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Plasma and Urinary 11-Desoxycorticosteroid (11-DOCS) Response to Metyrapone in Pituitary, Renal and Hepatic Disease

Metabolic Research Section, Minneapolis Veterans Administration Hospital, the Department of Medicine, University of Minnesota Medical School, and St. Joseph's Hospital St. Paul, Minnesota

Twenty-one normal subjects and 60 hospitalized patients responded to a 5 g 4 hr intravenous infusion of metyrapone with an 11-DOCS increase in the plasma of greater than 39 βug/100 ml (increment) and an increase in urinary 11-DOCS greater than 7.8 mg/24 hr. Thirty-two patients with clinical evidence of panhypopituitarism before the test responded with a low urinary response in all instances and had a low plasma response in all but one instance. Fourteen patients with acromegaly, as a group, in whom no evidence of hypofunction of the remaining trophic hormones was present, had normal urinary responses but low or low-normal plasma responses. The hepatomegaly and nephromegaly of these patients was offered as a possible explanation of this plasma-urinary dissociation. Six patients with advanced renal failure had low urinary responses in the presence of normal plasma responses. Five patients with cirrhosis of the liver and base line urinary 17-OHCS excretion below 3.6 mg/24 hr had low plasma and urinary responses to metyrapone and had some of the clinical findings of hypopituitarism. Seven patients with cirrhosis of the liver and urinary 17-OHCS excretion between 4.3 and 3.6 mg/24 hr had normal plasma and urinary 11-DOCS responses and did not have the clinical findings of the patients with impaired responses to metyrapone

Supported in part by the Veterans Administration Cooperative Study of Pituitary Function and USPHS Grant CA 05371-06 of the Cancer Institute.

Received April 12, 1967.

Accepted July 18, 1967.