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Metyrapone test in Cushing's disease.

The Journal of Clinical Endocrinology and Metabolism

|March 1, 1975

Summary

The modified metyrapone test for Cushing's syndrome is unreliable. Standard metyrapone testing shows a significantly higher urinary 17-hydroxycorticosteroid response than the modified 2g dose test.

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Area of Science:

Endocrinology
Clinical Chemistry

Background:

Cushing's syndrome is a hormonal disorder caused by prolonged exposure to high cortisol levels.
Accurate diagnostic testing is crucial for effective management of Cushing's syndrome.

Purpose of the Study:

To compare the diagnostic accuracy of a modified metyrapone test with the standard metyrapone test for Cushing's syndrome.
To evaluate the reliability of a single 2g oral dose of metyrapone administered at 10 PM.

Main Methods:

The study involved 3 patients with Cushing's disease, each undergoing both the modified and standard metyrapone tests on four separate occasions.
Urinary 17-hydroxycorticosteroid excretion was measured to assess the response to metyrapone administration.

Main Results:

The modified metyrapone test yielded significantly lower increments in urinary 17-hydroxycorticosteroid excretion compared to the standard test.
Response to the modified test was marginal in most studies, ranging from 10.7% to 44% of the standard test results.
Considerable variation in urinary steroid excretion was observed within patients, highlighting potential diagnostic challenges.

Conclusions:

The modified metyrapone test is not recommended for evaluating Cushing's syndrome due to its unreliability.
The standard metyrapone test remains the preferred method for diagnosing Cushing's syndrome.
The modified test may lead to erroneous diagnostic conclusions.

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