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

Bruce S. Keenan, Inese Z. Beitins, Peter A. Lee, Avinoam Kowarski, Robert M. Blizzard, Claude J. Migeon

Research output: Contribution to journalArticle

18 Citations (Scopus)

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 (± S D) 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 d= 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
DOIs
StatePublished - Oct 1973

Fingerprint

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

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Keenan, Bruce S. ; Beitins, Inese Z. ; Lee, Peter A. ; Kowarski, Avinoam ; Blizzard, Robert M. ; Migeon, Claude 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.
@article{e4edfb2644164aae8a74cffcf582899d,
title = "Estimation of ACTH reserve on normal and hypopituitary subjects: Comparison of oral and intravenous metyrapone with insulin hypoglycemia",
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 (± S D) 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 d= 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.",
author = "Keenan, {Bruce S.} and Beitins, {Inese Z.} and Lee, {Peter A.} and Avinoam Kowarski and Blizzard, {Robert M.} and Migeon, {Claude J.}",
year = "1973",
month = "10",
doi = "10.1210/jcem-37-4-540",
language = "English (US)",
volume = "37",
pages = "540--549",
journal = "Journal of Clinical Endocrinology and Metabolism",
issn = "0021-972X",
publisher = "The Endocrine Society",
number = "4",

}

Estimation of ACTH reserve on normal and hypopituitary subjects : Comparison of oral and intravenous metyrapone with insulin hypoglycemia. / Keenan, Bruce S.; Beitins, Inese Z.; Lee, Peter A.; Kowarski, Avinoam; Blizzard, Robert M.; Migeon, Claude J.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 37, No. 4, 10.1973, p. 540-549.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Estimation of ACTH reserve on normal and hypopituitary subjects

T2 - Comparison of oral and intravenous metyrapone with insulin hypoglycemia

AU - Keenan, Bruce S.

AU - Beitins, Inese Z.

AU - Lee, Peter A.

AU - Kowarski, Avinoam

AU - Blizzard, Robert M.

AU - Migeon, Claude J.

PY - 1973/10

Y1 - 1973/10

N2 - 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 (± S D) 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 d= 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.

AB - 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 (± S D) 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 d= 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.

UR - http://www.scopus.com/inward/record.url?scp=0015909028&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0015909028&partnerID=8YFLogxK

U2 - 10.1210/jcem-37-4-540

DO - 10.1210/jcem-37-4-540

M3 - Article

C2 - 4355091

AN - SCOPUS:0015909028

VL - 37

SP - 540

EP - 549

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

SN - 0021-972X

IS - 4

ER -