I was indeed born a salt waster. According to my parents, my first couple of weeks of life were a downward spiral as I was projectile vomiting everything they tried to feed me. Amazingly, they found a doctor who realized that I was a salt waster. I can also remember as a child how carefully my doctor's questioned my mother to be sure I was eating plenty of salt. Fortunately for me salt wasters can survive without florinef if they consume enough salt (and water) to replace that which they lose in the urine. Florinef is a synthetic analog of aldosterone and wasn't available when I was born in 1950. I don't know when it first became available but it was probably some time in the seventies. Prior to that, salt wasting was treated by dietary salt replacement. If salt wasting isn't treated, the result is a life threatening electrolyte imbalance involving hyponatremia (low sodium) and hyperkalemia (high potassium). Since proper electrolyte balance is necessary for muscle contraction and the heart is a muscle, this imbalance ultimately results in heart failure. A while back I promised to write about salt wasting, so for those who are interested here is some additional background information. The most critical function of the kidneys is to maintain blood volume. Next most important is to maintain electrolyte (sodium/potassium) balance. Low blood volume is detected in the kidneys which respond by releasing renin. In a series of steps renin causes an increase in the levels of a hormone called Angiotensin II which: Inhibits further renin release Constricts arterioles (small blood vessels) Stimulates aldosterone secretion by the adrenal cortex Aldosterone is the hormone that causes the kidneys to retain sodium and excrete potassium. Normally if blood volume is low, a person feels thirsty and drinks more water. If the increased water intake causes the sodium concentration in the blood to drop, renin levels will go up, causing the adrenals to synthesize aldosterone and thus causing salt retention. There may also be a craving to eat something salty. Alternatively, if a normal person has consumed excess salt, renin production is turned off and the excess salt is simply lost in the urine. Most people are able to maintain a good salt/water balance by this mechanism. Salt wasters also will produce renin in response to a fall in blood pressure but their adrenal glands don't respond by producing aldosterone. Just as in the case of cortisol, when the adrenals are stimulated to make aldosterone but can't, 17-OH progesterone accumulates. Florinef performs the same function as aldosterone. The only problem with florinef is that it isn't turned off once it has done its job. If florinef prevents the body from dumping excess salt, the result is hypertension. This is why it is important for someone on florinef to closely monitor their blood pressure and get a feel for the relationship between their salt intake, their florinef dosage and their blood pressure. One final note, unlike prednisone and dexamethasone, hydrocortisone (Cortef) has some salt retaining activity. I hope this answered your questions. Joan