Related Experiment Videos
Evaluation of single oral dose metyrapone tests in children with hypopituitarism
Insights
A single-dose metyrapone test reliably assesses pituitary-adrenal reserve in children with hypopituitarism. This short test effectively compares with prolonged metyrapone and insulin tolerance tests for evaluating adrenal function.
Area of Science:
- Pediatric Endocrinology
- Endocrinology
- Clinical Chemistry
Background:
- Hypopituitarism requires accurate assessment of pituitary-adrenal reserve.
- Traditional tests for adrenal function can be lengthy and invasive.
Purpose of the Study:
- To evaluate the efficacy of a single-dose metyrapone test in children with hypopituitarism.
- To compare the single-dose metyrapone test with prolonged metyrapone and insulin-induced hypoglycemia tests.
- To explore the relationship between test results and the etiology of hypopituitarism.
Main Methods:
- Compared 8 a.m. plasma 11-deoxycorticoid response (11-DOCS) after a single midnight oral metyrapone dose (short test) with prolonged metyrapone and arginine-insulin tests.
- Assessed 11-DOCS and cortisol levels in control and hypopituitary subjects.
- Analyzed correlation between baseline cortisol and 11-DOCS response.
Main Results:
- The short metyrapone test yielded comparable results to prolonged metyrapone tests in 25/27 patients.
- The short test results correlated well with the arginine-insulin test in 34/40 patients.
- Lower 11-DOCS response in the short test was observed in children with operated craniopharyngiomas compared to idiopathic hypopituitarism (p<0.001).
- Baseline cortisol positively correlated with 11-DOCS response (p<0.001).
Conclusions:
- The single-dose oral metyrapone stimulation test is a reliable and effective method for evaluating pituitary-adrenal reserve in children with hypopituitarism.
- The short test offers a practical alternative to more complex diagnostic procedures.
- Test results may provide insights into the underlying etiology of hypopituitarism.
Abstract:
Evaluation of single-dose metyrapone tests in children with hypopituitarism; comparison with the prolonged metyrapone and insulin induced hypoglycaemia tests and their relationship with the etiology of hypopituitarism. Acta Paediatr Scand, 65:177, 1976.--Pituitary-adrenal reserve was evaluated in control and hypopituitary subjects by comparing the 8 a.m. plasma 11-deoxycorticoid response (11-DOCS) to a single midnight oral dose of metyrapone (short test) with 1) the 8 a.m. 11-DOCS increase under repeated oral doses of metyrapone (prolonged test) and 2) with the plasma corticoid response during arginine-insulin test. In the short and the prolonged metyrapone tests, the same response was obtained in 25 out of 27 patients. The short test was repeated in 22 patients and the 11-DOCS response did not show a significant difference. In 34 of 40 patients, the response to the short test was comparable to the response during the arginine-insulin test; only 3 patients with a normal 11-DOCS rise to the short test had a low response to insulin and vice versa. Among the low responders to the short test, the mean 11-DOCS value was significantly lower in subjects with operated craniopharyngiomas than in idiopathic hypopituitary patients (p less than 0.001). In the short test, the 8 a.m. baseline cortisol value was positively correlated with the 8 a.m. 11-DOCS response (p less than 0.001), the cortisol level allowing to predict the 11-DOCS response in 28 out of 53 patients. Thus, the short oral metyrapone stimulation was found to be a reliable test in hypopituitary children.