Single-dose metyrapone test at 06.00 h: an accurate method for assessment of pituitary-adrenal reserve

Abstract

One dose of metyrapone (1.5g) administered at 06.00 h, with subsequent measurement of 1 1 -d e o x ycortisol and 17-hydroxycort i cost eroi d (17-OHCS) levels in plasma at 12.00 and 14.00 h, allowed accurate assessment of the pituitary-adrenal reserve. Normal response was defined as achieving a serum 17-OHCS level of more than 10.0 \g=m\g/100 ml and a 11-deoxycortisol level of more than 6.0 \g=m\g/100 ml at either 12.00 or 14.00 h.These criteria are based on a group of 18 persons with normal pituitary-adrenal axis, and 86 additional cases responded in this normal range. In this group of 104 subjects, 11-deoxycortisol levels rose to 9.2 \ m=+-\ 3.5 \ g=m\ g/ 100 ml at noon and 17-OHCS levels to 15.4 \ m=+-\ 4.7 \g=m\g/100 ml at 14.00 h. Post-metyrapone 17-OHCS levels were significantly higher than normal cortisol levels at these times (P < 0.001) and than those observed at 08.00 h on the day of the test, demonstrating stimulation of adrenal corticoid production in addition to blockade of cortisol production by metyrapone. Thi rty\x=req-\ one patients found to suffer from secondary adrenal failure showed impaired response. All these patients had limited pituitary-adrenal reserve, either proven by other pituitary-adrenal tests or implicated by severe pituitary disease.The metyrapone test was introduced by Liddle et al. (1959) and has since been widely accepted as an accurate means of assessing pituitary-adrenal reserve. By blocking 11-ß-hydroxylation of steAddress requests for reprints to:

The effect of an inhaled steroid on the hypothalamic‐pituitary‐adrenal axis‐which tests should be used?

“…Administration of metyrapone can cause dizziness and nausea, but this can be reduced by giving milk with the dose and advising the subject to lie slill for an hour. The single-dose metyrapone test at 0600 hr is preferable to the more complicated multiple-dose tests and has been shown to be more effective than the midnight dosing methods [6]. In the present study, the single-dose metyrapone test at 0600 hr showed a reduced response, with an appreciably lower degree of recovery from the metyrapone-induced hypocortisolaemia, during dosing with inhaled beclomethasone dipropionate.…”

“…Normal values for the single-dose metyrapone test have been determined as plasma I l-deoxycortisot >173 nmol/I. and summated plasma 11-deoxycortisol and cortisol > 283 nmol/1 at 1200 or 1400 hr [6]. By these criteria, five of the six subjects in our study, during steroid treatment only, had abnormally low plasma 11-deoxycortisol.…”

“…U.K.) administered intramuscularly. The single-dose metyrapone test [6] commenced with the oral administration of 1-5 g metyrapone (Metopirone, Ciba. Horsham, U.K.) at 0600 hr.…”

Comparison of Adrenocorticotropin and Adrenal Steroid Responses to Corticotropin-Releasing Hormone Versus Metyrapone Testing in Patients with Hypopituitarism

“…The shorter, more widely used singledose metyrapone test (17) was not used in this study because very mild or subtle forms of ACTH deficiency may not be detected by this test (15) and reported data of normal subjects were limited to adults (18,19). The longer, multiple-dose metyrapone test would allow a more definitive assessment of ACTH reserve status for comparison with CRH testing.…”

Prednisolone metasulphobenzoate foam retention enemas suppress the hypothalamo‐pituitary‐adrenal axis

“…to 288 +252 nmol/L. P < 0.02; stimulated mean plasma 11-deoxycortisol concentration fell from 6 77 & 3 3 3 to 407k 326 nmol/L, P < 0.01. Mean fasting plasma glucose, insulin, C-peptide, fructosamine and triglyceride concentration were unchanged, whilst the mean serum cholesterol concentrations rose from 5.6+ 7 .I to 6.0+ 1.2 mmol/L (not significant).…”