Comparison of adrenocorticotropin and adrenal steroid responses to corticotropin-releasing hormone versus metyrapone testing in patients with hypopituitarism.
We compared the responses of ACTH and cortisol (F) to corticotropin-releasing hormone (CRH) administration (ovine 1 microgram/kg i.v. bolus) with the responses of urinary 17-OH corticosteroids (17-OHCS) and serum deoxycorticosterone (DOC) to metyrapone administration (450 mg/m2/dose every 4 h x seven doses) in 16 hypopituitary patients. Glucocorticoid therapy for these patients was withheld for a minimum of 3 wk before testing. The CRH test was performed 3 d before or 3 wk after the metyrapone test was used to diagnose the ACTH reserve status. In nine ACTH-intact hypopituitary patients (post-metyrapone 17-OHCS > 12.2 mumol/m2/d; DOC > or = 11.5 nmol/L), the peak F (497-773 nmol/L) and ACTH (5.2-22 pmol/L) responses to CRH stimulation were similar to those of normal subjects (F peak = 554-993 nmol/L and ACTH peak = 6-25 pmol/L at 15-60 min). In one patient with partial ACTH deficiency (postmetyrapone 17-OHCS = 10.5 mumol/m2/d; DOC = 6 nmol/L), the peak F response was low and delayed (246 nmol/L at 180 min) and the peak ACTH response was normal (7 pmol/L). Six severely ACTH-deficient patients (postmetyrapone 17-OHCS < 5.4 mumol/m2/d; DOC < or = 3.4 nmol/L) had a low F response at 15-90 min in all, with a delayed rise in three at 120-180 min in response to CRH administration, whereas ACTH responses were variable: absent or low, normal, delayed, or persistently exaggerated. In conclusion, the CRH-stimulated F response pattern in hypopituitary patients was comparable to the urinary 17-OHCS and serum DOC response to metyrapone administration.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Pediatrics, University of Illinois, College of Medicine at Chicago 60612.
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Riddick
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Chrousos
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Jeffries
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Pang
D015065:17-Hydroxycorticosteroids / Q000652:urine; D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000097:blood* / Q000172:deficiency; D002648:Child; D002675:Child, Preschool; D003346:Corticotropin-Releasing Hormone; D003900:Desoxycorticosterone / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007018:Hypopituitarism / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000502:physiology; D008297:Male; D008797:Metyrapone; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000502:physiology
D015065:17-Hydroxycorticosteroids; D003900:Desoxycorticosterone; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone; D008797:Metyrapone