Steiner H, Bähr V, Exner P, Oelkers P W
Department of Internal Medicine, Klinikum Steglitz, Freie Universität Berlin, Germany.
Exp Clin Endocrinol. 1994;102(1):33-8. doi: 10.1055/s-0029-1211262.
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.
比较短程甲吡酮试验中促肾上腺皮质激素（ACTH）和11-脱氧皮质醇（化合物S）反应的敏感性，并将后者与胰岛素低血糖试验进行比较。
对115次短程甲吡酮试验进行回顾性评估，并比较18对甲吡酮试验和胰岛素试验。研究了20名健康对照者和95名确诊为垂体疾病的患者。所有激素均通过灵敏的放射免疫测定法进行检测。
在不需要氢化可的松替代治疗的垂体疾病患者（n = 70）中，甲吡酮试验中ACTH反应低于正常的有47例（< 33 pmol/L），而化合物S反应低于正常的仅21例（< 200 nmol/L）。将ACTH与化合物S之间的关系与正常受试者获得的ACTH-皮质醇剂量反应曲线进行比较表明，甲吡酮后ACTH反应低于正常水平在13至33 pmol/L之间时，仍可产生正常的化合物S反应。甲吡酮试验的结果与胰岛素试验的结果显著相关。
在甲吡酮试验范围内测量血浆ACTH，使该试验比仅测量类固醇更能敏感地检测继发性肾上腺皮质功能不全。甲吡酮试验的结果与胰岛素低血糖引起的皮质醇反应显著相关。
