cortodoxone and Pituitary-Diseases

The 1 microgram ACTH stimulation test has been advocated as a sensitive indicator of the integrity of the hypothalamic-pituitary-adrenal axis in patients with suspected hypopituitarism. The aim of our study was to define the normal response to 1 microgram ACTH stimulation in a control population and to study the sensitivity and specificity of the test in a group of patients with suspected pituitary disease.. A prospective analysis of the performance of the 1 microgram ACTH stimulation test in a group of patients with pituitary disease.. The cortisol response to 1 microgram ACTH was evaluated in 21 normal subjects and 65 patients with pituitary disease. The patients with pituitary disease were divided into two groups according to the 11-deoxycortisol response to overnight metyrapone: normal (11-deoxycortisol > 200 nmol/l) and subnormal ACTH secretory status (11-deoxycortisol < 200 nmol/l).. In both controls and patients, blood was sampled for cortisol at - 15, 0, + 20, + 30, + 40 and + 60 minutes after intravenous administration of 1 microgram synthetic ACTH (Synacthen(R)). The overnight metyrapone test was performed only in the subjects with pituitary disease. Metyrapone (30 mg/kg) was administered orally at 2300 h and blood was sampled at 0830 h the following morning for 11-deoxycortisol.. The 65 patients with pituitary disease were categorized according to the 11-deoxycortisol response to metyrapone as follows: 53 normal (11-deoxycortisol > 200 nmol/l) and 12 subnormal (< 200 nmol/l). The 12 patients who failed the metyrapone test had a significantly impaired cortisol response to low dose ACTH stimulation at all time points when compared with both the control group and the pituitary patients with a normal response to metyrapone (P < 0.001). Comparing the pituitary patients who had a normal response to metyrapone and the control subjects, there was no significant difference in the cortisol response to ACTH (P > 0.05). The minimum cortisol response at 30 minutes in the 21 control subjects was 414 nmol/l and this was defined as the minimum normal cortisol response to 1 microg ACTH. Using this criterion, six of the 12 patients with a subnormal response to metyrapone had a normal cortisol response to low dose ACTH stimulation. Empirically increasing the cortisol cut-off to 600 nmol/l increased the sensitivity of the low dose ACTH test to 83%, although the specificity was reduced from 100% to only 58%.. The normal cortisol response to low dose ACTH stimulation in 50% of the patients with ACTH deficiency proven on metyrapone testing suggests that the 1 microgram ACTH stimulation test, like the 250 microgram-test, lacks sensitivity for the diagnosis of ACTH deficiency.

Topics: Adult; Case-Control Studies; Cortodoxone; Cosyntropin; Female; Humans; Hydrocortisone; Male; Metyrapone; Middle Aged; Pituitary Diseases; Reference Values; ROC Curve; Sensitivity and Specificity; Stimulation, Chemical

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.. 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.. 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.. 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.

Topics: Adrenocorticotropic Hormone; Adult; Aged; Aged, 80 and over; Blood Glucose; Cortodoxone; Female; Humans; Insulin; Male; Metyrapone; Middle Aged; Pituitary Diseases; Retrospective Studies

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)

Topics: Adrenal Cortex Hormones; Adrenal Insufficiency; Adrenocorticotropic Hormone; Adult; Aged; Aldosterone; Blood Glucose; Cortodoxone; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Female; Humans; Hydrocortisone; Hypothalamic Diseases; Insulin; Male; Metyrapone; Middle Aged; Pituitary Diseases; Prednisone

In normal subjects, plasma pregnenolone sulfate (PS) levels high at birth, decreased during the first year of life in relation to the pattern of involution of the fetal adrenal zone. Thereafter, PS levels, in contrast with those of DHAS, did not show the abrupt rise characteristic of the adrenarche, but increased very progressively till adulthood. The response of PS to various provocative tests of adrenal and pituitary function (ACTH and Metyrapone stimulation, dexamethasone suppression), has been established in normal subjects. The measurement of plasma PS levels in basal conditions as well as in response to dynamic tests was very useful in the diagnosis of various adrenal and pituitary diseases in children.

Topics: Adolescent; Adrenal Gland Diseases; Adrenal Insufficiency; Adrenocorticotropic Hormone; Aging; Child; Child, Preschool; Cortodoxone; Dexamethasone; Female; Humans; Hydrocortisone; Infant; Metyrapone; Pituitary Diseases; Pregnenolone

In a retrospective study on 59 patients (2 hypothalamic, 44 pituitary, 13 no confirmed disease) 69 pairs of insulin hypoglycemia tests (IHT) and short metyrapone tests (SMT) were evaluated. Cortisol and 11-desoxy-cortisol rsp. were compared as the endpoints. In 6 cases, the IHT was a technical failure because of insufficient hypoglycemia. In 25% of 63 pairs of tests, both tests were normal, (Group I), in 30% both abnormal (Gr. II). In 21%, IHT was normal, SMT abnormal (Gr. III) and in 24% IHT was abnormal and SMT normal (Gr. IV). The 2 patients with hypothalamic disease were in Group IV with completely normal SMT and severely pathological IHT. Other discrepancies could not be attributed to special pituitary disorders. In 9 patients of Group III and in 8 patients of Group IV (n = 17), the IHT alone was repeated 6-48 months after the original pair of tests which had been performed in most cases early after pituitary surgery. In 12 cases, the repeat IHT followed the trend of the SMT of the original test pair. In 5 cases, the IHT was unchanged. 14 of 19 patients of Group II, but only 5 of 28 patients of Group III and IV required permanent substitution with hydrocortisone.

Topics: Blood Glucose; Cortodoxone; Female; Humans; Hydrocortisone; Hypothalamic Diseases; Insulin; Male; Metyrapone; Pituitary Diseases

Serum 11-deoxycortisol (S) determination has been used to evaluate the pituitary adrenal response to the short metyrapone (MTP) test. The validity of this indirect evaluation of corticotrophin ACTH reserve has been questioned since the MTP-induced S elevation may reflect a passive accumulation rather than an ACTH activated adrenal response. The purpose of this study was to evaluate the usefulness of serum beta-lipotrophin (beta-LPH) measurement during the short midnight MTP test (30 mg/kg body weight) in patients with pituitary diseases (n = 36) and in patients with Cushing's syndrome (n = 8). In 28/36 patients with pituitary diseases both S and beta-LPH concentrations were increased normally by MTP. In 8/36 patients the beta-LPH response was lacking, while their serum S concentrations increased significantly. The absence of beta-LPH response to MTP in these 8 patients was in good agreement with the diagnosis of ACTH insufficiency because in 7 of them the cortisol response to insulin induced hypoglycaemia was also insufficient. In the 8 patients with Cushing's syndrome serum S concentration increased following MTP administration in all the cases. In 2 with adrenal adenoma the increase of S level was an ACTH-independent phenomenon, since beta-LPH level was undetectable both before and after MTP administration. In 2 patients with ectopic ACTH secretion, the basal beta-LPH concentrations were high and remained unmodified by MTP administration. In the 4 patients with Cushing's disease, MTP administration resulted in a dramatic increase of beta-LPH concentration. We conclude that beta-LPH measurement improves the utility of the short MTP test for investigation of pituitary adrenal function.

Topics: Adrenocorticotropic Hormone; Adult; beta-Lipotropin; Cortodoxone; Cushing Syndrome; Female; Humans; Insulin; Male; Metyrapone; Middle Aged; Pituitary Diseases; Pituitary-Adrenal System

Twelve patients (10 women and 2 men) with a primary empty sella turcica were studied. Endocrine function tests were performed as follows: growth hormone (GH) was measured after insulin-induced-hypoglycaemia, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) after LH-releasing hormone, thyrotrophin (TSH) and prolactin after thyrotrophin-releasing hormone; pituitary reserve of adrenocorticotrophin (ACTH) was determined by measurement of plasma cortisol after lysine-vasopressin and 11 deoxycortisol after metyrapone. Five of the patients (group A) had no endocrine disturbance. Seven patients (group B) had a hypothalamo-pituitary disorder. Two of them had panhypopituitarism which appeared in one case after meningoencephalitis and in the other after a severe cranial trauma. In two cases an amenorrhoea-galactorrhoea syndrome with increased prolactin level (68 and 230 ng/ml) led to a diagnosis of a prolactin producing adenoma, which was confirmed by surgery. Finally three cases of amenorrhoeagalactorrhoea, with normal prolactin level, and/or diabetes insipidus remained unexplained. However, no causal relationship could be demonstrated between the pituitary disturbance and the "empty sella". Primary empty sella turcica is therefore a neuroanatomical and neuroradiological entity with no endocrine implication. A pituitary disorder might suggest a microadenoma or an incidentally associated disease.

Topics: Adolescent; Adrenal Glands; Adult; Cortodoxone; Diabetes Insipidus; Estradiol; Female; Follicle Stimulating Hormone; Growth Hormone; Humans; Hydrocortisone; Hypopituitarism; Luteinizing Hormone; Male; Menstruation Disturbances; Middle Aged; Ovary; Pituitary Diseases; Pituitary Gland; Pituitary Gland, Anterior; Prolactin; Sella Turcica; Testis; Testosterone; Thyroid Gland; Thyroxine

In this paper the clinical and laboratory-chemical methods of a metopiron short test at midnight are described. In addition to this the results after a conceptional metopiron longtime test and a metopiron short test are compared in 40 endocrinologically healthy persons. It was shown that, compared with the long-term test, in the metopiron short test at midnight no reduction of the informations and of the exactness of the results appears. Since the isolated determination of the increase of substance S after metopiron reveals a relatively broad area of distribution in literature the interpretation normal-pathological is problematic. Therefore it is tried to obtain an improved evidence in the test with the help of an interpretation quotient Q which establishes the variables measured in the regulating circle of the adrenocortico-pituitary system (decrease of the 11-hydrocorticosteroid and increase of the 11-desoxycorticosol in the plasma after application of metopiron, r = 0,96 shown a very good correlation of these two sizes). After utilization of the method of interpretation in persons with different diseases of endocrinological and nonendocrinological etiology the results were in every case good classifications into the areas normal, with limiting value and phathological. The classification of the individual clinical pictures with the help of the interpretation mode mentioned is discussed. Finally the advantages and disadvantages of the used method are compiled.

Topics: 11-Hydroxycorticosteroids; 17-Hydroxycorticosteroids; Adrenal Gland Diseases; Cortodoxone; Humans; Hypothalamo-Hypophyseal System; Metyrapone; Pituitary Diseases; Time Factors