CHRONIC ADRENOCORTICAL DYSFUNCTION, INCLUDING ALDOSTERONE DEFICIENCY: STUDIES OF STEROID AND ELECTROLYTE METABOLISM*

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Abstract
Metabolic studies were made on a 44-year-old man in whom acute adrenal insufficiency with vascular collapse and characteristic changes in electrolytes following a minor operation called attention to an unusual instance of adrenal dysfunction of at least twenty years'' duration. Excretion of aldosterone was less than 0.5 microgram per twenty-four hours and was not augmented by restriction of sodium or administration of corticosterone. Loss of sodium and retention of potassium occurred with hyponatremia and hyperpotassemia during a period when the daily sodium intake was less than 200 mEq. Normal values for electrolytes were restored by administration of aldosterone or 9[alpha]-fluorocortisol, but not by use of corticotropin or cortisone. Values of plasma and urinary corticosteroids were normal but were not increased by corticotropin. Hydrocortisone and cortisone were identified in the urine. Results of glucose-tolerance tests were normal. Diuresis after ingestion of water was impaired. Urinary excretion of 17-ketosteroids was in the high normal range, and that of pregnanetriol and estrogens was moderately increased; the values for these constituents were not increased by corticotropin but were decreased by cortisone or corticosterone.