Abstract
Extract: We have found repeatedly low or low-normal levels of aldosterone excretion in the urine of a boy presenting at birth with vasopressin-resistant diabetes insipidus. The only renal disorder was a lack of urinary concentrating ability.
A satisfactory gain of weight and height and a normal psychological development were obtained by use of a salt-free diet and small doses of hydrochlorothiazide administered during 18 consecutive months.
Aldostcrone excretion (< 1 to 7.3 μg/24 h) and secretion (40 μg/24 h) were surprisingly low, in view of sodium deprivation and thiazide treatment. Plasma renin activity was 53 ng/1/min, a value compatible with sodium restriction.
Angiotensin infusion over a period of 8 hours produced only a small increase of urinary excretion of aldosterone (7 μg/12 h). In a normal child of the same age, an 8-hour infusion of angiotensin raises urinary aldosterone excretion to 11.3 μg/12 h on a daily intake of 40 mEq Na and to 37 μg/12 h on an intake of 5 mEq Na.
Our patient showed a slight increase of exchangeable sodium (54.9 mEq/kg at 14 months and 53.1 mEq/kg at 3 years) and of bromide-space (27.9% of total body weight), and a markedly decreased excahangeable potassium (23.9 and 24.5 mEq/kg), without hypokaliemia.
Speculation: These results suggest that the existence of permanently increased total body stores of sodium in the presence of potassium depletion may decrease the production of aldosterone in the face of sodium restriction.
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Godard, C., Mégevand, A., De Sousa, R. et al. Etude du métabolisme de l'aldostérone dans un cas de diabète insipide néphrogénique congénital. Pediatr Res 2, 22–28 (1968). https://doi.org/10.1203/00006450-196801000-00002
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DOI: https://doi.org/10.1203/00006450-196801000-00002