Assessment of hypothalamic-pituitary-adrenal (HPA) axis dysfunction: comparison of ACTH stimulation, insulin-hypoglycemia and metyrapone.
The response to ACTH stimulation, insulin-hypoglycemia and metyrapone in patients with suspected HPA axis dysfunction due to corticosteroid therapy (Group I, n = 10), or pituitary surgery (Group II, n = 7) and in a control population (Group III, n = 8) was studied. Group I patients had been maintained on a stable low dose of prednisone 5.0-7.5 mg/day for 1 month-16 yr (mean = 31 mos) prior to testing. Basal 08:00 h cortisol levels in this group were not different from control values. However, the mean responses to all three testing procedures were suppressed (Group I vs III, ACTH p less than 0.001, insulin p less than 0.01, metyrapone p less than 0.05). Group II patients had undergone surgery 1-26 months (mean = 10 mo) prior to testing and had been maintained subsequently on a stable dose of prednisone 5.0-7.5 mg/day. In this group basal mean 08:00 h cortisol and the cortisol response to ACTH and insulin-hypoglycemia were not significantly different from control values while the response to metyrapone was suppressed (Group II vs III p less than 0.02). Basal serum DHEA-S levels were suppressed in both Groups I and II when compared to Group III (p less than 0.001). Discordant responses to the three testing procedures were noted in 6 patients with suspected HPA dysfunction with abnormal test results in 1/6 using cortrosyn, 3/6 using insulin-hypoglycemia and 4/6 using metyrapone.(ABSTRACT TRUNCATED AT 250 WORDS)
Hartzband
P I
PI
UCLA School of Medicine, Department of Medicine 90024.
Van Herle
A J
AJ
Sorger
L
L
Cope
D
D
D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000309:Adrenal Insufficiency / Q000097:blood* / Q000209:etiology; D000324:Adrenocorticotropic Hormone; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D003350:Cortodoxone / Q000097:blood; D003687:Dehydroepiandrosterone / Q000031:analogs & derivatives / Q000097:blood; D019314:Dehydroepiandrosterone Sulfate; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007027:Hypothalamic Diseases / Q000150:complications*; D007328:Insulin; D008297:Male; D008797:Metyrapone; D008875:Middle Aged; D010900:Pituitary Diseases / Q000150:complications*; D011241:Prednisone / Q000009:adverse effects
D000305:Adrenal Cortex Hormones; D001786:Blood Glucose; D007328:Insulin; D003687:Dehydroepiandrosterone; D000450:Aldosterone; D019314:Dehydroepiandrosterone Sulfate; D000324:Adrenocorticotropic Hormone; D011241:Prednisone; D003350:Cortodoxone; D006854:Hydrocortisone; D008797:Metyrapone