Hypoadrenocorticotropism with Hyponatremia, Resembling Antidiuretic Hormone Excess

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Abstract
A 64-year old man had convulsions, low serum sodium and osmola-lity, high urine osmolality, and no diuresis after water loading. The criteria for the presence of excess antidiuretic hormone appeared to be present, but it was found that diuresis occurred both after adrenocorticotropin and after prednisone. The disorder appears to be due to a lesion in the hypothalamus or adenohypophysis resulting in isolated adrenotropic deficiency, with primary water imbalance as the principal feature of the consequent adrenal cortical insufficiency. To distinguish patients with this syndrome from those with inappropriate antidiuretic hormone levels, one must carry out formal tests of adrenal cortical function.