Metabolic Aspects Of MéNièRe's Disease

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Abstract
Metabolic dysfunction is one of many factors mentioned as a primary or contributing cause of Ménière's disease. This evaluation consists of three parts: (1) thyroid studies, (2) five‐hour glucose tolerance test, and (3) adrenal and pituitary tests.Ninety‐eight patients with Ménière's disease are evaluated with an FTA absorption test. neuro‐otologic, allergic, and metabolic studies. The results of the metabolic evaluation are reviewed.Thyroid function is evaluated with the thyroxine (T4) free index test and the serum‐bound thyroxine (T4) test of Murphy‐Pattee. Although 27% had low normal or hypothyroid findings, it was of clinical significance in only 17% of the patients.The five‐hour glucose tolerance test was used to diagnose hyperglycemia and hypoglycemia.Thirty percent of the 70 patients evaluated had an abnormal five‐hour glucose tolerance test. The 19 patients (28%) with a hypoglycemic curve are almost equally divided between a flat glucose tolerance curve, a reactive hypoglycemic curve, and chemical or latent diabetic curve. A manifest diabetic curve was present in two patients. Hypoglycemia was not a primary factor in Ménière's disease but was an important contributing cause in 12 patients that responded to a combination of dietary, allergic or endocrine therapy.The symptoms of Ménière's disease often become manifest during periods of stress. The adrenal pituitary axis plays a vital role in man's reaction to stress. For this reason, hypoadrenal function was suggested as an etiology in some patients with Ménière's disease.In this study two recently devised tests were used to measure adrenocortical reserve: (1) ACTH plasma cortisol stimulation test, and (2) insulin stimulation test.Sixty of the 98 patients were evaluated with the ACTH plasma cortisol stimulation test, and one‐third had a lowered adrenocortical reserve. Further endocrine studies are being performed to determine the presence of a specific endocrine problem.After evaluation of 98 patients with Ménière's disease, we concluded the following: The five‐hour glucose tolerance test is helpful in identifying hypoglycemia, which may be a contributing factor in Ménière's disease. Non‐myxedematous hypothyroidism may play an important role in some patients with Ménière's disease. Further endocrine studies will be necessary to determine the significance of the lowered adrenocortical reserve as shown by the ACTH plasma cortisol stimulation test.