DAS VERHALTEN DER CORTICOSTEROIDE IM PLASMA WÄHREND DER INSULINHYPOGLYKÄMIE UND UNTER LYSIN-VASOPRESSIN ALS FUNKTIONSPRÜFUNG DES HYPOTHALAMUS-HYPOPHYSEN-NEBENNIERENRINDEN-SYSTEMS

Abstract

ABSTRACT In eleven patients, two with no endocrine disorders and nine suffering from adrenocortical dysfunction, the plasma corticosteroids were estimated during insulin induced hypoglycaemia and lysin-vasopressin infusion. Both tests were combined and arranged in order to evaluate the hypothalamo-pituitary-adrenal axis. The following findings were obtained: In the two subjects with no endocrine disorders and in two of the three dwarf patients there was a distinct rise in plasma corticosteroids both during insulin induced hypoglycaemia and lysin-vasopressin infusion. This result was considered to indicate a normal adrenocorticotrophic function of the hypothalamo-pituitary axis. In three patients, suffering apparently from disorders localized primarily in or above the hypothalamus, there was no increase in the plasma corticosteroids during insulin induced hypoglycaemia, indicating an impaired CRF-regulation. However, these patients responded adequately to lysin-vasopressin, showing a normal or primarily undisturbed adrenocorticotrophic activity of the pituitary gland. In three patients with primary pituitary disorders there was no increase in the plasma corticosteroids either during insulin induced hypoglycaemia or lysin-vasopressin infusion. While one patient with Cushing's syndrome due to bilateral adrenal hyperplasia showed a marked rise in plasma corticosteroid concentration during lysin-vasopressin infusion, another patient suffering from Cushing's syndrome due to an adrenocortical adenoma failed to respond. This difference in behaviour provides a simple aid in the differential diagnosis of Cushing's syndrome. The results confirm that this combined test provides a useful contribution in the diagnosis of hypothalamo-pituitary-adrenocortical disorders.