Advances in the diagnosis and treatment of adrenal insufficiency

Thorn, George W.; Forsham, Peter H.; Frawley, Thomas F.; Wilson, D.Laurence; Renold, Albert E.; Fredrickson, Donald S.; Jenkins, Dalton

doi:10.1016/0002-9343(51)90330-0

Cited by 107 publications

(14 citation statements)

References 29 publications

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“…It has long been known that patients with adrenal insufficiency may have a craving for NaCl. Fifteen to 20%o of the patients with adrenal insufficiency have been noted to exhibit this salt craving (5,6). In our studies, all patients with this disease had an abnormally lowered taste threshold for NaCl.…”

Section: Discussionsupporting

confidence: 48%

Studies on Taste Thresholds in Normal Man and in Patients With Adrenal Cortical Insufficiency: The Role of Adrenal Cortical Steroids and of Serum Sodium Concentration

Henkin¹,

Gill²,

Bartter³

1963

J. Clin. Invest.

290

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Patients with adrenal cortical insufficiency exhibit an increased taste sensitivity for sodium chloride (NaCl) (1). Treatment with carbohydrate-active steroids returns the abnormal threshold to normal levels (1). In a variety of acute and chronic debilitating diseases, a number of them exhibiting major abnormalities of water and electrolyte metabolism, taste threshold for NaCi is comparable to that observed in healthy subjects (1). Taste thresholds for all modalities are decreased in cystic fibrosis, but they do not change after treatment with steroids (2).The present study was designed to examine in detail taste thresholds in adrenal insufficiency and to explore the effect of adrenal cortical hormones on taste. METHODSThe subjects of this study were 13 normal volunteers, aged 6 to 35, two patients with anterior pituitary insufficiency, aged 21 and 36, and seven patients with Addison's disease, aged 25 to 65. All patients with Addison's disease had clinical features of this disease, urinary 17-hydroxycorticosteroids that were below 2 mg per 24 hours and did not increase with adrenocorticotropin (ACTH), 40 U given intravenously over 8 hours, each day for 5 days. Both patients with anterior pituitary insufficiency had hypothyroidism, hypogonadism, and adrenal insufficiency, with urinary 1 7-hydroxycorticosteroids in J.M. and S.P. of 1.1 and 2.2 mg per day, respectively, rising to 27 and 10.9 mg per day, respectively, with ACTH. All patients remained on an air-conditioned metabolic ward and ate a normal diet, which was well tolerated even when they were not receiving treatment. Sodium intake was 100 to 200 mEq per day. Body weight, determined with metabolic scales daily on arising, was used to provide a gross estimate of changes in the volume of body fluids. The patients were studied under each of three conditions: a) untreated for 4 or more days, b) treated with desoxycorticosterone acetate (DOCA), 20 mg per day for 1 to 7 days, and c) treated with prednisolone (A1F), 20 mg per day for 2 to 5 days.In addition, detection thresholds for the taste of NaCl were measured between 7 and 8 a.m. in three normal Caucasian males, aged 18 to 20, before and during treatment with Pitressin. The two levels of sodium intake during Pitressin were 9 mEq and 150 mEq per day. Taste was evaluated by measuring the detection threshold. A detection threshold is defined as the lowest concentration of test solution that can be consistently distinguished from distilled water. Thresholds were measured by one observer in the early morning hours in the normal subjects and in the morning or evening hours, or both, in the patients with adrenal insufficiency. Occasional retesting of the patient by another observer gave comparable results on each occasion. At the time of testing, the patients had not smoked or eaten for at least 1 hour. After the mouth was rinsed with distilled water, the solutions of test substance or glass-distilled water were administered as single drops and placed on alternate sides of the anterior one-third of the tongue.Each...

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Section: Discussionsupporting

confidence: 48%

Studies on Taste Thresholds in Normal Man and in Patients With Adrenal Cortical Insufficiency: The Role of Adrenal Cortical Steroids and of Serum Sodium Concentration

Henkin¹,

Gill²,

Bartter³

1963

J. Clin. Invest.

290

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“…Sodium-deficient humans typically report having a peculiar sensation in the mouth that is more commonly associated with thirst than with sodium appetite [25]. Patients with adrenal insufficiency losing large amounts of urinary sodium also do not report a specific craving for salt but instead report a longing for salty foods [27,113]. Humans do, however, demonstrate changes in preference for sodium under sodium deficiency or restriction conditions.…”

Section: Taste and Sodium Appetitementioning

confidence: 99%

Salt craving: The psychobiology of pathogenic sodium intake

Morris

Johnson

2008

Physiology & Behavior

115

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Ionic sodium, obtained from dietary sources usually in the form of sodium chloride (NaCl, common table salt) is essential to physiological function, and in humans salt is generally regarded as highly palatable. This marriage of pleasant taste and physiological utility might appear fortunate -an appealing taste helps to ensure that such a vital substance is ingested. However, the powerful mechanisms governing sodium retention and sodium balance are unfortunately best adapted for an environment in which few humans still exist. Our physiological and behavioral means for maintaining body sodium and fluid homeostasis evolved in hot climates where sources of dietary sodium were scarce. For many reasons, contemporary diets are high in salt and daily sodium intakes are excessive. High sodium consumption can have pathological consequences. Although there are a number of obstacles to limiting salt ingestion, high sodium intake, like smoking, is a modifiable behavioral risk factor for many cardiovascular diseases. This review discusses the psychobiological mechanisms that promote and maintain excessive dietary sodium intake. Of particular importance are experiencedependent processes including the sensitization of the neural systems underlying sodium appetite and the effects of sodium balance on hedonic state and mood. Accumulating evidence suggests that plasticity within the central nervous system as a result of experience with high salt intake, sodium depletion, or a chronic unresolved sodium appetite fosters enduring changes in sodium related appetitive and consummatory behaviors.

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“…[41,50,121,124], has not been very useful. Since this method did not give satisfactory results unless a constant diet was applied [73], it has soon been abandoned [83,123], Some authors used the hormone-in duced increase of potassium excretion as an indirect measure of adreno cortical function. Application of depot ACTH on several days was followed by a drop of the Na/K ratio in the urine [88].…”

Section: Stimulation Tests Using Other Indirect Parameters O F Adrenomentioning

confidence: 99%

“…injection of normal ACTH preparations or administration of depot corticotropin have been used as alternative methods of ACTH application. In the case of a negative 4-hour test, T horn et al [103,122,123] injected additionally 10 1U of ACTH every 6 h up to 48 h (48-hours ACTH test), in order to distinguish between primary and secondary adrenal hypofunction. In secondary adrenal insufficiency, eosinopenia occured not later than 4 h after the last injection.…”

mentioning

confidence: 99%

Adrenocortical Stimulation Tests with ACTH: Developments and Changes of a Diagnostic Procedure

Knappe¹

1971

Horm Res Paediatr

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Stimulation tests with ACTH have undergone various modifications due to the advent of different methods for an assessment of adrenocortical function. An attempt was made to review the manifold diagnostic procedures and to compare them with the experience obtained from an intravenous 1-hour test with fluorometric determination of plasma 11-hydroxycorticosteroids. The latter procedure represents the most simple reliable method being widely adequate to the requirements of clinical practice including outpatient performance. The results of the 1-hour ACTH test in adrenocortical diseases as well as in other clinical conditions are described.

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Advances in the diagnosis and treatment of adrenal insufficiency

Cited by 107 publications

References 29 publications

Studies on Taste Thresholds in Normal Man and in Patients With Adrenal Cortical Insufficiency: The Role of Adrenal Cortical Steroids and of Serum Sodium Concentration

Studies on Taste Thresholds in Normal Man and in Patients With Adrenal Cortical Insufficiency: The Role of Adrenal Cortical Steroids and of Serum Sodium Concentration

Salt craving: The psychobiology of pathogenic sodium intake

Adrenocortical Stimulation Tests with ACTH: Developments and Changes of a Diagnostic Procedure

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