Estimation of ACTH reserve on normal and hypopituitary subjects: Comparison of oral and intravenous metyrapone with insulin hypoglycemia

B. S. Keenan, I. Z. Beitins, P. A. Lee, A. Kowarski, R. M. Blizzard, C. J. Migeon

Research output: Contribution to journalArticle

Abstract

Pituitary adrenal reserve was evaluated in control and idiopathic hypopituitary (IH) subjects using the plasma 11 deoxycortisol response to a 4 hr infusion of metyrapone, the urinary 17 hydroxycorticosteroid (17 OHCS) response to oral metyrapone and the plasma corticoid response during a combined arginine insulin tolerance test (AITT). In the iv metyrapone test, mean (±SD) 11 deoxycortisol values in μg/100 ml for control subjects (N = 16) are: 0 hr = 0.8 ± 0.5; 4 hr = 5.4 ± 1.8; 5 hr = 5.9 ± 1.5. For IH patients untreated with corticosteroids (N = 9) the corresponding values were: 1.5 ± 1.3; 7.9 ± 4.1; and 8.5 ± 4.3, respectively. All of the control and 8 of 9 IH subjects showed significant positive responses. Six of the IH subjects had abnormal oral metyrapone tests on at least 1 occasion. During the AITT, mean values (±SD) in μg/100 ml for control subjects (N = 10) were: baseline = 9.3 ± 4.8; 45 min after insulin = 20.3 ± 4.5; 60 min after insulin = 23.9 ± 4.7. Corresponding values in untreated IH subjects (N = 9) were 11.0 ± 3.3; 23.7 ± 4.7; and 27.0 ± 6.7. All control and IH subjects had significant positive responses to the AITT. Two patients with organic hypopituitarism and 1 IH patient treated with cortisone failed to respond to any of these stimuli. These data suggest that IH patients with abnormal oral metyrapone tests may have a mild defect in control of ACTH secretion which is overcome by more potent stimuli such as iv metyrapone or insulin induced hypoglycemia. The latter 2 may be more useful in assessing the need for corticoid replacement.

Original languageEnglish (US)
Pages (from-to)540-549
Number of pages10
JournalJournal of Clinical Endocrinology and Metabolism
Volume37
Issue number4
StatePublished - 1973

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Metyrapone
Hypoglycemia
Adrenocorticotropic Hormone
Insulin
Cortodoxone
Arginine
Adrenal Cortex Hormones
17-Hydroxycorticosteroids
Plasmas
Hypopituitarism
Cortisone
Defects

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

Estimation of ACTH reserve on normal and hypopituitary subjects : Comparison of oral and intravenous metyrapone with insulin hypoglycemia. / Keenan, B. S.; Beitins, I. Z.; Lee, P. A.; Kowarski, A.; Blizzard, R. M.; Migeon, C. J.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 37, No. 4, 1973, p. 540-549.

Research output: Contribution to journalArticle

Keenan, B. S. ; Beitins, I. Z. ; Lee, P. A. ; Kowarski, A. ; Blizzard, R. M. ; Migeon, C. J. / Estimation of ACTH reserve on normal and hypopituitary subjects : Comparison of oral and intravenous metyrapone with insulin hypoglycemia. In: Journal of Clinical Endocrinology and Metabolism. 1973 ; Vol. 37, No. 4. pp. 540-549.
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