title: Dynamics of Adrenocorticotropin after Application of Metyrapone.
abstract: Purpose:To investigate the kinetics of adrenocorticotropin (ACTH) following oral metyrapone administration and describe differences between ACTH-deficient and non-ACTH-deficient subjects.Methods:Patients from a tertiary endocrine center at a University Hospital in Munich, Germany, were tested for secondary adrenal insufficiency in a regular patient care setting. Metyrapone (Metopirone, HRA Pharma, France) was administered with a dosage of 40 mg/kg bodyweight at 8 a.m. Consecutive levels of ACTH were determined at 0, 60, 120, 180, and 240 min. Patients were categorized according to their need of glucocorticoid substitution in the follow-up phase.Results:A significant rise in ACTH concentration compared to basal values was found at 60 and 120 min following oral metyrapone administration. ACTH concentrations at 60 and 120 min predicted patients without need for glucocorticoid substitution. ACTH concentrations determined later had no additional benefit.Conclusion:In contrast to previous reports, we found a significant rise in ACTH concentration as soon as one hour after oral metyrapone administration. ACTH values seem to estimate the pituitary corticotrophic function when correlating results to the further clinical course of subjects. Further studies are needed to investigate this finding as a potential basis for a ACTH-based metyrapone short test protocol.
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, TU München, Munich.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Noe
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, TU München, Munich.
authors.forename: Alexander
authors.initials: A
authors.lastname: von Werder
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, TU München, Munich.
authors.forename: Roman
authors.initials: R
authors.lastname: Iakoubov
authors.affiliation: Institut für Klinische Chemie und Pathobiochemie, Klinikum rechts der Isar, TU München, Munich.
authors.forename: Heike
authors.initials: H
authors.lastname: Schneider
authors.affiliation: Institut für Klinische Chemie und Pathobiochemie, Klinikum rechts der Isar, TU München, Munich.
authors.forename: Markus
authors.initials: M
authors.lastname: Thaler
authors.affiliation: Institut für Klinische Chemie und Pathobiochemie, Klinikum rechts der Isar, TU München, Munich.
authors.forename: Peter
authors.initials: P
authors.lastname: Luppa
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, TU München, Munich.
authors.forename: Bruno
authors.initials: B
authors.lastname: Neu
mesh_terms: D000284:Administration, Oral; D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007018:Hypopituitarism / Q000097:blood / Q000188:drug therapy; D008297:Male; D008797:Metyrapone / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D008875:Middle Aged; D062606:Tertiary Care Centers
chemical_list: D000324:Adrenocorticotropic Hormone; D008797:Metyrapone