ADRENAL CORTICAL REGULATION OF THE DISTRIBUTION OF WATER AND ELECTROLYTES IN THE HUMAN BODY 1

Abstract

Acute adrenal insufficiency resulting from withdrawal of hormone and reduction of dietary salt was observed in 7 human subjects previously rendered adrenal-deficient by therapeutic subtotal adrenalectomy for hypertension. Subjects were on constant diet throughout, and metabolic balance studies were made during (1) a 3-day control period, when cortisone and desoxycorticosterone and supplementary salt were provided, and (2) the subsequent 3-day exptl. period. The volume of distr. of inulin (inulin space) was measured on the last control day and again 53 hrs. following withdrawal of hormone and supplementary salt. A large reduction of inulin space (mean 26 %) uniformly attended acute adrenal insufficiency; a smaller (calculated) simultaneous reduction of chloride space was observed. The net reduction of the total water, Na+, Cl-, and K+ in the inulin space could never be accounted for by external losses; internal transfers of these substances out of the inulin space are therefore indicated. Transferred Na+ and Cl- were uniformly in excess of net external loss. Similar calculations indicate transfer of H2O and K+, but not of Na+, out of the chloride space. Desoxycorticosterone, cortisone, and hydrocortisone, all appear capable of preventing or reversing the abnormality of H2O and electrolyte distribution characteristic of acute adrenal insufficiency in man.