Discordant Cortisol Response to Exogenous ACTH and Insulin-Induced Hypoglycemia in Patients with Pituitary Disease

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Abstract
AN assessment of hypothalamic-pituitary-adrcnocortical (HPA) function in patients with pituitary or hypothalamic disease is often necessary for estimating the risk that acute adrenal insufficiency will occur in response to severe stress, such as trauma, surgery, or infection. Several investigators have suggested that the adrenal response to an intravenous bolus dose of ACTH accurately predicts the integrity of the HPA axis, without causing the side effects attendant on insulin-induced hypoglycemia or administration of metyrapone or pyrogen.1 2 3 However, ACTH stimulation does not directly measure hypothalamic or pituitary responsiveness, and thus it carries the theoretical risk of diagnostic error in patients with pituitary . . .