Hypertonic saline test for the investigation of posterior pituitary function
a Department of
Paediatrics, John Radcliffe Hospital, Oxford, UK, b Department of
Paediatrics, Royal Victoria Infirmary, Newcastle, UK, c Department of Medicine, University of Bristol,
Bristol, UK
Correspondence to: Dr D B Dunger, Department of Paediatrics, Level 4, John Radcliffe Hospital, Oxford OX3 9DU, UK. email: david.dunger{at}paediatrics.ox.ac.uk
Accepted 22 April 1998
The hypertonic saline test is a useful technique for
distinguishing partial diabetes insipidus from psychogenic polydipsia, and for the diagnosis of complex disorders of osmoreceptor and posterior pituitary function. However, there is little information concerning its use in childhood. The experience of using this test in
five children (11 months to 18 years) who presented diagnostic problems
is reported. In two patients, in whom water deprivation tests were
equivocal or impractical, an inappropriately low antidiuretic hormone
(ADH) concentration (< 1 pmol/l) was demonstrated in the presence of
an adequate osmotic stimulus (plasma osmolality > 295 mosmol/kg). In
two children
one presenting with adipsic hypernatraemia and the
other with hyponatraemia complicating desmopressin treatment of partial
diabetes insipidusdefects of osmoreceptor function were identified.
Confirming a diagnosis of idiopathic syndrome of inappropriate ADH
secretion (SIADH) was possible in a patient with no other evidence of
pituitary dysfunction. The hypertonic saline test was well tolerated,
easy to perform, and diagnostic in all cases.
© 1998 by Archives of Disease in Childhood
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