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The interrelationship of sodium balance, plasma renin activity and ACTH in congenital adrenal hyperplasia.

Metabolic studies in seven children with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency revealed that all subjects displayed abnormalities in sodium balance which ranged from borderline depletion in the simple virilizers detectableonly by high levels of plasma renin activity to overt salt-loss and hypovolemia in the salt-losers. These abnormalities suggested that aldosterone biosynthesis was relatively impaired in all subjects, but more in the saltlosers. Sodium depletion, while on constant glucocorticoid replacement therapy, induced marked elevations of plasma renin activity which was associated with a hypersecretion of ACTH, with levels often over 1000 pg/ml. However, individuals whose hypothalamic-pituitary axis was completely suppressed with dexamethasone did not show a rise in ACTH levels. The degree of ACTH stimulation was significantly correlated with the levels of plasma renin activity (r = 0.811, P < 0.001) and was proportional to the degree of sodium loss, thus representin...