An elderly woman with ureteral carcinoma had a persistently low serum sodium which was partially restored by oral and iv sodium chloride. For nineteen years she had received annual DOC pellet implants for treatment of presumed Addison's disease. Plasma cortisol and urinary 17-OHCS levels were normal and rose normally after ACTH. Urinary aldosterone was very low, and did not increase with ACTH or salt restriction. Plasma renin was normal to high and increased with a low salt diet. Gas-liquid chromatigraphic analysis of C-21 steroid metabolites disclosed normal values for THE, THF, THB, THDOC pregnanediol and pregnanetriol. The patient was maintained with fludrocortisone but expired in four months. Adrenal histology was normal.
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Mellinger et al. (1972) studied this question.