Best J D, Alford F P, Donald R A
Clin Endocrinol (Oxf). 1980 Jul;13(1):69-76. doi: 10.1111/j.1365-2265.1980.tb01024.x.
The prolonged metyrapone test is used to assess the hypothalamic-pituitary-adrenal axis. The dynamic responses of cortisol, ACTH and 11-deoxycortisol over the 3 h of the single morning dose metyrapone test have been examined in fourteen normal adult subjects. In every case there was a rapid, sustained fall in cortisol, but the resultant ACTH responses were extremely variable and in two subjects did not exceed values obtained during the control studies. The rise in 11-deoxycortisol was also variable and in several instances occurred without any significant elevation in ACTH. In these cases, the rise in 11-deoxycortisol may be due to a normal level of production of steroids with a shift from cortisol to 1-deoxycortisol induced by the metyrapone. Thus, the hypothalamic-pituitary-adrenal axis may not be adequately tested, and this together with the high incidence of unpleasant side effects, makes the 3 h oral metyrapone test unsatisfactory for routine use in adults.
延长甲吡酮试验用于评估下丘脑 - 垂体 - 肾上腺轴。在14名正常成年受试者中，对单次晨起剂量甲吡酮试验3小时内皮质醇、促肾上腺皮质激素（ACTH）和11 - 脱氧皮质醇的动态反应进行了检测。在每种情况下，皮质醇都迅速、持续下降，但由此产生的ACTH反应变化极大，有两名受试者的反应未超过对照研究期间获得的值。11 - 脱氧皮质醇的升高也各不相同，在一些情况下，ACTH没有任何显著升高时11 - 脱氧皮质醇就出现了升高。在这些情况下，11 - 脱氧皮质醇的升高可能是由于类固醇的正常生成水平，由甲吡酮诱导从皮质醇向1 - 脱氧皮质醇转变所致。因此，下丘脑 - 垂体 - 肾上腺轴可能未得到充分检测，再加上不良副作用的高发生率，使得3小时口服甲吡酮试验不适合在成人中常规使用。
