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Cited by 46Adrenal Hormones and DisordersStress Responses and CortisolPituitary Gland Disorders and Treatments

Assessment of hypothalamic-pituitary-adrenal (HPA) axis dysfunction: comparison of ACTH stimulation, insulin-hypoglycemia and metyrapone

Hartzband, P. I., Van Herle, A. J., Sorger, L., Cope, D.·1988·Journal of Endocrinological Investigation
DOI 10.1007/bf03350221
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Abstract

The response to ACTH stimulation, insulin-hypoglycemia and metyrapone in patients with suspected HPA axis dysfunction due to corticosteroid therapy (Group I, n = 10), or pituitary surgery (Group II, n = 7) and in a control population (Group III, n = 8) was studied. Group I patients had been maintained on a stable low dose of prednisone 5.0-7.5 mg/day for 1 month-16 yr (mean = 31 mos) prior to testing. Basal 08:00 h cortisol levels in this group were not different from control values. However, the mean responses to all three testing procedures were suppressed (Group I vs III, ACTH p less than 0.001, insulin p less than 0.01, metyrapone p less than 0.05). Group II patients had undergone surgery 1-26 months (mean = 10 mo) prior to testing and had been maintained subsequently on a stable dose of prednisone 5.0-7.5 mg/day. In this group basal mean 08:00 h cortisol and the cortisol response to ACTH and insulin-hypoglycemia were not significantly different from control values while the response to metyrapone was suppressed (Group II vs III p less than 0.02). Basal serum DHEA-S levels were suppressed in both Groups I and II when compared to Group III (p less than 0.001). Discordant responses to the three testing procedures were noted in 6 patients with suspected HPA dysfunction with abnormal test results in 1/6 using cortrosyn, 3/6 using insulin-hypoglycemia and 4/6 using metyrapone.(ABSTRACT TRUNCATED AT 250 WORDS)

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  • Metyrapone is a powerful inhibitor of steroidogenesis at the level of CYP11B1.

    “Another powerful inhibitor of steroidogenesis at the level of CYP11B1 is metyrapone (321)”

    From Adrenocortical carcinoma (2014) · cites this paper as [321]

  • Due to inhibition of CYP11B1, a relative increase in adrenal androgens may occur, possibly worsening symptoms related to hyperandrogenemia.

    “Due to the inhibition of CYP11B1, a relative increase in adrenal androgens may occur, possibly worsening symptoms related to hyperandrogenemia.”

    From Adrenocortical carcinoma (2014) · cites this paper as [321]

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Authors
Hartzband, P. I., Van Herle, A. J., Sorger, L., & Cope, D.
Affiliations
University of California, Los Angeles (US)
Venue
Journal of Endocrinological Investigation
Publisher
Springer Science and Business Media LLC
Published
1988-12
Volume
11
Issue
11
Pages
769-776
ISSN
  • 0391-4097 (ISSN-L)
  • 1720-8386
DOI
10.1007/bf03350221
OpenAlex
W2046065643
Cited by
46
References
24
Citations by year
2025: 2 · 2023: 1 · 2021: 2 · 2019: 1 · 2018: 1 · 2016: 1 · 2015: 1 · 2014: 2 · 2013: 1
FWCI
0.31
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Journal of Endocrinological Investigation (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (AM-07094)
  • National Center for Research Resources (RR0865)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
Keywords
HPA axis dysregulation, secondary adrenal insufficiency, metyrapone test, ACTH stimulation test, insulin hypoglycemia test, prednisone, dehydroepiandrosterone sulfate, cortisol response, pituitary surgery
MeSH terms
Adrenal Cortex Hormones, Adrenal Insufficiency, Adrenocorticotropic Hormone, Adult, Aged, Aldosterone, Blood Glucose, Cortodoxone, Dehydroepiandrosterone, Female, Humans, Hydrocortisone, Hypothalamic Diseases, Insulin, Male, Metyrapone, Middle Aged, Pituitary Diseases, Prednisone, Dehydroepiandrosterone Sulfate

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