Related Experiment Video
Updated: Jul 7, 2026

A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
High prevalence of central adrenal insufficiency in patients with Prader-Willi syndrome
Roderick F A de Lind van Wijngaarden1, Barto J Otten, Dederieke A M Festen
1Dutch Growth Research Foundation and Erasmus University Medical Center/Sophia Children's Hospital, Westzeedijk 106, Rotterdam, The Netherlands. r.delindvanwijngaarden@erasmusmc.nl
Context:
The annual death rate of Prader-Willi syndrome (PWS) patients is very high (3%). Many of these deaths are sudden and unexplained.
Objective:
Because most deaths occur during moderate infections and PWS patients suffer from various hypothalamic insufficiencies, we investigated whether PWS patients suffer from central adrenal insufficiency (CAI) during stressful conditions.
Design:
Overnight single-dose metyrapone tests were performed. Metyrapone (30 mg/kg) was administered at 2330 h. At 0400, 0600, and 0730 h, ACTH, 11-deoxycortisol, cortisol, and glucose levels were measured. Diurnal salivary cortisol profiles were assessed on a different day at wake-up, 30 min after wake-up, at 1400 h, and at 2000 h.
Setting:
The study was conducted in a pediatric intensive care unit.
Patients:
Patients included 25 randomly selected PWS patients.
Main Outcome Measure:
Patients were considered as having CAI when ACTH levels remained below 33 pmol/liter at 0730 h.
Results:
Median (interquartile range) age was 9.7 (6.8-13.6) yr. Fifteen patients (60%) had an insufficient ACTH response (CAI, P < 0.001). There was no significant difference in age, gender, genotype, and body mass index SD score between patients with CAI and those without. Morning salivary cortisol levels and diurnal profiles were normal in all children, suggesting that CAI becomes apparent only during stressful conditions.
Conclusions:
Strikingly, 60% of our PWS patients had CAI. The high percentage of CAI in PWS patients might explain the high rate of sudden death in these patients, particularly during infection-related stress. Based on our data, one should consider treatment with hydrocortisone during acute illness in PWS patients unless CAI has recently been ruled out with a metyrapone test.
Related Concept Videos
Adrenal Gland Disorders
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
Cushing Syndrome I: Introduction
Cushing Syndrome II: Pathophysiology
Graves Disease II: Pathophysiology
Hormones of the Adrenal Glands
The adrenal cortex, a powerhouse of hormone synthesis, generates over two dozen corticosteroid hormones. The zona glomerulosa produces mineralocorticoids, exemplified by aldosterone, influencing the electrolyte composition of body fluids. The synthesis of glucocorticoids such as cortisol and corticosterone...
Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation

