POSSIBLE INVOLVEMENT OF HYPERSECRETION OF ADH IN HYPONATREMIA IN A DIABETIC PATIENT COMPLICATED WITH SEVERE NEUROPATHY

The present case was a 44-year-old man who had been diagnosed as havin g noninsulin-dependent diabetes mellitus 2 years before admission. He gradually showed severe neuropathy and emaciation because of poor cont rol of his blood glucose levels. He was admitted to our hospital becau se of disturbance of consciousness with hyponatremia. The endocrinolog ical findings including thyroid and adrenal functions revealed no abno rmalities. Insufficiency of water diuresis was noted in the water load ing test. Severe orthostatic hypotension was noted during the standing up test, and an excessive response in the plasma ADH level was also n oted. These findings demonstrated that excessive ADH secretion occurre d to compensate for the fall in blood pressure because of the breakdow n of homeostatic regulation in blood pressure due to diabetic neuropat hy. It is suggested that hyponatremia seemed to be subsequently induce d by hypersecretion of ADH.