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Adrenocorticotropin Deficiency: Correction of Hyponatremia and Hypoaldosteronism with Chronic Glucocorticoid Therapy^*

Department of Medicine, Columbia University College of Physicians and Surgeons, and Presbyterian Hospital New York, New York 10032

Address requests for reprints to: Dr. George R. Merriam, National Institutes of Health, Building 10, Room 10B09, Bethesda, Maryland 20205.

A 36-yr-old woman with a chronic wasting illness associated with hyponatremia and hypotension proved to have secondary adrenal insufficiency and low levels of GH and PRL. TSH, LH, and FSH responses remained normal. Aldosterone excretion was markedly reduced (0.74 g/day) before replacement therapy was started, but normal renin and aldosterone responses to sodium restriction were observed after 6 months of corticosteroid treatment. These responses were maintained after acute steroid withdrawal despite the continued absence of ACTH.

Chronically adequate glucocorticoid levels were necessary to maintain a normal aldosterone response in this patient. If there is also a pituitary factor required for this response, it does not appear to be ACTH.

^* This work was supported by Grant RR-0645 from the NIH, Grant C114524 from the New York State Department of Health, and Grant 1160 from the Council for Tobacco Research.

Received March 15, 1979.

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