A Comparative Study of Endocrine Tests in Hypothalamic Disease. Circadian Periodicity of Plasma 11-OHCS Levels, Plasma 11-OHCS and Growth Hormone Response to Insulin Hypoglycemia and Metyrapone Responsiveness

Abstract

Studies of circadian periodicity of plasma 11-oxysteroid (11-OHCS) levels, of the response of plasma 11-OHCS and plasma growth hormone to insulin hypoglycemia, and of metyrapone responsiveness have been carried out in 14 subjects with localized hypothalamic disease. None of the subjects had evidence of primary sellar involvement. The only evidence of hypopituitarism (utilizing tests of basal endocrine function) was undetectable urinary gonadotropin levels in one of these subjects. Abnormal circadian patterns of plasma 11- OHCS levels were observed in 7 of these 14 subjects. Adequate insulin hypoglycemia resulted in normal increases of plasma 11-OHCS levels in each of 11 subjects in whom this was studied, and in normal increases of growth hormone levels in 10 of 13 subjects. Normal urinary 17-OHCS responses to metyrapone administration were present in 9 of 10 subjects who were tested. These studies indicate that abnormalities in the circadian periodicity of plasma 11-OHCS levels may be the earliest endocrine abnormality to be detected in patients with delimited hypothalamic disease.