Pituitary function tests: Comparison of ACTH and 11-deoxy-cortisol responses in the metyrapone test and with the insulin hypoglycemia test

Steiner, Hans; Bähr, V.; Exner, P.; Oelkers, P W

doi:10.1055/s-0029-1211262

Cited by 40 publications

(59 citation statements)

References 2 publications

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“…Children with CAI had higher levels of cortisol at 0730 h than children without CAI (P ϭ 0.08), as was previously reported (19). Levels did not differ at 2330, 0400, and 0600 h (P ϭ 0.2, P ϭ 0.4, and P ϭ 0.2, respectively).…”

Section: Adrenal Insufficiencysupporting

confidence: 82%

“…Of these 11 children with CAI, seven had 11-deoxycortisol levels below the classical cutoff level of 200 nmol/liter (16,17,19,21), suggesting that these children have CAI with adrenal atrophy. Four children had CAI with 11-deoxycortisol levels above 200 nmol/liter, suggesting that these patients have partial or no adrenal atrophy.…”

Section: Discussionmentioning

confidence: 99%

“…In 25 children, fasting blood samples were taken for the analysis of ACTH, 11-deoxycortisol, cortisol, and glucose at 0730 h (16,17,19) and in 16 children also at 2330, 0400, and 0600 h.…”

Section: Overnight Single-dose Metyrapone Testmentioning

confidence: 99%

“…The decline in plasma cortisol stimulates ACTH production. The cutoff level for an appropriate ACTH response is 33 pmol/liter at 0730 h (19). Those failing to achieve such an ACTH response are considered as having CAI (16, 17, 19 -21).…”

mentioning

confidence: 99%

See 3 more Smart Citations

High Prevalence of Central Adrenal Insufficiency in Patients with Prader-Willi Syndrome

Wijngaarden

Otten

Festen

et al. 2008

The Journal of Clinical Endocrinology &Amp; Metabolism

134

100

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Section: Adrenal Insufficiencysupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

“…In 25 children, fasting blood samples were taken for the analysis of ACTH, 11-deoxycortisol, cortisol, and glucose at 0730 h (16,17,19) and in 16 children also at 2330, 0400, and 0600 h.…”

Section: Overnight Single-dose Metyrapone Testmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

High Prevalence of Central Adrenal Insufficiency in Patients with Prader-Willi Syndrome

Wijngaarden

Otten

Festen

et al. 2008

The Journal of Clinical Endocrinology &Amp; Metabolism

134

100

View full text Add to dashboard Cite

show abstract

“…The use of this test has been challenging due to unavailability of metyrapone and risk of inducing an adrenal crisis. The variation in ACTH assays and availability of 11 deoxycortisol assays make this test a suboptimal modality for testing in these children (16,17).…”

Section: Dynamic Testing Of Hpa Axismentioning

confidence: 99%

Recovery of steroid induced adrenal insufficiency

Younes

2017

Transl. Pediatr

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Secondary adrenal insufficiency can result from insufficient stimulation of the adrenal glands due to inadequate secretion or synthesis of adrenocorticotropic hormone (ACTH). This can be caused by hypopituitarism, central nervous system injury (tumors, radiation, and surgery) or long-term glucocorticoid therapy. Glucocorticoids were introduced in the 1950s, and have been used for their anti-inflammatory and other pharmacological effects, and also as replacement therapy for adrenal insufficiency. However, chronic glucocorticoid use may lead to suppression of the hypothalamic pituitary adrenal axis through negative feedback. This may lead to secondary adrenal insufficiency. Typically, the hypothalamic pituitary adrenal axis recovers after cessation of glucocorticoids, but the timing of recovery can be variable and can take anywhere from 6-12 months. Understanding the effect of exogenous glucocorticoids on the hypothalamic pituitary adrenal axis, recovery of the axis, and tests used to assess the recovery, are crucial to avoid prescribing unnecessary steroid replacement or missing a critical diagnosis with detrimental consequences.

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Low Ambient Temperature and Neuroendocrine Response to Hypoglycemia in Men

et al. 1995

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Nutritional factors, such as an excess or a deficiency of glucose, play an important role in neuroendocrine regulations. Hormonal and metabolic responses to hypoglycemia were examined in healthy non-obese volunteers under conditions of low ambient temperature. Hypoglycemia was induced by intravenous injection of insulin in two randomized trials performed at room temperature and at 4 degrees C. At room temperature, the typical neuroendocrine response to hypoglycemia was established. The increases of ACTH, beta-endorphin, growth hormone and cortisol in response to insulin hypoglycemia failed to be modified by low ambient temperature. Acute cold exposure significantly reduced epinephrine and totally inhibited prolactin response to insulin-induced hypoglycemia. In spite of significant changes in epinephrine response to hypoglycemia at low ambient temperature, no striking differences in plasma glucose levels compared to those measured at room temperature were observed. However, under conditions of low temperature the reestablishment of normoglycemia was delayed. No changes in free fatty acids were found under our experimental conditions. The presented data show that low ambient temperature exerts selective effects on some neuroendocrine and metabolic parameters.

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Pituitary function tests: Comparison of ACTH and 11-deoxy-cortisol responses in the metyrapone test and with the insulin hypoglycemia test

Abstract: 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.

Cited by 40 publications

References 2 publications

High Prevalence of Central Adrenal Insufficiency in Patients with Prader-Willi Syndrome

High Prevalence of Central Adrenal Insufficiency in Patients with Prader-Willi Syndrome

Recovery of steroid induced adrenal insufficiency

Low Ambient Temperature and Neuroendocrine Response to Hypoglycemia in Men

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