Effect of Oral Cortisone on Water Diuresis in Addison's Disease and Hypopituitarism

Oleesky, S.; Stanbury, Sarah

doi:10.1016/s0140-6736(51)92932-7

Cited by 29 publications

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“…Inability to excrete a water load in hypopituitarism is well documented, and hyponatremia has been recognized as a frequent manifestation (1)(2)(3)(4)(5). The defect has been shown to be correctable by glucocorticoid administration (2,3,5), but the pathophysiologic mechanisms involved remain controversial and incompletely understood.…”

Section: Discussionmentioning

confidence: 99%

“…A defect in the excretion of a water load and its correction by glucocorticoid administration have been well documented in patients with hypopituitarism and adrenal insufficiency (1)(2)(3)(4)(5), but the physiologic mechanisms underlying these observations have not been completely elucidated. While several mechanisms may contribute to the defect in water excretion in hypopituitarism, many feel that the major factor is insufficient impermeability to water of the distal tubular and collecting duct epithelium due either to a direct effect of glucocorticoid deficiency or indirectly via elevated levels of circulating antidiuretic hormone (ADH).…”

Section: Introductionmentioning

confidence: 99%

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Role of antidiuretic hormone in the abnormal water diuresis of anterior hypopituitarism in man

Agus¹,

Goldberg²

1971

J. Clin. Invest.

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A B S T R A C T To evaluate the role of antidiuretic hormone (ADH) in the defect in water excretion which is characteristic of glucocorticoid deficiency, the effects of hydrocortisone and ethanol upon urinary dilution during a sustained water load were studied in patients with anterior hypopituitarism. A spectrum of defects in urinary dilution was found in the seven patients with anterior hypopituitarism, and the subjects were separable into two groups. Four patients were unable to excrete a urine hypotonic to plasma (group I) while three diluted the urine (group II). In two of the group II patients, despite maintenance of hydration, urinary osmolality later rose to hypertonicity. Physiological doses of hydrocortisone improved urinary dilution in all patients.Submaximal doses of oral hydrocortisone, when given to the group I patients, converted their response to hydration to one characteristic of the group II patients, i.e., an initial hypotonic urine followed by a secondary rise to hypertonicity. Ethanol, a known inhibitor of ADH secretion, had no effect in the group I patients. When two of these patients were pretreated with submaximal doses of hydrocortisone, however, so that they were able to transiently dilute the urine, ethanol prevented the secondary rise in urine osmolality. Similarly, the administration of ethanol to the untreated group II patients, when the urine was hypotonic, improved diluting ability as characterized by a lowering of urinary osmolality and an increased excretion of solute-free water in all three patients. Hydrocortisone did not improve urinary dilution in three patients with complete hypophyseal diabetes insipidus and one with both anterior and posterior insufficiency receiving constant infusions of vasopressin. These data suggest, therefore, that inappropriately elevated levels of ADH play a major role in the defect in water excretion of anterior hypopituitar-A preliminary report of this work was published: 1962.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Role of antidiuretic hormone in the abnormal water diuresis of anterior hypopituitarism in man

Agus¹,

Goldberg²

1971

J. Clin. Invest.

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“…It is well established that glucocorticoids, in contrast to aldosterone and desoxycorticosterone acetate (DOCA), correct the water clearing defect in Addisonian patients and adrenalectomized dogs (9)(10)(11)(12)(13)(14)(15)(16)(17)(18). The correction of this defect by *Submitted for publication January 9, 1964; accepted April 23, 1964. Supported by grant A-277 from the National Institute of Arthritis and Metabolic Diseases, Bethesda, Md hydrocortisone could not be attributed solely to the rise in glomerular filtration rate (GFR) frequently produced by this agent (16)(17)(18).…”

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confidence: 99%

Renal Tubular Effects of Hydrocortisone and Aldosterone in Normal Hydropenic Man: Comment on Sites of Action *

Yunis¹,

Bercovitch²,

Stein³

et al. 1964

J. Clin. Invest.

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“…The deficient diuretic response to water which is characteristic of patients with adrenal insufficiency can be rapidly corrected by the administration of cortisone (1)(2)(3). The mechanism of the defective diuresis and the precise nature of the response to hormonal replacement have not been established.…”

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confidence: 99%

The Effects of Cortisone and Hydrocortisone on Water Diuresis and Renal Function in Man

Raisz¹,

McNeely²,

L³

et al. 1957

J. Clin. Invest.

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The deficient diuretic response to water which is characteristic of patients with adrenal insufficiency can be rapidly corrected by the administration of cortisone (1-3). The mechanism of the defective diuresis and the precise nature of the response to hormonal replacement have not been established. A number of observations, chiefly in experimental animals, have suggested that administration of various adrenocortical preparations in large "pharmacologic" doses also influences water diuresis in the normal organism (4). However, no systematic study of the latter effect has been made in man. The present report describes the effects of large doses of cortisone and hydrocortisone on water diuresis, renal solute excretion, glomerular filtration rate, and effective renal plasma flow in man. Striking augmentation of the maximal rates of urine flow observed during maintained water loading was a regular occurrence. The steroids studied appear to have a specific influence upon water reabsorption by the renal tubules, an action which can be separated from their effect on renal hemodynamics. MATERIALS AND METHODSThe subjects were adult male patients free from cardiovascular, renal and endocrine disease. Three sets of studies concerning water diuresis were carried out.Group I-A-Intermittent studies during prolonged intramuscular administration of cortisone. In these experiments creatinine clearance was measured, but not inulin or para-aminohippurate clearances. Urinary total solute concentration was calculated from determined cations and urea; freezing point determinations were not made.1 Present address: Veterans Administration Hospital, Syracuse, New York.Group I-B--Serial studies at intervals of one to three days during prolonged oral cortisone and hydrocortisone administration. Clearances of inulin and para-aminohippurate, as well as of creatinine, were determined. Urinary osmolality was measured cryoscopically.Group II-The acute response to intravenous infusion of hydrocortisone during water diuresis. Renal clearances and urinary total solute concentrations were measured as in I-B.Details of experimental procedure will be given together with the results in each group. Chemical methods and calculationsUrine and serum were analyzed for sodium, potassium, chloride and creatinine by methods previously described (5). Serum creatinine was determined after adsorption on Lloyd's reagent (6). Total solute concentration in urine and serum was measured by freezing point depression using a Fiske osmometer (Advanced Instruments, Inc., Needham, Mass.

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Effect of Oral Cortisone on Water Diuresis in Addison's Disease and Hypopituitarism

Cited by 29 publications

References 0 publications

Role of antidiuretic hormone in the abnormal water diuresis of anterior hypopituitarism in man

Role of antidiuretic hormone in the abnormal water diuresis of anterior hypopituitarism in man

Renal Tubular Effects of Hydrocortisone and Aldosterone in Normal Hydropenic Man: Comment on Sites of Action *

The Effects of Cortisone and Hydrocortisone on Water Diuresis and Renal Function in Man

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