Critical Evaluation of the 5-Day Metyrapone Test

Leisti, Seppo; Perheentupa, Jaakko

doi:10.1159/000178775

Cited by 4 publications

(2 citation statements)

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“…This index is called 'relative maximal excretion' (RME). Setting the 90% confidence interval of RME in the reference series for the normal range gave the best discrimination of the ACTH-deficient subjects from the reference subjects (Leisti & Perheentupa, 1977a).…”

Section: Methodsmentioning

confidence: 99%

Evaluation of 3 Hour Metyrapone Test in Children and Adolescents

Leisti

1977

Clinical Endocrinology

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An evaluation of a new 3 h metyrapone test is presented. The test consists of one oral dose of metyrapone given at 08.00-09.00 hours, and determination of plasma deoxycortisol from a single capillary blood sample taken 3 h later. The test has been assessed in children and adolescents in conjunction with a 5 day metyrapone test, insulin test, vasopressin test, and ACTH test in forty-five reference subjects, in thirty-six hypopituitary subjects with normal or deficient ACTH secretion, in three subjects with primary adrenocortical disease and in ten subjects prior to and after pharmacological prednisone medication. During the first hour after metyrapone the plasma cortisol level decreased to almost the low level maintained for the rest of the 3 h period. The plasma deoxycortisol concentration was basally less than or equal to 35 nmol/l and increased continuously during the 3 h period to the mean level of 299 (95% confidence interval 133-669) nmol/l in the reference subjects. The new test proved to be as accurate as the insulin test in detecting ACTH deficiency. No significant rise was observed in the plasma somatotrophin (GH) level in those children who had a normal GH response to insulin hypoglycaemia.

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Section: Methodsmentioning

confidence: 99%

Evaluation of 3 Hour Metyrapone Test in Children and Adolescents

Leisti

1977

Clinical Endocrinology

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“…Birke and his coworkers (5) observed a similar correlation in the urinary excretion of cortisol metabolites after 8-hr ACTH infusion and allowed for it in establishing the criteria of a normal response. Such a correlation also appears in the 5-day metyrapone test (29). If the variation in the stimulated level were causally dependent on the variation in the basal level, the regression of the stimulated level on the basal level would have to be considered in defining the criteria.…”

Section: Comparison Of Responses To Aci'h Amentioning

confidence: 97%

Two-hour Adrenocorticotropic Hormone Test: Accuracy in the Evaluation of the Hypothalamic- Pituitary-Adrenocortical Axis

Leisti

Perheentupa

1978

Pediatr Res

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Summary subnormal basal and stimulated levels. Thus the ACTH test didThe inter-and intraindividual variations of response to an iv not diierentiate this state from ACTH deficiency.bolus of tetracosactide (0.25 mgl1.73 m2) were studied, and a definitive diagnostic 2-hr test was established. The test was Speculation given to 179 subjects: hypopituitary, prednisone-treated nephrotics, patients with the autoimmune polyendocrinopathyWhen the Witeria for a in the 2-hr iv ACTH candidinsis syndrome (APECS), and reference subjects. ~t was test have been carefully established, this test will serve as a repeated in 62 cases and the total of 84 test pairs was analyzed. definitive procedure for the diagnosis and follow-up of states me test was either at 8-9 AM or at 10-11 AM, 2 hr associated with ACTH deficiency, as well as in primary diseases after the injection of insulin for an insulin test. Thirty subjects of the adrenal cortex. Like the other ACTH tests, however, it had both the A~H test and the i n s u l i n -~~~H test. capillary will not diierentiate with certainty between primary and secondblood samples for fluorometric determination of plasma cortisol ary adrenOcOrtical were taken 1 , 2 , and 3 hr after the injection.The distributions of the basal and stimulated levels were positively skewed, and log transformation of the data gaveIn the diagnosis of adrenocortical failure, stimulation with a clearly more appropriate statistics. In most subjects the single dose of exogenous ACTH with determination of the level was highest 2 hr &ter the injection. There was no swifiresponse in plasma cortisol level has partly replaced longer tests. cant difference in the response to ACTH whether it was Bven The shortest test in wide use consists of an im or iv injection of alone or in the insulin-ACTH test. All the poststimulation the 1-24 peptide (20,24,38) and determination of plasma cortisol levels showed a positive interindividual correlation with cortisol before and 30 min after the injection (4, 11, 18, 37, 39, the basal levels, and all the increments a negative interindividual 41). However, this test is not accurate, and it is used mainly as correlation with the basal levels.a screening procedure, with variable criteria for a normal reIn repented tests, the intraindividunl variation in the responses sponse. In none of the 1 to 3-hr tests so far introduced have was &redly correlated with the level of the response, and this criteria for a normal response been adequately established on a correlation could be removed by dividing the intrapair difference theoretically sound basis (23, 3 1-33, 35, 42). We have made a in the values of the parameters by the sum of the values for careful evaluation of a 2-hr ACTH test, which we here propose percentage of intrapair difference (PIPD). m e SD of the for a definitive diagnostic procedure. A preliminary report has distribution of PIPDs was used for an index of precision. The 2-appeared (28). hr cortisol level was substantially more precise than either the basal level or the increment. In an...

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