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Urinary Antidiuretic Hormone in Polyuric Disorders and in Inappropriate ADH Syndrome

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Supported in part by Veterans Administration Research Funds and by grant RR-229 from the General Clinical Research Centers Program of the Division of Research Resources, National Institutes of Health, Bethesda, Md.

▸Requests for reprints should be addressed to Myron Miller, M.D., Veterans Administration Hospital, Irving Ave. and University Place, Syracuse, N.Y. 13210.

Syracuse, New York

Ann Intern Med. 1972;77(5):715-721. doi:10.7326/0003-4819-77-5-715
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Urinary antidiuretic hormone (ADH) excretion was measured by radioimmunoassay in patients with polyuric disorders and with the inappropriate ADH syndrome. The hormone was undetectable in patients with severe hypothalamic diabetes insipidus who were on ad libitum fluid intake, and subnormal in patients with partial diabetes insipidus. After dehydration ADH appeared in the urine of those patients who could concentrate to isotonic or hypertonic levels, directly confirming partial ADH deficiency. Patients with nephrogenic diabetes insipidus on ad libitum fluid intake had measurable ADH in the urine, which increased after dehydration and suppressed after water loading. Thus patients with hypothalamic diabetes insipidus could be clearly differentiated from those with nephrogenic diabetes insipidus. Only one patient with inappropriate ADH syndrome had ADH levels exceeding the normal range. But hormone excretion was inappropriately high in relation to the level of plasma osmolality and was always detectable after water loading. The urinary ADH response to water loading allows the certain diagnosis of inappropriate ADH syndrome and is a useful tool for evaluating the response of the underlying disorder to therapy.





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