THE OVERNIGHT SINGLE-DOSE METYRAPONE TEST IS A SIMPLE AND RELIABLE INDEX OF THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS
THE OVERNIGHT SINGLE-DOSE METYRAPONE TEST IS A SIMPLE AND RELIABLE INDEX OF THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS
复制标题
DOI：
10.1111/j.1365-2265.1994.tb03011.x
复制
发表时间：
1994-05-01
影响因子：
3.2
通讯作者：
MCKENNA, TJ
中科院分区：
文献类型：
--
作者：
FIAD, TM;KIRBY, JM;MCKENNA, TJ
目的ACTH刺激试验检查肾上腺反应性，但可能不能检查整个下丘脑-垂体-肾上腺（HPA）轴，需要肠外给药。低血糖时的皮质醇反应提供了整个下丘脑轴活动的指标，但对患者和医务人员要求很高。本研究的目的是检查隔夜单剂量美替拉酮试验的性能，因为它提供了一个简单的替代测试HPA轴功能。对1979年至1991年在某中心进行的夜间美替拉酮试验进行设计审计。398名患者接受了576项检查。可比较87例与ACTH刺激试验、17例与胰岛素低血糖试验的反应。子夜口服美替拉酮片30 mg/kg后，于0800 - 0930 h采血，进行11-脱氧皮质醇和皮质醇的放射免疫测定。结果398例患者共进行了576次美替拉酮试验，均未发生严重副作用。105例患者被诊断为肾功能不全。其中18人患有原发性肾上腺疾病，87人患有下丘脑-垂体紊乱。在原发性肾上腺功能不全的患者中，甲替拉酮、促肾上腺皮质激素和低血糖试验的一致性为100%。在19例继发性肾上腺功能不全患者中，同时进行了metyrapone和ACTH试验，10例患者（53%）观察到这两项试验不一致。其中9例患者对ACTH表现出正常反应，而对metyrapone表现出亚正常反应。只有一名患者对ACTH的异常皮质醇反应与对美替拉酮的正常反应相关。相比之下，在17例患者中，只有1例患者对metyrapone试验表现出正常反应，而对低血糖反应不正常。结论：由于美替rapone试验提供的下丘脑-垂体轴功能信息与低血糖试验相似，我们建议使用隔夜美替rapone试验作为安全、简单、可靠的下丘脑-垂体轴完整性指标。ACTH刺激试验不应用于疑似继发性肾上腺功能不全的患者。
OBJECTIVE The ACTH stimulation test examines adrenal responsiveness but may not examine the entire hypothalam ic-pituitary-adrenal (HPA) axis and requires parenteral administration. The cortisol response to hypoglycaemia provides an index of activity of the entire HPA axis but is demanding for patients and medical staff. The aim of the present study was to examine the performance of the overnight single-dose metyrapone test as it provides a simple alternative test for HPA axis function.DESIGN Audit of the overnight metyrapone test performed in one centre between 1979 and 1991.PATIENTS Three hundred and ninety-eight patients underwent 576 tests. Comparisons between the responses to metyrapone and the ACTH stimulation test and of the responses to metyrapone and insulin induced hypoglycaemia test were possible in 87 and 17 patients respectively.MEASUREMENTS Following the midnight administration of metyrapone tablets, 30 mg/kg orally, blood samples were obtained between 0800 and 0930 h for radioimmunoassay of both 11-deoxycortisol and cortisol.RESULTS Five hundred and seventy-six metyrapone tests were performed on 398 patients with no serious side-effects encountered. Andrenal insufficiency was diagnosed in 105 patients. Of these, 18 had a primary adrenal disorder and 87 had a disorder of the hypothalamic-pituitary unit. One hundred per cent concordance between the metyrapone, the ACTH and the hypoglycaemia test was seen in patients with primary adrenal insufficiency. In 19 patients with secondary adrenal insufficiency, who underwent both the metyrapone and the ACTH tests, discord between these two tests was observed in 10 patients (53%). Nine of these patients demonstrated a normal response to ACTH and a subnormal response to metyrapone. In only one patient was an abnormal cortisol response to ACTH associated with a normal response to metyrapone. In contrast, in 17 patients discord between the metyrapone and the hypoglycaemia test was seen in only 1 patient who demonstrated a normal response to the metyrapone test and a subnormal response to hypoglycaemia.CONCLUSION Since the metyrapone test gives similar information about hypothalamic-pituitary axis function as does the hypoglycaemia test, we recommend the use of the overnight metyrapone test as a safe, simple and reliable index of the hypothalamic-pituitary axis integrity. The ACTH stimulation test should not be used for patients suspected of having secondary adrenal insufficiency.