Single-dose metyrapone test at 06.00 h: an accurate method for assessment of pituitary-adrenal reserve

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Abstract
One dose of metyrapone (1.5 g) administered at 06.00 h, with subsequent measurement of 11-deoxycortisol and 17-hydroxycorticosteroid (17-OHCS) levels in plasma at 12.00 and 14.00 h, allowed accurate assessment of the pituitary-adrenal reserve. Normal response was defined as achieving a serum 17-OHCS level of more than 10.0 .mu.g/100 ml and a 11-deoxycortisol level of more than 6.0 .mu.g/100 ml at either 12.00 or 14.00 h. These criteria are based on a group of 18 persons with normal pituitary-adrenal axis, and 86 additional cases responded in this normal range. In this group of 104 subjects, 11-deoxycortisol levels rose to 9.2 .+-. 3.5 .mu.g/100 ml at noon and 17-OHCS levels to 15.4 .+-. 4.7 .mu.g/100 ml at 14.00 h. Post-metyrapone 17-OHCS levels were significantly higher than normal cortisol levels at these times (P < 0.001) and than those observed at 08.00 h on the day of the test, demonstrating stimulation of adrenal corticoid production in addition to blockade of cortisol production by metyrapone. Thirty-one patients found to suffer from secondary adrenal failure showed impaired response. All these patients had limited pituitary-adrenal reserve, either proved by other pituitary-adrenal tests or implicated by severe pituitary disease.

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