Sodium and Chloride Depletion in Acute Porphyria with Reference to the Status of Adrenal Cortical Function.

The fact that depletion of sodium and of chloride may occur in acute porphyria, in the absence of alkalosis due to vomiting, has recently been noted independently by Abrahams, Gavey and Maclagan (1) and by Linder (2). These authors suggested that a possible basis for this deficiency was that of adrenal cortical failure, but the response of their two patients to substitution therapy with cortical hormones does not appear to have given unequivocal evidence for this hypothesis. The present paper presents an attempt to explore this question in further detail. The plan of investigation falls under two headings: firstly to study the function of the adrenal cortex during the height of an attack of acute porphyria and secondly to observe the response to desoxycorticosterone administration in greater detail. Prunty, Forsham and Thorn (3) have recently indicated that the elucidation of adrenal cortical function with respect to its relation to electrolyte metabolism is a complex matter, whereas the functional production of the 1 1-oxy-steroid group of hormones is more easily assessable by urine analysis and the use of the response to purified adrenocorticotrophic hormone. The severity of the illness of the patient under observation was considered a contraindication precluding the use of the deprivation test of Cutler, Power and Wilder (4).