Abstract
Defects in water excretion and urinary dilution have been well known in patients with hypopituitarism and adrenal insufficiency, but there are few reports of nocternal polyuria in these patients. Serial studies were done in 8 children (aged 5-13) with pituitary dwarfism and ACTH deficiency (A), 4 of them had enuresis, 5 with pituitary dwarfism and no ACTHdeficiency (aged 2-10) and 14 constitutional dwarfs (aged 3-15) as controls. Daily urine volumes of these patients with A were 0.8-1.81/day with highly concentrated urine (>500mOsm/1) at day-time(D) and diluted urine (<400mOsm/1) at night(N). The ratio of 12 hour urine volume of D/N were 0.65-1.0 in these patients with A and 1.3-4.9 in children without A. The patients with A excreted<40% of the ingested water (20ml/kg) within 4 hours in the morning and it was corrected by steroid administration. In the evening they could excrete normally>80% of the water. After an over-night fast, they could not concentrate their urine maximally, but it was also corrected by steroid administration. Their 6-hourly urine samples showed low 17 KGS without circadian rhythm. Our results suggest that they may not able to excrete ingested water in the morning in the absence of appropriately elevated levels of glucocorticoids and excrete water lately at night. We are now investigating serym levels of ADH and our results seem to support that the elevated levels of circulating ADH are involved in the impaired water diuresis in the patients.
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Maesaka, H., Yokoya, S. & Suwa, S. Nocternal polyuria in patients with anterior hypopituitarism. Pediatr Res 15, 1571 (1981). https://doi.org/10.1203/00006450-198112000-00214
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DOI: https://doi.org/10.1203/00006450-198112000-00214