A CORTISONE-RESISTANT ABNORMALITY IN THE DIURETIC RESPONSE TO INGESTED WATER IN PRIMARY MYXEDEMA

Abstract

IN NORMAL humans the ingestion of 20 milliliters of water per kilogram of body weight evokes a characteristic water diuresis. After a slight delay, urine flow increases and peak flows are achieved within one hour, at which time a copious dilute urine is excreted. In primary hypoadrenalism the excretion of water after ingesting such a water load is delayed (1, 2). The following report indicates that a similar abnormality in the diuretic response to ingested water is associated with untreated primary idiopathic myxedema. In bypoadrenalism treatment with cortisone reinstates a normal diuretic response to a water load (1, 3). Studies are presented to show that cortisone therapy does not establish a normal diuretic response in untreated primary myxedema, whereas thyroid therapy does in association with the change to the euthyroid state. Studies in postoperative myxedema and in postirradiation myxedema are also reported. Eleven patients (9 female, 2 male) with primary myxedema (8 idiopathic, 2 postoperative, 1 postirradiation) were given the standard water test as described by Robinson, Power and Kepler (2). The results were evaluated in the usual manner, and in addition the percentage of the water load excreted in the four-hour period was calculated. To obviate the factor of intestinal absorption, on three occasions the water load was given intravenously as 5 per cent glucose in distilled water. The foregoing procedures were carried out'prior to therapy and after administering 1) cortisone, 2) thyroid, and 3) thja-oid and cortisone, in the dosages indicated in Table 1.