THE EFFECTS OF PROGRESSIVE REDUCTION OF SODIUM INTAKE ON ADRENAL STEROID EXCRETION AND ELECTROLYTE BALANCE IN A CASE OF CONGENITAL ADRENAL HYPERPLASIA OF THE SALTLOSING TYPE*

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Abstract
Two balance studies, two and a half years apart, were conducted on a child exhibiting congenital adrenal hyperplasia of the salt-losing type. These studies were performed at the ages of 18 months and 4 years. The increased aldosterone excretion which occurred in response to restricted sodium intake and administration of ACTH was not associated with a positive sodium balance. Coincident with a negative sodium balance and elevated excretion of aldosterone the urine contained a biologically active fraction, obtained by paper chromatographic procedures, which promoted natriuresis and inhibited the sodium- retaining effect of desoxycorticosterone in the adrenalectomized rat. THE syndrome of congenital adrenal hyperplasia has been well described with regard to its clinical and pathologic manifestations (1–5), biochemical characteristics (6, 7), genetic patterns (8) and the effects of treatment (1, 3, 9–14). Elucidation of the cause of the electrolyte disturbance occurring in a subgroup of these patients presenting virilization and addisonian-like crises has not yet occurred.