a simple one. Various combinations of the following factors have been considered as responsible: stasis of water in the bowel, abnormal distribution of water in the body, a fault at the renal level, and increased activity of the posterior pituitary gland. Although defective absorption from the gut is a well known finding in adrenal insufficiency, it does not appear to be an essential factor in the faulty water diuresis; for isotonic fluids given intravenously (6, 7) or intraperitoneally (8, 9) still fail to be excreted promptly. Observations are conflicting as to whether the delayed water excretion in adrenal insufficiency is due primarily to an abnormal fluid distribution in the tissues. In adrenalectomized rats Gaunt (9) has presented indirect evidence suggesting that ingested water passes principally into the intracellular phase; on the other hand, Shipley's studies indicate that it is mainly extracellular (10). Both are agreed that the blood volume is not increased following water ingestion and this would indicate that the water is not available for ready excretion by the kidneys in adrenalectomized animals. No clinical studies on this aspect of the problem have been reported up to the. present time.