Pituitary function tests: comparison of ACTH and 11-deoxy-cortisol responses in the metyrapone test and with the insulin hypoglycemia test.

H Steiner, V Bähr, P Exner, P W Oelkers
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引用次数: 54

Abstract

Purpose: To compare the sensitivity of ACTH and 11-deoxy-cortisol (comp. S) responses in the short metyrapone test and the latter with the insulin hypoglycemia test.

Methods: Retrospective evaluation of 115 short metyrapone tests and comparison of 18 pairs of metyrapone and insulin tests. 20 healthy controls and 95 patients with confirmed pituitary disease were studied. All hormones were measured by sensitive radioimmunoassays.

Results: In patients with pituitary disease not requiring hydrocortisone substitution (n = 70), the ACTH response in the metyrapone test was subnormal in 47 cases (< 33 pmol/L), the comp. S response (< 200 nmol/L) in 21 cases only. Comparison of the relationship between ACTH and comp. S with an ACTH-cortisol dose-response curve obtained in normal subjects shows that subnormal ACTH responses after metyrapone in the range between 13 and 33 pmol/L still generate normal comp. S responses. The results of the metyrapone test correlated significantly with those of the insulin test.

Conclusions: Measuring plasma ACTH in the scope of the metyrapone test makes the test more sensitive to detect secondary adrenal insufficiency than with steroid measurements alone. Results of the metyrapone test correlate significantly with the cortisol response to insulin hypoglycemia.

垂体功能试验:甲替拉酮试验和胰岛素低血糖试验中ACTH和11-脱氧皮质醇反应的比较
目的:比较短时间美替拉酮试验和短时间美替拉酮与胰岛素低血糖试验中ACTH和11-脱氧皮质醇(comp. S)的敏感性。方法:回顾性评价115例短时间美替拉酮试验,比较18对美替拉酮与胰岛素试验。研究对象为20名健康对照者和95名确诊垂体疾病患者。所有激素均采用灵敏放射免疫测定法测定。结果:在不需要氢化可的松替代的垂体疾病患者(n = 70)中,47例甲替松试验中ACTH反应低于正常(< 33 pmol/L),仅21例ACTH反应< 200 nmol/L。将正常受试者ACTH与comp. S的关系与ACTH-皮质醇的剂量反应曲线进行比较,发现在13 ~ 33 pmol/L范围内,甲替拉酮作用后ACTH的亚正常反应仍能产生正常的comp. S反应。美替拉酮试验结果与胰岛素试验结果显著相关。结论:在美替拉酮试验范围内测量血浆ACTH使该试验对继发性肾上腺功能不全的检测比单独使用类固醇测量更敏感。美替拉酮试验结果与胰岛素低血糖时皮质醇的反应显著相关。
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