Increased salt appetite in patients with CAH - 21 - OH deficiency ( congenital adrenal hyperplasia

Salt appetite was investigated in 14 patients with congenital adrenal hyperplasia (CAH) of the salt-wasting form (SW), 12 with the simple virilized form that are not salt-losing, and 18 healthy siblings. Salt appetite was evaluated by questionnaire, preference tests, and dietary analyses. The findings showed that SW who were not therapeutically normalized, showed increased salt appetite, but no change in sweet preference. Their salt appetite correlated with symptoms of salt-wasting, namely, plasma renin activity, plasma K, urine Na, and (inversely) with BP. Sensitivity to the taste of NaCl was not altered. Factor analysis of a larger group confirmed the distinction between salt appetite and sweet preference, but intake of dietary Na and sweet carbohydrates, and intake of salty and sweet snacks, did not reflect distinct salt or sweet preferences. We confirm that putative perinatal dehydration, due to maternal nausea and vomiting during pregnancy, childhood vomiting, and diarrhea, and occasioning saline infusions, was related to increased salt appetite in adolescence. The findings suggest that salt appetite in humans is determined by interdependent, innate, physiological, and acquired attributes. Salt appetite in salt-wasting patients is an adaptive response mediated by the renin-angiotensin system, an innate predisposition to acquire salt preference both in anticipation of sodium loss and as its consequence and imprinting by perinatal hyponatremic occurrences. The findings contribute to our understanding of human salt intake, provide insight into the motivation for salt in patients with CAH-21 deficiency, and may point the way to improve therapeutic compliance in these patients. 3-5