Robert L. Lebowitz, M.D. Children' s Hospital, Harvard Medical School Boston, Massachusetts

This boy presented with urosepsis (urinary tract infection with fever) and was thought to have adrenogenital syndrome of the salt-losing type because on admission, his serum sodium was 114 (normal 140) even though he had normal genitalia and normal descended testes. Evaluation showed bilateral grade 4-5 reflux (figure 1). His urethra was normal. His "salt-losing state" was due to urinary infection causing transient unresponsiveness of the distal renal tubules to aldosterone. Once the infection was treated, his metabolic problems disappeared and he had bilateral ureteral reimplants. (Urosepsis in infants with vesicoureteral reflux masquerading as the salt-losing type of congenital adrenal hyperplasia. Pediatr Radiol 1989; 19:548-550